Airway obstruction/management in the PACU

A morbidly obese female s/p gastric bypass is now desaturating into the mid 80's in the PACU.   She was intubated awake initially due to her airway anatomy.

• What are some of the potential causes that enter your mind?  You should be able to come up with at least five!
• Assuming she needs to be reintubated, list in detail what you want brought to you by the anesthesia technician.  Would you intubate her awake again or do a RSI?  Justify your answer.
  
• How does CPAP work in obese patients with sleep apnea?

References: (note, all residents should have access to Anesthesiology articles online if they receive the journal.  Many other journals are available with a USF account through MD Consult...just access it from the departmental home page)

1. Benumof JL.  Obstructive sleep apnea in the adult obese patient: implications for airway management. Anesthesiol Clin North America. 2002 Dec;20(4):789-811.
2. ASA Practice Guidelines for Management of the Difficult Airway (pdf file)
3. Rosenblatt W, Whipple J.  The Difficult Airway Algorithm of the American Society of Anesthesiologists. Anesth Analg 2003;96:1233 (Editorial that kinda simplifies it -- pdf file)