In morbidly obese patients with a high Mallampati score or large neck circumference, awake fiber-optic intubation should be considered a first-choice technique for tracheal intubation. Other possibilities include performing the tracheal intubation with rigid intubating devices designed for a “difficult airway,” such as a Glidescope, Bullard laryngoscope, or Wuscope. After being sedated, morbidly obese patients, especially those with sleep apnea, are prone to upper-airway collapse, which thus contributes to increased resistance and obstructive apnea. This situation may convert an elective airway to an emergency procedure. Spontaneous breathing will provide oxygenation and the airway will open to a greater degree, thus providing a better view. Therefore, all attempts should be made to preserve spontaneous ventilation during management of a difficult airway. Alternative airway management, such as translaryngeal illumination with a lighted stylette (e.g., Lightwand), may not be effective in these patients because of increased soft tissue over the anterior neck or redundant tissue in the posterior pharynx.