The goal of this randomized clinical trial is to optimize the inspiratory pressure during facemask ventilation (FMV) in morbidly obese patients (BMI ≥40 kg/m²), to ensure adequate ventilation while minimizing the risk of gastric insufflation by real-time ultrasound guidance
Adult patients (18-65 years old) scheduled for elective surgery under general anesthesia requiring facemask ventilation.
Morbid obesity (BMI ≥40 kg/m²).
American Society of Anesthesiologists (ASA) physical status II-III.
Normal upper gastrointestinal anatomy (no history of gastric surgery, esophageal strictures, or hiatus hernia).
• Emergency surgery (due to inability to ensure proper fasting or preoperative assessment).
Known or suspected difficult airway (Mallampati class IV, limited neck mobility, or history of difficult intubation).
Gastroesophageal reflux disease (GERD) or high aspiration risk (e.g., pregnancy, symptomatic hiatal hernia).
Contraindications to facemask ventilation (facial trauma, beard/mask seal interference).