In the MOANS mnemonic, what does O stand for?

• A. Obese or late pregnancy
• B. Obstruction
• C. Oral injury
• D. Osmolarity

Answer: (A)

O stands for obesity or late pregnancy. This factor flags potential difficulty with airway management because both conditions reduce how easily you can ventilate and intubate. Obesity lowers functional residual capacity, increases oxygen demand, and can make mask sealing harder due to facial adiposity, leading to faster desaturation if you’re not well preoxygenated. Late pregnancy also lowers lung volumes as the enlarged uterus pushes up on the diaphragm, adds airway edema from hormonal changes, and increases the risk of aspiration. So when O is present, you plan for a potentially difficult airway: ensure thorough preoxygenation, be prepared for rapid sequence intubation if appropriate, and have alternative airway devices and suction ready. The other options don’t capture these predictive airway challenges: obstruction refers to a blockage, oral injury to trauma of the mouth, and osmolarity is not related to airway management.