Determination of the Optimal Inspiratory Pressure to Decrease Incidence of Gastric Insufflation With Adequate Ventilation During Facemask Ventilation in Morbidly Obese Patients

Inclusion Criteria: * 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). * Fasted for at least 6 hours for solids and 2 hours for fluids (standard preoperative fasting guidelines). Exclusion Criteria: * • 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). * Severe cardiopulmonary disease (e.g., severe COPD, pulmonary hypertension, or unstable angina). * Neuromuscular disorders affecting respiratory function. * Refusal to participate or inability to provide informed consent.