Regional anesthesia in the obese patient can be challenging and possibly carries a greater failure rate as compared with that in the non-obese patient. We retrospectively reviewed our prospectively gathered peripheral block data to determine the influence of body weight on success rate of the supraclavicular block. Obesity was defined as body mass index > or =30. The overall success rate was 97.3% in nonobese and 94.3% in obese patients (P < 0.01). Residents completed 80% of the blocks in nonobese patients and 73% in obese patients (P < 0.01). No difference in acute complications was observed. Obesity is associated with a slight decrease in success rate of supraclavicular block and an increase in its relative difficulty without apparent effect on acute complications.
Controlled or induced hypotension is an anesthetic technique that involves deliberate lowering of the blood pressure to a systolic pressure of 80–90 mm Hg or mean arterial pressure (MAP) to 50–65 mm Hg or 30% less than baseline. The goals of this technique include reducing operative blood loss and improving surgical visibility and thus decreasing operative time. Deep anesthesia with combinations of volatile agent, propofol, or opioid infusions is one approach to providing hypotension. Alternatively, dedicated hypotensive agents such as β-blockers, calcium channel blockers, and vasodilators may be used to achieve these goals. Pharmacological methods may be supplemented by postural (reverse Trendelenburg position) and ventilatory (hyperventilation) interventions. Controlled hypotension carries the theoretical risk of organ hypoperfusion with resultant cerebral, myocardial, hepatic, splanchnic, and renal ischemia. Patients should be carefully selected and attention given to those who are at increased risk of these complications. Decisions regarding the depth and duration of hypotension should be made with these preoperative considerations in mind.
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