Anesthetic management of obese and morbidly obese parturients

Abstract

The prevalence of obese parturients is increasing worldwide. This review describes safe analgesic techniques for labor and anesthetic management during cesarean sections in obese parturients. The epidural analgesic technique is the best way to provide good pain relief during the labor phase and can be easily converted to a surgical anesthetic condition. However, the insertion of the epidural catheter in obese parturients is technically more difficult compared to that in non-obese parturients. The distance from the skin to the epidural space increases in proportion to the body mass index (BMI): 4.4 cm in mothers of normal weight and 7.5 cm in mothers with BMI 50 and above. Neuraxial blocks are the ideal anesthetic methods and gold standard techniques for cesarean section in pregnant women with obesity. Single-shot spinal anesthesia is the most common type of anesthesia used for cesarean sections. The advantage of single-shot spinal anesthesia is a dense-sufficient block of rapid onset. A combined spinal-epidural (CSE) anesthetic technique is also recommended as an attractive alternative method. In obese parturients, the operation time can be longer than expected, and therefore, the CSE technique provides the advantage of rapid onset and intense block for prolonged operation with postoperative pain control. The risk of postoperative complications is very high in obese parturients. Therefore, detailed communication of the parturient's medical condition and the details of surgery and anesthesia between the anesthesiologist and obstetrician is important prior to cesarean section in obese pregnant women.

Comparison of Spinal Morphine and Transversus Abdominis Plane Block on Opioid Requirements After Caesarean Section: An Observational Study

“…Obese mothers are usually hospitalized for a much longer time. 19 The average length of cesarean section in the spinal morphine group and the TAP block group was 89.08 minutes and 89.54 minutes, respectively. Surgery can stimulate the inflammatory process which leads to local edema, increased tissue pressure, and stimulation of nociceptors.…”

“…Obese mothers are usually hospitalized for a much longer time. 19 The average length of cesarean section in the spinal morphine group and the TAP Differing from the intrathecal administration of local anesthetic agents, spinal morphine administration does not cause muscle weakness, loss of proprioceptive sensation, or sympathetic denervation. Morphine is often considered a quintessential opioid analgesic.…”

Artificial intelligence enhanced ultrasound (AI-US) in a severe obese parturient: a case report

“…In this population, considering the higher frequency of comorbidities and the higher risk of obstetric complications, epidural catheter placement can be a lifeline in an emergent or unplanned conversion to cesarean Sect [ 3 ].…”