<p>Obesity And Obstetric Anesthesia: Current Insights</p>

Abstract

Obesity is a significant global health problem. It results in a higher incidence of complications for pregnant women and their neonates. Cesarean deliveries are more common in obese parturients as well. The increased burden of comorbidities seen in this population, such as obstructive sleep apnea, necessitates antepartum anesthetic consultation. These patients pose unique challenges for the practicing anesthesiologist and may benefit from optimization prior to delivery. Complications from anesthesia and overall morbidity and mortality are higher in this population. Neuraxial anesthesia can be challenging to place in the obese parturient, but is the preferred anesthetic for cesarean delivery to avoid airway manipulation, minimize aspiration risk, prevent fetal exposure to volatile anesthetic, and decrease risk of post-partum hemorrhage from volatile anesthetic exposure. Monitoring and positioning of these patients for surgery may pose specific challenges. Functional labor epidural catheters can be topped up to provide conditions suitable for surgery. In the absence of a working epidural catheter, a combined spinal epidural anesthetic is often the technique of choice due to relative ease of placement versus a single shot spinal technique as well as the ability to extend the anesthetic through the epidural portion. For cesarean delivery with a vertical supraumbilical skin incision, a two-catheter technique may be beneficial. Concern for thromboembolism necessitates early mobilization and a multimodal analgesic regimen can help accomplish this. In addition, thromboprophylaxis is recommended in this population after delivery—especially cesarean delivery. These patients also need close monitoring in the post-partum period when they are at increased risk for several complications.

Pushing the Envelope in Obstetric Care: A Case Report of Cesarean Delivery in a Parturient with a BMI >100 kg m−2

“…Double neuraxial catheter techniques may be beneficial for high vertical supraumbilical incisions [1]. As BMI increases, optimal image quality with ultrasound may be difficult to obtain [1]. Although we were unable to estimate the depth to the epidural space, identification of the midline by ultrasound did increase our confidence prior to epidural placement.…”

“…Obesity is a systemic disease associated with multiple comorbidities [1]. Practitioners must be knowledgeable about the peripartum implications of obesity.…”

“…Consideration may also be given to allowing patients to lie in the lateral position prior to securing the catheter, as this could allow the soft tissues to move even further. With increased time being required to position the patient and longer neuraxial procedure times [1], performance of the block in the preoperative area may contribute to operating room efficiency [17]. A possible disadvantage is catheter dislodgement during patient movement [15]; however, transfer with an air mattress and adequate catheter length in the epidural space reduces this possibility [18].…”

“…Obesity is a global epidemic that is reaching alarming proportions in the pregnant population. An increasing number of patients with a body mass index (BMI) ≥ 60 kg m −2 , referred to as super-super obesity, are being seen [1], resulting in obstetric, anesthetic, and logistical challenges. We describe management of cesarean delivery (CD) in a parturient with a BMI of 112 kg m −2 and emphasize multidisciplinary planning and communication for optimal outcomes.…”

Maternal Diet Quality, Body Mass Index and Resource Use in the Perinatal Period: An Observational Study

“…Aside from the economic impact, obesity and increased case complexity have procedural complications for clinicians and the healthcare system. For example, complications from anaesthesia are higher in obese patients compared to normal weight patients [ 36 ]. There is increased risk of incorrectly placing an epidural in obese patients as the distance to the epidural space is greater with increased BMI [ 36 , 37 ], risk of difficult intubation is increased in obese patients, monitoring and positioning obese patients under anaesthesia can also pose specific challenges [ 36 ].…”