Morbidly obese parturient: Challenges for the anaesthesiologist, including managing the difficult airway in obstetrics. What is new?

Abstract

The purpose of this article is to review the fundamental aspects of obesity, pregnancy and a combination of both. The scientific aim is to understand the physiological changes, pathological clinical presentations and application of technical skills and pharmacological knowledge on this unique clinical condition. The goal of this presentation is to define the difficult airway, highlight the main reasons for difficult or failed intubation and propose a practical approach to management Throughout the review, an important component is the necessity for team work between the anaesthesiologist and the obstetrician. Certain protocols are recommended to meet the anaesthetic challenges and finally concluding with “what is new?” in obstetric anaesthesia.

Weight does Matter! A Study of Effect of Obesity on Pregnancy and its Outcome

“…12 Postnatal complication: From the observation (Table 5), it is clear that wound disruption is more common in obese class III patient, i.e. 10% as compared to 1.5% in normal BMI cases (p = 0.002).…”

Analgesia for labour: an evidence‐based insight for the obstetrician

“…Many authorities, such as the American Congress of Obstetricians and Gynecologists, recommend the insertion of an early epidural anaesthesia in obese mothers to alleviate or prevent these issues . Despite this recommendation, the technicalities of epidural insertion in the obese woman include multiple attempts at insertion, longer epidural needles and higher rates of dural puncture and epidural migration into the fatty subcutaneous tissue . Ultrasound guidance to facilitate catheterisation of the epidural space may help overcome such difficulties.…”

Pregnancy with super-obesity: an emerging pandemic

“…Regional anaesthesia requires appropriate delineation of landmarks, adequate patient positioning prior to and after performing the block, choosing a needle of sufficient length and the appropriate dose of local anaesthetic. 7 Low transverse skin incisions and transverse uterine incisions are definitely superior and must be the first option. Closure of the subcutaneous layer is recommended, but the placement of subcutaneous drains remains controversial.…”