Key result
Anesthesia in morbidly obese parturients is technically challenging, with a higher incidence of hypotension during neuraxial anesthesia but a lower risk of post-dural puncture headache.
Anesthesia in morbidly obese parturients requires careful consideration of technical difficulties, increased hypotension risk, and altered complication rates.
Alerts clinicians to technical challenges in obese parturients; leaves open need for prospective validation before practice change.
The provision of anesthesia to the morbidly obese parturient is technically challenging. The anesthesia provider anticipates difficulty with intravenous access, positioning, monitoring, and placement of neuraxial anesthesia. There is a higher incidence of hypotension in obese parturients during neuraxial anesthesia most likely due to concealed aortocaval compression as positioning these patients is difficult. Most providers will provide either epidural or combined spinal/epidural anesthesia for cesarean delivery due to the variable duration of the surgical procedure. Among obese gravidas, there is a lower risk of the development of a headache from an accidental dural puncture, due not to the body habitus, but rather to the group's higher cesarean delivery rate. It is the process of bearing down during delivery that increases the chance of the development of a headache following dural puncture.
No takes yet. Share an insight, caveat, or question.
Robert R. Gaiser (2015) conducted a review in Morbid obesity in parturients. Anesthesia was evaluated. Anesthesia in morbidly obese parturients is technically challenging, with a higher incidence of hypotension during neuraxial anesthesia but a lower risk of post-dural puncture headache.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: