Spinal Anesthesia for Cesarean Section in a Class III Obese Parturient: A Case Report

Figures

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  Figure 1. Pre-procedural neuraxial ultrasound examinations. Picture A (left) shows the transverse interlaminar view at the L3-L4 level. This view helps to identify the midline, confirm the interspaces, determine the needle entry angle, and estimate the depth of the intrathecal space. Picture B (right) shows the paramedian sagittal laminar view. The laminae of L3, L4, and L5 appear as a series of “steps,” with the interspaces between laminae visible. This view helps to identify the levels and interspaces. SP: Partial acoustic shadow from the spinous process; AP: Articular processes; PC: Posterior complex (ligamentum flavum + dura mater); ITS: Intrathecal space.

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  Figure 2. Intraoperative vital signs, relevant events, and medication administration timeline. The X-axis (time) is displayed in 15-minute increments. The Y-axis indicates blood pressure in mmHg and heart rate in beats per minute (bpm). The gray shaded area represents systolic/diastolic blood pressure ranges; blue crosses (×) and lines show mean NIBP, and red circles (●) indicate heart rate or pulse. Red arrows mark key events: spinal anesthesia placement and supine positioning. Medication doses (listed below) are shown in mg or mL at the time administered. ISOinsp, ISOexp, SEVOinsp, SEVOexp, DESinsp, and DESexp stand for inhaled and exhaled concentrations of isoflurane, sevoflurane, and desflurane. None of these general anesthetics were used; they are displayed as part of the anesthesia record by default in the electronic medical record system. BP: Blood pressure; NIBP: Noninvasive blood pressure; HR: Heart rate; FiO₂: Fraction of inspired oxygen; ETCO₂: End-tidal carbon dioxide.