The morbidly obese parturient: myths versus facts

M. Vercauteren¹, L. Sermeus¹, H. Coppejans¹, Y. Jacquemyn²

1 Department of Anesthesia, Antwerp University Hospital, Belgium
2 Department of Obstetrics & Gynaecology, Antwerp University Hospital, Belgium

Abstract

More patients present nowadays with extreme overweight. Whereas the choice of the best anaesthesia technique may be a challenging dilemma and affected by the several risks, some of these risks are overstated.
Fear to perform regional anesthesia in the morbidly obese may be ungrounded. Performing neuraxial analgesia or anaesthesia in the sitting position may offer more optimal conditions. The patient may help to guide the needle to a midline plane. Needles rarely need to be longer than in the non-obese. Accidental taps are not necessarily more frequent while resulting in less Post Dural Puncture Headache (PDPH). It may be wise to place epidural catheters as soon as possible during labour as catheters sometimes require replacement and because of their benefit in case of a rather frequent conversion to a C-section.
Also the risk of failed intubation in the obese patient seems to be overemphasized. However, in all cases, the anaesthetist should be prepared having (difficult) intubation equipment ready. Pre-delivery screening for diabetes, hypertension and intubating anatomy may also help to anticipate possible problems.

Keywords: obesity, general anaesthesia, regional anaesthesia, Caesarean, intubation, failure

J Rom Anest Terap Int 2010; 17: 49-53

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Parturienta cu obezitate morbidă: mituri şi fapte