Anesthesia for Cesarean Delivery in the Morbidly Obese Parturient - Comparison of Commonly used Anesthesia Techniques

Abstract

Background: Obesity in pregnancy can add significantly to obstetric and anesthetic complications. The objective of this study is to identify and compare anesthesia-related complications in different types of elective cesarean anesthetics in morbidly obese parturients. Methods:Retrospective review was done on 205 records of elective cesareans for pregnants with Body Mass Index (BMI) ≥ 40. Data extracted include: type of anesthesia, intraoperative and early postoperative complications, duration of surgery, newborn birth weight, cord blood pH and Apgar scores. Results: The incidence of significant intra-operative hypotension: 65.0%, bradycardia 3.04%, nausea and vomiting 14.21%. Intraoperative hypotension: 67% in spinal and CSE group vs. 34.8% in epidural group (p = 0.0022). Super Morbid Obese (SMO) patients (BMI > 50) had a greater number of attempts at placement for regional techniques compared to Morbidly Obese (MO) patients (BMI 40−49.9) (2.02 vs. 2.61, p = 0.0255). SMO patients had longer mean surgical times (86.6 vs. 107.55 min, p = 0.0001), received more intraoperative crystalloids (1887 vs. 1699 ml, p = 0.0376) and colloids (33.9 vs. 12.6%, p = 0.0007) compared to MO patients. No other complications were significantly different between the 2 compared anesthetic techniques or BMI classes. Conclusion:Spinal anesthesia was the most commonly used technique. It resulted in more hypotension. Parturients with BMI ≥ 50 were more challenging to manage with more regional anesthesia placement attempts, larger fluid volumes and longer surgery times. A well-organized RCT could prove beneficial in validating the most profitable and safe anesthetic technique for bariatric parturients.