Obesity and Obstetric Anaesthesia

Mace, Hamish; Paech, Mike; McDonnell, Nolan

doi:10.1177/0310057x1103900410

Cited by 34 publications

(23 citation statements)

References 128 publications

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“…This recommendation is based on the increased incidence of emergency caesarean delivery, instrumental delivery and macrosomic neonates in the obese population, and the predicted risks and difficulty in providing anaesthetic care [ 6 ]. While the presence of a labour epidural allows for extension to surgical anaesthesia if necessary, the insertion and management of labour epidurals in obese women is not always straight-forward [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

What is the failure rate in extending labour analgesia in patients with a body mass index ≥ 40 kg/m2compared with patients with a body mass index < 30 kg/m2? a retrospective pilot study

2015

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BackgroundEarly utilisation of neuraxial anaesthesia has been recommended to reduce the need for general anaesthesia in obese parturients. The insertion and management of labour epidurals in obese women is not straight-forward. The aim of this pilot study was to compare the failure rate of extension of epidural analgesia for emergency caesarean section, in pregnant women with a body mass index (BMI) ≥ 40 kg/m2, to those with a BMI < 30 kg/m2. The results will be used to calculate the sample size of a planned prospective study.MethodsIn this retrospective, (1:1) case–control pilot study, obese subjects and control subjects were selected from the obstetric database, if they delivered between January 2007 and December 2011. All subjects used epidural analgesia during labour and subsequently required anaesthesia for Category 1 or 2 Caesarean Section. Data was extracted from the patient medical record. Failure to extend was analysed using liberal and restrictive definitions. Chi-square or Fisher’s exact tests were used to detect differences between groups. Multiple logistic regression was used to examine variables predictive of extension failure.ResultsThere were 63 subjects in each group. The mean BMI of the obese group was 45.4 (5.8) kg/m2 and 23.9 (3.0) kg/m2 in the control group. The odds ratio for failure to extend the existing epidural blockade (liberal definition) was 2.48 (95 % CI:1.02 – 6.03) for the obese group compared with the control group (adjusted for age, parity and gestation). Using the restrictive definition, the odds ratio for failure in the obese group was 6.78 (95 % CI:1.43 – 32.2). The combination of respiratory co-morbidity and gestational diabetes significantly predicted extension failure. Surgical time and epidural complications on labour ward were significantly greater in the obese group.ConclusionsIn this small retrospective cohort, patients with a BMI ≥ 40 kg/m2 were significantly more likely to fail epidural extension for caesarean section. The presence of respiratory co-morbidity and gestational diabetes were significant predictors of extension failure; their clinical relevance requires further evaluation.

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Section: Introductionmentioning

confidence: 99%

What is the failure rate in extending labour analgesia in patients with a body mass index ≥ 40 kg/m2compared with patients with a body mass index < 30 kg/m2? a retrospective pilot study

2015

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“…In our survey this association was meaningful for the arterial hypertension, the nocturnal burrs and the OSAS. At the obese pregnant women, the OSAS is even more frequent and the episodes of arterial desaturation in oxygen that can occur during the syndrome of apnea of the sleep are a threat for the mother and the fetus [11].…”

Section: Discussionmentioning

confidence: 99%

Complications of Obesity in Cesarized Parturients in the Teaching Centers of Cotonou

Hodé¹,

Zoumenou²,

Hounkpatin³

et al. 2018

OJEMD

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This survey had the objective to determine the frequency of the obesity at the parturient, to value the impact of the obesity on the childbirth by Caesarean and the complications postoperative immediate in the teaching hospitals of Cotonou. Patients and Method: We did a prospective, comparative and analytic survey from January 13 to April 13, 2012. Eight hundred ninety-one consecutive parturients having had a Caesarean were included. We studied the anesthetic techniques, the techniques of control of the aerial ways, the number of necessary tests for the tracheal intubation, the complications and aftercare of the first 48 hours. A comparison has been made according to the BMI. The obesity has been defined by a BMI ≥ 30 kg/m 2. The parturient has been classified in two groups: Non-obese: BMI ≤ 30 kg/m 2 , obese: BMI ≥ 30. Results: There were 703 (78.90%) Caesareans in emergency and 188 (21.09%) programmed Caesareans. The obesity which has been recovered at 286 parturient is 32.10%. The obese parturient also required more frequently several lumbar punctures (p < 0.001) at the time of the spinal anesthesia and more of conversion of the spinal anesthesia into a general anesthesia (p = 0.008). The postoperative complications: laryngeal pain, back pain and suppuration of the wound were more frequent at the obese parturient. Conclusion: Many changes led by pregnancy are added to those of the obesity to drive to functional changes, a reduction of the physiological reserve and finally to an in

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“…Pregnancy itself increases the chance of difficult intubation, and obesity appears to multiply this risk -noted to be as high as 33% [57]. The obese patient is also at risk for aspiration (especially if a difficult intubation is encountered), as well as earlier oxygen desaturation [58].…”

Section: Anesthetic Considerationsmentioning

confidence: 99%

Obesity: Unique Challenges at the Time of Cesarean Delivery

Roloff¹,

Cao²,

Okekpe³

et al. 2020

Recent Advances in Cesarean Delivery

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The obesity epidemic has touched all aspects of obstetric care, including the practice of cesarean delivery. Obesity is an independent risk factor for cesarean delivery, and the increased prevalence of obesity has contributed to the overall rise in primary cesarean delivery seen over the past few decades. Because of the frequent existence of co-morbidities such as hypertension and diabetes, obesity is a plausible contributor to rising maternal mortality. In addition, obese women who undergo both primary and repeat cesarean delivery have a higher chance to develop surgical and post-operative complications, including wound infection and thromboembolic events. Surgical complications increase steadily with increasing maternal weight. In this chapter, we will review the incidence and contributing factors that lead to cesarean delivery in obese patients, peri-operative complications, and strategies to reduce these risks in obese women undergoing cesarean delivery.

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Obesity and Obstetric Anaesthesia

Cited by 34 publications

References 128 publications

What is the failure rate in extending labour analgesia in patients with a body mass index ≥ 40 kg/m2compared with patients with a body mass index < 30 kg/m2? a retrospective pilot study

What is the failure rate in extending labour analgesia in patients with a body mass index ≥ 40 kg/m2compared with patients with a body mass index < 30 kg/m2? a retrospective pilot study

Complications of Obesity in Cesarized Parturients in the Teaching Centers of Cotonou

Obesity: Unique Challenges at the Time of Cesarean Delivery

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