The challenges of obesity and obstetric anaesthesia

Kanakarajan, Saravanakumar; Rao, Sudarsan Gururaja; Cooper, G. M.

doi:10.1097/gco.0b013e3280101019

Cited by 55 publications

(23 citation statements)

References 31 publications

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“…Invasive blood pressure monitoring may be considered when this is not possible, and is an added benefit for women with preexisting hypertension or preeclampsia. 26,34 Intravenous magnesium can prolong the effects of nondepolarizing muscle relaxants and has tocolytic effects on uterine smooth muscle, increasing the potential for postpartum uterine atony. Parturients may present with a prior history of bariatric surgery and need to be evaluated for mineral deficiencies.…”

Section: Anesthetic Management Of a Morbidly Obese Parturient Preanesmentioning

confidence: 99%

Anesthetic Considerations for the Morbid Obese Parturient

Badve

Golfeiz

Vallejo

2014

International Anesthesiology Clinics

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Obesity has reached epidemic proportions. Excess body weight is the sixth most important factor increasing the disease burden worldwide. Globally, approximately1.5 billion adults and up to 20% of children are now classified as overweight or obese. 1,2 The Center for Disease Control (CDC) 2009 to 2010 National Health and Nutrition Examination Survey (NHANES) showed that in the United States alone over 78 million adults and about 12.5 million children and adolescents were obese. Obesity is an important public health issue among women of reproductive age, as the physiology of pregnancy is further complicated by the presence of obesity. This has important consequences on both maternal and fetal outcomes. ' Disease Burden and EpidemiologyObesity has been most widely classified on the basis of body mass index (BMI), thus allowing comparison of weight status within and between populations. BMI is defined as the weight in kilograms divided by the square of the height in meters (kg/m 2 ). A BMI that exceeds 25 kg/m 2 is indicative of an overweight individual, and a BMI that exceeds 30 kg/m 2 is indicative of an obese individual. Obesity is further subclassified as class I (BMI = 30.00 to 34.99 kg/m 2 ), class II (BMI = 35.00 to 39.99 kg/m 2 ), and class III or morbidly obese (BMI > 40 kg/m 2 ) ( Table 1). 3 A 30% increase in overall mortality has been described for each 5 kg/m 2 increase in BMI. It has been shown that increasing weight

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Section: Anesthetic Management Of a Morbidly Obese Parturient Preanesmentioning

confidence: 99%

Anesthetic Considerations for the Morbid Obese Parturient

Badve

Golfeiz

Vallejo

2014

International Anesthesiology Clinics

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“…8,13 In those proceeding to delivery by caesarean section, obesity carries a risk of failed regional anaesthesia, inadequate analgesia, difficulty with intravenous access and requirement for general anaesthetia, which is in turn complicated by obesity-related difficulty with intubation. 25,27 Operative wounds following caesarean sections are also more likely to get infected and break down, leading to specific recommendations for subcutaneous suturing and antibiotic prophylaxis. Puerperal infections of the respiratory and urinary tract are also more likely with raised BMI.…”

Section: Adverse Pregnancy Outcomementioning

confidence: 99%

The maternal and fetal impacts of obesity and gestational diabetes on pregnancy outcome

Dennedy

Dunne

2010

Best Practice & Research Clinical Endocrinology & Metab

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“…24 Obese women are more likely to have co-morbidites such as hypertension, ischaemic heart disease and heart failure, adding to the risks associated with anaesthesia.…”

Section: Anaesthesiamentioning

confidence: 99%

Obesity in pregnancy: risks and management

2009

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Summary: Maternal obesity is now considered one of the most commonly occurring risk factors seen in obstetric practice. Compared with women with a healthy pre-pregnancy weight, women with obesity are at increased risk of miscarriage, gestational diabetes, preeclampsia, venous thromboembolism, induced labour, caesarean section, anaesthetic complications and wound infections, and they are less likely to initiate or maintain breastfeeding. Babies of obese mothers are at increased risk of stillbirth, congenital anomalies, prematurity, macrosomia and neonatal death. Intrauterine exposure to obesity is also associated with an increased risk of developing obesity and metabolic disorders in childhood. This article reviews the prevalence of obesity in pregnancy and the associated maternal and fetal complications. Recommendations and suggestions for pre-conception, antenatal and postnatal care of women with obesity are presented, and current research in the UK and future research priorities are considered.Keywords: body mass index, complications, management, obesity, pregnancy, risk CONTEXT OF THIS REVIEWMaternal obesity is now considered one of the most commonly occurring risk factors seen in obstetric practice, and obstetricians are increasingly faced with caring for women who are obese. Such patients pose particular management problems relating both to increased risks of specific complications, and to medical, surgical and technical challenges in providing safe maternity care. It is therefore not surprising that obesity is associated with increased rates of maternal and perinatal morbidity and mortality. Despite these problems, there remains a lack of awareness of both the range and severity of the problems associated with obesity in pregnancy.

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The challenges of obesity and obstetric anaesthesia

Abstract: Effective communication and good teamwork between an anaesthetist and an obstetrician are essential for the care of obese parturients. A more liberalized use of regional techniques may be a means of further reducing the anaesthesia-related maternal mortality.

Cited by 55 publications

References 31 publications

Anesthetic Considerations for the Morbid Obese Parturient

Anesthetic Considerations for the Morbid Obese Parturient

The maternal and fetal impacts of obesity and gestational diabetes on pregnancy outcome

Obesity in pregnancy: risks and management

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