///2009 Abstract Details
2009 Abstract Details2018-05-01T17:45:11+00:00

Regional analgesia in a morbidly obese parturient

Abstract Number: 32
Abstract Type: Case Report/Case Series

Uma Munnur M.B.B.S1 ; Maya S Suresh M.B.B.S2

Introduction:

As maternal BMI increases, the concomitant diseases also increase. In the 2000-2002 Confidential Enquiries into Maternal Deaths and Child Health, 35% of all parturients who died were obese

Case report:

A 33 year old morbidly obese lady, G2P0A1 at 39 2/7 weeks was scheduled for induction of labor secondary to Diabetes Mellitus Class B. Her comorbidities included morbid obesity, NIDDM for 8 years, chronic hypertension and hypothyroidism. Her medications included aldomet, labetalol, novolin N and R Insulin.

She was 54" tall and weighed 600 lbs, with BMI of 100kg/m2. Her airway exam was a Mallampati Class II, thyromental distance >6.5cm, oral opening >3cm, and she had full dentition. The patient requested an epidural for labor pain. It required approximately 30 minutes getting the patient to a sitting position on the side of the bed and subsequent taping of superfluous back tissue laterally to expose the midline. A midline approach at the L3-L4 level using loss of resistance to air was used with a 6-inch 17g Tuohy needle. Loss of resistance to air was found at 12cm. Neither cerebrospinal fluid nor blood was aspirated; a 3ml test dose of lidocaine with epinephrine was given with negative results. The epidural catheter was inserted easily to 20cm, allowing 8cm in the epidural space. The patient tolerated the procedure well; she was given a total of 14 ml of Bupivacaine 0.125% + Fentanyl 2mcg/ml in incremental doses for the initial bolus, and placed on a 10 ml/hr infusion of the same solution. An arterial line was placed due to inaccurate blood pressure readings by the noninvasive blood pressure cuff with ultrasound guidance.

She was comfortable and slept through the night and was snoring. Next morning she delivered a live 3337 gm boy with apgars of 9 at 1 minute and 9 at 5 minutes. On the following day, patient was doing well with no headache or back pain and stable vital signs.

Conclusion

Morbid obesity in pregnancy is a growing problem and has a significant impact on maternal morbidity and mortality. Early preoperative assessment, epidural insertion, and replacement for failed regional analgesia are advocated to decrease potential complications. The patient delivered vaginally without any pain and discharged home the next day.

References:

1. Obese Surg, 2008, 1517-21

2. Anesth Intensive Care, 2008, 751

3. J Obstet Gynaecol, 2008, 301-4

4. RCOG, 2004, 122-133

SOAP 2009