Obesity in Parturients- Does pre-anaesthesia consultation improve patient outcomes?
Abstract Number: 83
Abstract Type: Original Research
Introduction: Obesity in pregnancy is increasingly common and has multiple implications for anaesthetists. Obese patients are more likely to require operative delivery and in parallel experience an increased incidence of difficult airway management (failed intubation, mask ventilation, surgical airway access) and are consequently at increased risk of hypoxia, death and brain injury during general anaesthesia. Efforts to reduce patient risk include elective pre-anaesthesia assessment and planning to reduce the requirement for general anaesthesia by advocating early epidurals in those in labour.
Methods: We conducted a one year retrospective study to determine the effectiveness of the pre-anaesthesia assessment on peripartum anaesthetic and obstetric outcomes. We compared these outcomes in consecutive obese patients (OP) who had attended the clinic with obese patients not referred to the clinic (obese controls-OC) and non obese controls (NOC). After ethical approval 93 charts were reviewed. Outcomes included mode of delivery, epidural rate, cervix dilatation at the time of epidural catheter insertion, depth of epidural space, number of attempts, number of top-ups, epidural failures and patient co-morbidities.
Results: Caesarean section (CS) was more common in OP (52%) and OC (58%) compared to NOC (17%) (p=0.05). In labouring patients, emergency CS occurred with similar frequency in both obese groups and was higher than the non obese controls (Table). Epidurals were administered with equivalent frequency in all groups (Table) but at an earlier stage of cervical dilatation in OP than other groups. Epidural insertion was successful in all patients. There was no emergency general anaesthesia in any group.
Conclusions: Caesarean section is common in obese patients. The low requirement for general anaesthesia indicates that current anaesthetic management is at least partially effective. Whilst obese patients who attend clinic tend to request epidural early during labour, a large proportion do not receive or request epidurals in labour and may be therefore in the event of an emergency CS at increased risk of having general anaesthesia.