Type of Anesthesia in the Morbidly Obese Parturients: Anesthesia-Related Complications and their Management - A Retrospective Study
Abstract Number: F-11
Abstract Type: Original Research
Obesity in pregnancy can add significantly to obstetric and anesthetic related morbidity such as pre-eclampsia, diabetes, DVT, challenges with airway access and spinal or epidural placement, difficulty with positioning and prolonged surgery times 1,2,3.
The objective of this study was to identify anesthesia-related complications of different types of elective cesarean anesthetics in morbidly obese parturients in our institution. In so doing we hoped to recognize the most proficient anesthetic technique for this population.
Retrospective review was done on 206 records of elective cesarean parturients with a BMI ≥ 40. Data extracted were: type of anesthesia, intraoperative and early postoperative complications, duration of surgery, newborn birth weight, cord blood pH and APGAR scores.
The overall incidence of significant intra-operative hypotension after regional anesthesia was 65.0%, bradycardia 3.04% and nausea and vomiting 14.21%. Additional intra-operative IV analgesia was required in 13.4%. Intraoperative hypotension occurred in 67% of patients in the spinal and CSE group vs. 34.8% in the epidural group (p=0.0022). Super morbid obese (SMO) patients (BMI ≥ 50) had a greater number of attempts at needle placement for regional techniques compared to morbidly obese (MO) patients (BMI 40-40.9) (2.02 vs. 2.61, p=0.0255). SMO patients also had longer mean surgical times (86.6 min vs. 107.55 min, p=0.0001), received more intraoperative crystalloids (1887 ml vs. 1699 ml, p=0.0376) and were more likely to receive intraoperative colloid (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.
In our study sample, spinal anesthesia was used more often than other techniques for cesarean delivery, and it resulted in more intra-operative hypotension. Parturients with BMI ≥ 50 were more challenging to manage and required: more attempts at needle placement for regional anesthesia; larger intra-operative fluid volumes and longer surgery times. Due consideration should be paid to adjusting the anesthetic technique in bariatric parturients. Perhaps an appropriately placed (eg. upper lumbar or lower thoracic) epidural technique is a more proficient route of anesthesia in these patients. A well-organized, randomized controlled trial could prove beneficial in validating the most profitable anesthetic technique for bariatric parturient that fosters safety for both mother and baby.
1. Roofthoft, E. Anesthesia for the morbidly obese parturient. Curr Opin Anaesthesiol. 2009 Jun; 22(3):341-6.
2. Saravankumar K., Rao S.G., Cooper G.M. Obesity and Obstetric Anesthesia. Anesthesia. 2006 Jan; 61 (1): 36-48.
3.Perlow JH, Morgan MA. Massive maternal obesity and perioperative cesarean morbidity. Am J Obstet Gynecol 1994; 170:560-565.