Morbid obesity: Optimizing neuraxial analgesia and cesarean delivery outcomes

IF 2.8 3区 医学 Q1 ANESTHESIOLOGY
Jennifer E. Dominguez , Cameron R. Taylor , Thierry Girard
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引用次数: 0

Abstract

The issue of obesity continues to reach new levels globally, affecting individuals across the age continuum. Obesity in pregnancy is associated with myriad comorbidities which may negatively impact the fetus, particularly dysfunctional labor and failure to progress ending in unplanned cesarean delivery. Neuraxial anesthesia represents the gold standard for cesarean delivery anesthesia and is increasingly beneficial for obese patients due to the risk of difficult airway. Obese parturients demonstrate higher rates of venous thromboembolism and wound infections and appropriate prophylaxis strategies to prevent these complications is imperative. While neuraxial anesthesia is the preferred technique for peripartum analgesia and cesarean delivery anesthesia, procedures can be technically challenging in patients with obesity, and may require more time, longer needles, increased experience, or ultrasound guidance. There is some concern for respiratory depression with the administration of neuraxial opioids in patients with obesity which has culminated in the development of post-operative monitoring guidelines.
病态肥胖:优化神经轴镇痛和剖宫产结局
肥胖问题在全球范围内继续达到新的水平,影响着各个年龄段的个体。妊娠期肥胖与许多可能对胎儿产生负面影响的合并症有关,特别是功能障碍分娩和以意外剖宫产告终的进展失败。轴向麻醉是剖宫产麻醉的金标准,由于存在气道困难的风险,轴向麻醉对肥胖患者越来越有利。肥胖产妇静脉血栓栓塞和伤口感染的发生率较高,预防这些并发症的适当预防策略势在必行。虽然神经轴麻醉是围产期镇痛和剖宫产麻醉的首选技术,但对于肥胖患者来说,手术在技术上具有挑战性,可能需要更多的时间、更长的针头、更多的经验或超声指导。在肥胖患者中使用阿片类神经轴向药物会引起呼吸抑制,这在术后监测指南的制定中达到了顶峰。
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36 days
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