Obesity And Obstetric Anesthesia: Current Insights

IF 1.5 Q3 ANESTHESIOLOGY
C. Taylor, J. Dominguez, A. Habib
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引用次数: 27

Abstract

Abstract Obesity is a significant global health problem. It results in a higher incidence of complications for pregnant women and their neonates. Cesarean deliveries are more common in obese parturients as well. The increased burden of comorbidities seen in this population, such as obstructive sleep apnea, necessitates antepartum anesthetic consultation. These patients pose unique challenges for the practicing anesthesiologist and may benefit from optimization prior to delivery. Complications from anesthesia and overall morbidity and mortality are higher in this population. Neuraxial anesthesia can be challenging to place in the obese parturient, but is the preferred anesthetic for cesarean delivery to avoid airway manipulation, minimize aspiration risk, prevent fetal exposure to volatile anesthetic, and decrease risk of post-partum hemorrhage from volatile anesthetic exposure. Monitoring and positioning of these patients for surgery may pose specific challenges. Functional labor epidural catheters can be topped up to provide conditions suitable for surgery. In the absence of a working epidural catheter, a combined spinal epidural anesthetic is often the technique of choice due to relative ease of placement versus a single shot spinal technique as well as the ability to extend the anesthetic through the epidural portion. For cesarean delivery with a vertical supraumbilical skin incision, a two-catheter technique may be beneficial. Concern for thromboembolism necessitates early mobilization and a multimodal analgesic regimen can help accomplish this. In addition, thromboprophylaxis is recommended in this population after delivery—especially cesarean delivery. These patients also need close monitoring in the post-partum period when they are at increased risk for several complications.
肥胖与产科麻醉:最新见解
摘要肥胖是一个重要的全球健康问题。这导致孕妇及其新生儿并发症的发生率更高。剖宫产在肥胖产妇中也更常见。这一人群中出现的合并症负担增加,如阻塞性睡眠呼吸暂停,需要进行产前麻醉咨询。这些患者给执业麻醉师带来了独特的挑战,并可能从分娩前的优化中受益。麻醉并发症、总体发病率和死亡率在这一人群中较高。在肥胖产妇中使用轴颈麻醉可能很有挑战性,但它是剖宫产的首选麻醉剂,可以避免气道操作,最大限度地降低抽吸风险,防止胎儿暴露于挥发性麻醉剂,并降低挥发性麻醉剂暴露导致产后出血的风险。对这些患者进行手术监测和定位可能会带来特定的挑战。功能性分娩硬膜外导管可以加满,以提供适合手术的条件。在没有工作的硬膜外导管的情况下,由于与单次注射脊髓技术相比,放置相对容易,并且能够将麻醉剂延伸到硬膜外部分,因此通常选择腰麻-硬膜外联合麻醉技术。对于垂直脐上皮肤切口的剖宫产,双导管技术可能是有益的。对血栓栓塞症的关注需要尽早动员,多模式镇痛方案可以帮助实现这一点。此外,建议在分娩后对这一人群进行血栓预防,尤其是剖宫产。这些患者在产后也需要密切监测,因为他们出现多种并发症的风险增加。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.30
自引率
0.00%
发文量
12
审稿时长
16 weeks
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