Optimising anaesthetic care for the morbidly obese parturient:

Recommendations from a single-centre service evaluation

Authors: Hutkova, S. Dabbeghatta, A. Surendran

Introduction: 

The increasing prevalence of morbid obesity in obstetric practice, alongside rising operative delivery rates, highlights the need for robust peri-operative anaesthetic, surgical and organisational planning to optimise maternal safety and experience.

The anaesthesia related risks include difficulties with placement of vascular access and/ or regional anaesthesia and raised incidence of difficult or failed intubation.

Failure of regional anaesthesia in these patients is estimated to be up to 8% and the risk of conversion to general anaesthesia is therefore high.

Methrods: 

Retrospective evaluation of parturient with BMI ≥50 kg/m²

undergoing caesarean delivery

• Multidisciplinary antenatal planning

• Anaesthetic engagement

• Ultrasound use

• Intra-operative events

• Maternal satisfaction 

Results: 

Antenatal Planning: All patients reviewed by anaesthetist

Neuraxial Anaesthesia:  Spinal: 18, CSE: 5, Epidural: 2

Ultrasound: 36% used, Improved first-pass success

Outcome: 1 GA conversion, 1 dural puncture, No neurological complications

Maternal satisfaction: no dissatisfaction reported 

Monitoring: NIBP sufficient in most cases

Key: Neuraxial anesthesia was feasible in the vast majority of cases with high maternal satisfaction and minimal serious complications. Timely MDT planning with patient engagement is crucial. 

Conclusion: