Labor or Cesarean for Superobese Women?

Rates of severe maternal and neonatal morbidity were similar among superobese women undergoing primary cesarean delivery versus a trial of labor, most often ending in vaginal delivery | Clinical Anesthesiology

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Researchers say a prospective clinical trial is needed to determine whether one method of birth is superior to the other in mothers who are superobese.

According to Alexander Butwick, MBBS, FRCA, MS, among women who are superobese, rates of cesarean delivery are particularly high (≥50%), but little has been known about how delivery mode affects perinatal and neonatal outcomes. Dr. Butwick, who presented the findings at the 2016 annual meeting of the Society for Obstetric Anesthesia and Perinatology (abstract 01-02), is associate professor in the Department of Anesthesiology, Perioperative and Pain Medicine at Stanford University School of Medicine, in California.

Over the years, clinicians have observed that obesity is associated with an increased risk for obstetric, perinatal and anesthetic morbidities. Obese pregnant women are at an increased risk for gestational diabetes, preeclampsia, operative delivery, postpartum infection and venous thromboembolism.

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Use of ultrasound for spinal anesthesia in a super morbidly obese patient

Morimoto, Y. et al. (2017) Journal of Clinical Anesthesia. 36 pp. 88–89

Heather Spears, Wellcome Images

Image source: Heather Spears – Wellcome Images // CC BY-NC-ND 4.0

Highlights

  • We report the application of ultrasound prescan for spinal anesthesia to morbid obesity patient.
  • The transverse view of the patient’s lumbar spine showed the posterior dura, transverse process, and posterior vertebral body below the thick fat tissue.
  • At this point, spinal anesthesia was successfully performed.
  • Pre-insertion ultrasound guidance for spinal anesthesia was useful in this morbidly obese patient with a BMI of 50.

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Neck circumference as a predictor of difficult intubation and difficult mask ventilation in morbidly obese patients

Riad, W. et al. European Journal of Anaesthesiology: April 2016 – Volume 33 – Issue 4 – p 244–249

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Image source: Sarah Jordan

Background: There is conflicting evidence as to whether obesity and neck circumference are predictors of difficult intubation in the surgical population. In addition, the cut-off neck circumference related to difficult intubation has not been clearly identified.

Objectives: The primary study objective was to determine whether neck circumference and obesity were predictors of difficult intubation in morbidly obese surgical patients. Secondary outcomes included difficult mask ventilation.

Main Outcome Measures: The primary outcome of the study was difficult tracheal intubation. An Intubation Difficulty Scale (IDS) was derived using seven parameters and difficult intubation was defined as IDS of at least 5. The secondary outcome was difficult mask ventilation; mask ventilation was graded as easy or difficult (inadequate, desaturation, two-handed or impossible).

Results: Univariate analyses showed that difficult intubation was associated with neck circumference, males, BMI more than 50 kg m−2, American Society of Anesthesiologists (ASA) status and waist circumference, and difficult mask ventilation with neck circumference, males, BMI more than 50 kg m−2 and thyromental distance. Multiple logistic regression analysis showed that neck circumference more than 42 cm (P = 0.044) and BMI more than 50 kg m−2 (P = 0.017) were independent predictors of difficult intubation. Male sex (P = 0.004) and BMI more than 50 kg m−2 (P = 0.031) were independent predictors of difficult mask ventilation.

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