Article - Obesity & OB Anesthesia Flashcards
Does being obese increase the risk of requiring C section?
yup
Do obese preggos generally have a longer or shorter first stage of labor
longer
what is often seen in regards to babies weight when the mother is obese
higher fetal weights
Is there a higher rate of neuraxial failure in the obese population
yup
how does being obese affect the time of neuraxial procedures
longer
What % of maternal deaths were in overweight or obese mothers?
76%
are obese women more likely to die during labor
yes
Which class of obesity is it recommended for their to be a formal anesthesia consultation during the third trimester
Class 3 obesity. BMI > 40
What is included in the anesthesia consultation with obese mothers
- comprehensive physical exam
- extensive medical history
- screening for comorbidities
- screen for OSA
- pulm, CV, and airway assessment
Why is it advised that obese women need to request neuraxial anesthesia early in labor?
because placement is often challenging
- Requesting early is important to ensure sufficient time for placement/confirmation
- also reduces the risk of needing GA for emergency C section
Is the rate of OSA in obese pregnant women higher compared to healthy women
obvi
What adverse pregnancy outcomes are seen in women with OSA
hypertensive disorders
Gestational diabetes
What are the risk factors for OSA in pregnant women
- advanced maternal age
- obesity
- chronic HTN
- snoring
*usual OSA screening tools not shown to be accurate for the pregnant population
What is one of the safest methods for delivering labor analgesia in the obese population
epidural
When assessing analgesia epidural what would indicate being less likely to convert use to surgical anesthesia if necessary?
- fails to achieve a sensory level of T10
- requires frequent top offs
What should be done if the epidural is not providing adequate labor analgesia?
replace immediately to minimize risk of failure should a C section be required
What is the concern with administering IV analgesia to obese OSA parturients
they have increased sensitivity to respiratory depressant effects
What confirms placement for CSE
obtaining CSF through the spinal needle
an alternative technique to CSE in obese parturients
dual puncture epidural
What benefits were found to using the dual puncture epidural (DPE) instead of CSE in obese parturients?
- decrease the likelihood of asymmetric block
- less pruritus, hypotension, tachysytole, and category II fetal heart tracing
What limits the use of continuous spinal labor analgesia
risk of post-dural puncture headache
How do you Preoxygenate obese parturients?
3 mins of tidal volume breathing OR 8 deep breaths in 1min with 100%
what additional technique should be used during intubation to prolong the time to desaturation
administer 5L/min via nasal cannula
What position is preferred to sniffing position for intubation of obese parturients
ramp em up bby
Should dosing of induction drugs for obese parturients be based on total or ideal body weight?
ideal body weight
can you extubate an obese parturient deep
no no no must be fully awake
what device can be used to help with moving obese parturients onto the OR table and decrease the risk of injury
air-inflated mat
If cephalad retraction is used to gain a better view for C section what must be carefully monitored
hemodynamics and respiratory status.
* Fetal death linked to hypotension after cephalad retraction.
What postpartum complications are obese parturients at risk for
- wound complications
- UTI
- peripheral nerve injury
- VTE
- respiratory complications
- sepsis
- MI
- death
What method is seen as superior for post cesarean analgesia
neuraxial morphine
If neuraxial morphine is contraindicated d/t allergy or intolerance what is the next option often utilized for post cesarean analgesia?
PCA
Which block has been shown to reduce pain scores and analgesic consumption in patients who did not receive neuraxial morphine?
transversus abdominis plane (TAP) block
*not additionally beneficial if pt received neuraxial morphine
Why are local blocks an inferior technique for labor/postpartum analgesia
covers only incisional pain not visceral pain
Is there a universal VTE prophylaxis guideline for obese parturients
no, varies widely amongst institutions
