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Which Anesthetic (General or Regional) is Safest for a Caesarean Section in a Morbidly Obese Parturient?

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Controversies in the Anesthetic Management of the Obese Surgical Patient

Abstract

Obesity rates are steadily increasing among women of reproductive age, making it a common condition during pregnancy. Anesthesiologists are thus increasingly asked to care for morbidly obese parturient. Maternal obesity is associated with many complications during pregnancy, especially gestational diabetes and hypertensive disorders of pregnancy, and is also associated with increased rates of fetal complications. Obstetrical delivery in obese women is characterized by a high Caesarean section rate and an increased risk of anesthetic and postoperative complications. The advantages of general anesthesia for Caesarean section include a faster onset and less hemodynamic disturbance compared to regional anesthesia techniques. However, there is increased risk of failed endotracheal intubation, gastric aspiration and ventilation difficulties. Aspiration and Mendelson’s syndrome may occur, although it has not been clearly demonstrated whether the combination of pregnancy and obesity further increase the risk of pulmonary aspiration. Regional anesthesia seems to offers major advantages compared to general anesthesia. However, there is a paucity of information as to how morbidly obese patients tolerate regional anesthesia and what are the appropriate doses of local anesthetics for these patients. Which is the best anesthetic technique for Caesarean section to reduce the risks of minor and serious complications in obese patients is still unknown.

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Authors and Affiliations

  1. Department of Anesthesiology, ICU and Pain Therapy, Santa Maria degli Angeli Medical Centre, Via Montereale 24, 33170, Pordenone, Italy

    Yigal Leykin, Linda Miotto & Gianfederico Zannier

  2. Department of Anesthesia and ICU, University of Trieste, Trieste, Italy

    Yigal Leykin

Authors
  1. Yigal Leykin
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  2. Linda Miotto
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  3. Gianfederico Zannier
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Correspondence to Yigal Leykin .

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Editors and Affiliations

  1. Santa Maria degli Angeli Medical Centre, Pordenone, Italy

    Yigal Leykin

  2. Stanford University School of Medicine, Stanford, 94305, California, USA

    Jay B. Brodsky

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Leykin, Y., Miotto, L., Zannier, G. (2013). Which Anesthetic (General or Regional) is Safest for a Caesarean Section in a Morbidly Obese Parturient?. In: Leykin, Y., Brodsky, J. (eds) Controversies in the Anesthetic Management of the Obese Surgical Patient. Springer, Milano. https://doi.org/10.1007/978-88-470-2634-6_27

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  • DOI: https://doi.org/10.1007/978-88-470-2634-6_27

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  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-2633-9

  • Online ISBN: 978-88-470-2634-6

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