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Cesarean Delivery in a Patient With Body Mass Index Over 100: Continuous Spinal Anesthesia in Two Consecutive
Joseph L Reno1, Meghan I Cook2, Michael Kushelev3
1Anesthesiology and Pain Medicine, University of Washington, Seattle, USA.
Cureus
|July 26, 2021
Summary
Continuous spinal anesthesia effectively managed cesarean deliveries for a parturient with extreme obesity (BMI >100). This technique minimized risks, offering a potential approach for managing anesthesia in super-super morbidly obese patients.
Area of Science:
- Anesthesiology
- Obstetrics
- Bariatric Medicine
Background:
- Morbidly obese parturients (BMI >50 kg/m²) present anesthetic challenges.
- Limited data exists for patients with extreme obesity (BMI >100 kg/m²).
- This case report addresses anesthetic management for cesarean delivery in a patient with BMI >100 kg/m².
Observation:
- A patient with BMI 102 and later 116 underwent consecutive cesarean deliveries.
- Continuous spinal anesthesia was administered incrementally.
- A gradual semi-recumbent positioning was employed during anesthesia administration.
Findings:
- Incremental dosing of hyperbaric bupivacaine, fentanyl, and morphine via an intrathecal catheter provided effective anesthesia.
- The positioning strategy minimized risks of high spinal block and respiratory distress.
- The patient experienced no postdural puncture headache (PDPH).
Implications:
- This case provides insights for anesthetic technique and dosing in extremely obese parturients.
- Recommendations are offered for staffing, equipment, location, timing, and positioning.
- The findings contribute to managing anesthesia for cesarean delivery in patients with very high BMI.
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