Abstract PR207

Abstract

Background & Objectives: We conducted a service evaluation of anaesthesia in morbidly obese parturients in our unit. Our aims were to quantify the extent of the issue locally, identify the level of anaesthetist involved and make recommendations. Materials & Methods: Following hospital governance approval, cases were identified from the Anaesthesia Obstetric Database. Women with a Body Mass Index (BMI) more than 40 kg/m2 who required an anaesthetic intervention between 1st of January 2014 to 31st of December 2014 were included. Two hundred and fourteen individual cases were identified out of 5,848 deliveries. We obtained 151 case notes. Seventeen cases were excluded due to missing data or discrepancies, leaving 134 cases for analysis. Data was collected for demographics, mode of delivery, analgesia technique, anaesthesia, complications (resites, bloody taps, dural punctures), grade of anaesthetist and outcomes. Results: BMI ranged between 40 to 65 kg/m2 at term. Sixty-one women were seen in our dedicated antenatal high BMI clinic. Seventy-three women underwent a Lower Segment Caesarean Section (LSCS). There were six category 1 Caesarean sections with five general anaesthesia cases and one epidural top-up. A Decision to Delivery Interval time (DDI) of less than 30 minutes was achieved in all cases. Seven women had assisted vaginal delivery and fifty-four a normal vaginal delivery. Our rate of labour epidural/CSE in morbidly obese patients was 69.81%, with a failure rate of 17.15%. We found a poor correlation between the antenatally ultrasound estimated depth of epidural space and the actual depth found in labour. The following complications were identified: eight cases of multiple attempts (one being impossible), three cases of accidental dural punctures and three bloody taps. Our super-morbidly obese patients (BMI more than 50 kg/m2) were managed by senior anaesthetists (seventeen cases) and three cases were by juniors. Conclusion: Our data is similar to internationally published studies of morbidly obese parturients in terms LSCS incidence (54.47%), rate of labour epidural and regional anaesthesia failure.1 We recommended threading more length of epidural catheter in the space to account for its movement with position related tissue expansion.2 There should be senior anaesthetic involvement with all super-morbidly obese patients. The demographic data from this audit was used to inform a successful bid for equipment funding from the Department of Health.