Obese Parturients Research Articles

A randomised controlled trial of the effect of a head-elevation pillow on intrathecal local anaesthetic spread in caesarean section

BackgroundA head-elevation pillow places a patient in a ramped posture, which maximises the view of the larynx during laryngoscopy, particularly in obese parturients. In our institution an elevation pillow is used pre-emptively for neuraxial anaesthesia. We hypothesised that head-elevation may impair cephalad spread of local anaesthetic before caesarean section resulting in a lower block or longer time to achieve a T6 level. We aimed to investigate the effect of head-elevation on spread of intrathecal local anaesthetics during anaesthesia for caesarean section. MethodsOne-hundred parturients presenting for caesarean section under combined spinal-epidural anaesthesia were randomised to either the standard supine position with lateral displacement or in the supine position with lateral displacement on an head-elevation pillow. Each patient received intrathecal hyperbaric bupivacaine 11mg, morphine 100μg and fentanyl 15μg. Patients were assessed for adequacy of sensory block (T6 or higher) at 10min. ResultsSensory block to T6 was achieved within 10min in 65.9% of parturients in the Elevation Pillow Group compared to 95.7% in the Control Group (P<0.05). Compared to the Control Group, patients in the Elevation Pillow Group had greater requirements for epidural supplementation (43.5% vs 2.1%, P<0.001) or conversion to general anaesthesia (9.3% vs 0%, P<0.04). ConclusionsUse of a ramped position with an head-elevation pillow following injection of the intrathecal component of a combined spinal-epidural anaesthetic for scheduled caesarean section was associated with a significantly lower block height at 10min.

What is the failure rate in extending labour analgesia in patients with a body mass index ≥ 40 kg/m(2)compared with patients with a body mass index < 30 kg/m(2)? a retrospective pilot study.

BackgroundEarly utilisation of neuraxial anaesthesia has been recommended to reduce the need for general anaesthesia in obese parturients. The insertion and management of labour epidurals in obese women is not straight-forward. The aim of this pilot study was to compare the failure rate of extension of epidural analgesia for emergency caesarean section, in pregnant women with a body mass index (BMI) ≥ 40 kg/m2, to those with a BMI < 30 kg/m2. The results will be used to calculate the sample size of a planned prospective study.MethodsIn this retrospective, (1:1) case–control pilot study, obese subjects and control subjects were selected from the obstetric database, if they delivered between January 2007 and December 2011. All subjects used epidural analgesia during labour and subsequently required anaesthesia for Category 1 or 2 Caesarean Section. Data was extracted from the patient medical record. Failure to extend was analysed using liberal and restrictive definitions. Chi-square or Fisher’s exact tests were used to detect differences between groups. Multiple logistic regression was used to examine variables predictive of extension failure.ResultsThere were 63 subjects in each group. The mean BMI of the obese group was 45.4 (5.8) kg/m2 and 23.9 (3.0) kg/m2 in the control group. The odds ratio for failure to extend the existing epidural blockade (liberal definition) was 2.48 (95 % CI:1.02 – 6.03) for the obese group compared with the control group (adjusted for age, parity and gestation). Using the restrictive definition, the odds ratio for failure in the obese group was 6.78 (95 % CI:1.43 – 32.2). The combination of respiratory co-morbidity and gestational diabetes significantly predicted extension failure. Surgical time and epidural complications on labour ward were significantly greater in the obese group.ConclusionsIn this small retrospective cohort, patients with a BMI ≥ 40 kg/m2 were significantly more likely to fail epidural extension for caesarean section. The presence of respiratory co-morbidity and gestational diabetes were significant predictors of extension failure; their clinical relevance requires further evaluation.

The multidisciplinary approach to the care of the obese parturient

Maternal obesity in pregnancy is associated with increased maternal and fetal risks. Pregnancy management should include counseling, screening, and optimization of maternal health, increased fetal surveillance, and preparation for parturition. A multidisciplinary approach should be implemented including collaboration from obstetricians, nutritionists, anesthesiologists, social workers, and neonatologists to optimize perinatal outcomes. Pregnancy is an ideal window of opportunity to influence both the patient's long-term health and the health of the offspring.

Obesity in pregnancy: what's next? Long-term cardiovascular morbidity in a follow-up period of more than a decade

Objective: To investigate whether obesity during pregnancy poses a risk for subsequent maternal long-term cardiovascular morbidity, after controlling for diabetes and hypertensive disorders. Study design: Data were analyzed from consecutive pregnant women who delivered between 1988 and 1999, and were followed-up until 2010. Long-term cardiovascular morbidity was compared among women with and without obesity in pregnancy (maternal pre-pregnancy body mass index (BMI) of 30 kg/m2 or more). Kaplan–Meier survival curves were used to compare cumulative incidence of cardiovascular hospitalizations. Cox proportional hazards models were used to estimate the adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for long-term cardiovascular hospitalizations. Results: During the study period 46 688 women met the inclusion criteria, 1221 (2.6%) had a BMI ≥30 kg/m2. During a follow-up period of more than 10 years, patients with obesity had higher rates of simple cardiovascular events and total number of cardiovascular hospitalizations. These complications tended to occur at a shorter interval (mean 4871 days ± 950 versus 5060 days ± 1140; p = 0.001). In a Cox proportional hazards model that adjusted for diabetes mellitus, preeclampsia and maternal age, obesity was independently associated with cardiovascular hospitalizations (adjusted HR 2.6, 95% CI 2.0–3.4). Conclusion: Obesity during pregnancy is an independent risk factor for long-term cardiovascular morbidity, and these complications tend to occur earlier. Pregnancy should be considered as a window of opportunity to predict future health problems and as an opportunity to promote women's health. Obese parturients might benefit from cardiovascular risk screening that could lead to early detection and secondary prevention of cardiovascular morbidity.

Issue maternofœtale de la grossesse chez la femme obèse à l’hôpital gynéco-obstétrique et pédiatrique de Yaoundé, Cameroun

More than 25% of Cameroonians are obese. However, data and complications related to obesity during pregnancy are not known in our environment. Objectives: The aim of our study was to describe the materno-foetal outcome of pregnancy in obese women at the Gyneco-Obstetric and Pediatric Hospital of Yaounde, in Cameroon. Methodology: It was a descriptive and transversal study over 2 months. Patients in labour or in post-partum were grouped together in body mass index (BMI) classes and according to a BMI of < 30 kg/m 2 or ≥ 30 kg/m 2 . Pregnancy and delivery procedure were analyzed in order to bring out complications due to obesity. Results: Our sample was made of 231 patients. The obesity frequency was 16% in the beginning of pregnancy, and 48.9% at delivery. The average birth weight was 3,353 g for the new born babies of obese mothers compared with 3,099 g for those of non-obese women (P = 0.001). Macro- somia rate and the gap between the estimated foetal weight and the effective birth weight were significantly higher in obese women than in those who were not obese. The fre- quency of cephalo-pelvic disproportion was 6.7% for the obese parturient compared with 0.9% for non-obese partu- rient (P = 0.024). A caesarian section was carried out for 25.7% of the obese women and 11.9% of non-obese women (P = 0.007). However, there was no significant difference between obese and non-obese women concerning high

The analgesic efficacy of ultrasound-guided transversus abdominis plane block in comparison with subarachnoid morphine after cesarean section in morbidly obese parturients

Context Cesarean section is one of the most commonly performed surgical procedures. Intrathecal morphine is a popular and effective option for pain management following cesarean section. It is associated with side effects such as nausea, vomiting, pruritus, urinary retention, reactivation of oral herpes, and, rare but life-threatening, respiratory depression. The interest in transversus abdominis plane (TAP) block as a post-cesarean-delivery analgesic modality has surged in the past few years, and many studies have evaluated and compared its efficacy with intrathecal morphine. Aim The aim of the study was to compare spinal morphine and bilateral TAP block in cesarean section in morbidly obese parturients with respect to their postoperative analgesic efficacy and narcotic consumption. Settings and design This was a prospective randomized, double-blinded study. Materials and methods Parturients, 20 years or older, with BMI greater than 35 kg/m 2 , who were scheduled to undergo elective cesarean section were recruited for the study. They were assigned to receive either intrathecal morphine (the ITM group) 0.1 mg or TAP block (the TAP group) using ropivacaine 0.5% 20 ml on each side. The primary outcome was pain on movement, from supine to sitting position. The secondary outcomes were the presence and severity of nausea and pruritus and the presence of respiratory depression. Results We enrolled 60 patients, of whom 59 were analyzed. The numeric rating scale score for pain was less in the ITM group than in the TAP block group, and this difference was statistically significant. Both pruritus and nausea happened in more patients in the ITM group than in the TAP block group, and this difference was statistically significant in both the 8 and 16 h observations. Conclusion In morbidly obese parturients, intrathecal morphine has superior post-cesarean-delivery analgesic efficacy compared with the TAP block.

Challenge of morbid obesity in obstetric anesthesia

Objectives To discuss the pathophysiology of morbid obesity in pregnant ladies and the anesthetic management of morbidly obese parturients. Background The association between obesity and pregnancy can result in further limitation of parturient physiological reserve. Indeed, maternal obesity is associated with an increased risk of delivery and postpartum complications. Conclusion Complete understanding of the physiology, pathophysiology, comorbidies and their implications for anesthesia and analgesia in morbidly obese parturients should lead to improvement of safety and anesthetic care. 2- Reviews and Meta-Analyses. Objective To determine the anesthetic and obstetric complications in morbidly obese parturient that had caesarean delivery. Data analysis was preformed through a search on the pub med, Google and ovid medline data base. Recent Findings early epidural analgesia during labor is valuable and that regional anesthesia is usually preferable, but a number of challenges arise. Conclusions Morbidly obese women experienced increased complications during pregnancy and childbirth. Due to the high rate of caesarean sections and the potential difficulties of emergency anesthesia among these women, epidural anesthesia during labor should be planned and administered as often as possible.

Anesthesia for Cesarean Delivery in the Morbidly Obese Parturient - Comparison of Commonly used Anesthesia Techniques

Anesthesia for Cesarean Delivery in the Morbidly Obese Parturient - Comparison of Commonly used Anesthesia Techniques

A Randomized Controlled Comparison Between Combined Spinal-Epidural and Single-Shot Spinal Techniques in Morbidly Obese Parturients Undergoing Cesarean Delivery

BACKGROUND: There is no current consensus on the optimal technique for subarachnoid anesthesia in morbidly obese parturients even though some providers prefer the combined spinalepidural (CSE) over single-shot spinal (SSS) technique. In this randomized controlled study, we compared the time required for initiation of subarachnoid anesthesia between SSS and CSE techniques in morbidly obese parturients undergoing elective cesarean delivery. METHODS: Morbidly obese parturients presenting for elective cesarean delivery were randomized to receive subarachnoid anesthesia performed either with a SSS or a CSE technique. The spinal procedure in the sitting position was attempted by an experienced resident for up to 10 minutes, and if unsuccessful, the attending obstetric anesthesiologist assumed control of the procedure. The primary outcome was the time it took from the insertion of the introducer needle (SSS group) or insertion of the epidural needle (CSE group) to the end of intrathecal injection of drugs (procedure time). RESULTS: Forty-four patients were enrolled and completed the study. Three were excluded due to protocol violations. Of the remaining, 21 patients were in the SSS group and 20 in the CSE group. Demographic variables and mean (SD) body mass index (48.7 ± 7.6 kg/m 2 for SSS; 49.9 ± 8.6 kg/m 2 for CSE) were not different between groups. The median [interquartile range] for procedure time was 210 [116–692] seconds and 180 [75–450] seconds for SSS and CSE groups, respectively (P = 0.36), while the 95% confidence interval (CI) of the difference was −80 to +180 seconds. The first operator completed the procedure in <10 minutes in 71% of subjects in the SSS group and 95% of those in the CSE group (P = 0.09) and the 95% CI of the difference was −2% to +45%. There were more attempts to successful completion of the procedure in the SSS group (P = 0.007) with its 95% CI of the difference being +1 to +6. CONCLUSION: Our results suggest that the CSE technique is noninferior to the SS technique in morbidly obese parturients for time of initiation of subarachnoid anesthesia and may be accomplished with fewer attempts than the SSS technique with experienced residents. (Anesth Analg 2014;118:168–72)

A Randomized Controlled Comparison Between Combined Spinal-Epidural and Single-Shot Spinal Techniques in Morbidly Obese Parturients Undergoing Cesarean Delivery

A Randomized Controlled Comparison Between Combined Spinal-Epidural and Single-Shot Spinal Techniques in Morbidly Obese Parturients Undergoing Cesarean Delivery

Oxytocin utilization for labor induction in obese and lean women.

To determine if oxytocin dosage used for labor induction differed in obese and lean women, we analyzed records of patients who underwent term labor induction and delivered vaginally. Each of a cohort of 27 patients with a body mass index (BMI) >40 kg/m2 was matched with a patient with a BMI <28 kg/m2 for gestational age, for birth weight, and for cervical dilatation and fetal station at admission. The oxytocin dose administered during first stage labor was calculated for each patient. In addition to the matched characteristics, there was no difference between groups in parity, frequency of diabetes, epidural anesthesia use, or pharmacologic cervical ripening. Oxytocin utilization was significantly greater in obese women than in lean women. The maximum administration rate was 17.7±4.7 and 13.1±5.0 mU/min, respectively (P=0.001). Oxytocin administered per minute during the first stage of labor was greater in the obese group (11.6±4.8 vs. 8.6±4.1 mU/min; P=0.020). Neither active phase duration nor the maximum rate of dilatation differed significantly between the groups. That obese parturients required more oxytocin than lean women during the first stage of successful labor induction could not be explained by group differences in parity, birth weight, dysfunctional labor, pre-induction dilatation and station, or epidural use.

Diminished activity of circulating α1-antitrypsin is associated with pre-gestational isolated obesity

Objective: To examine possible correlation between α1-antitrypsin (AAT) levels and activity in patients with and without obesity, after excluding complications such as gestational diabetes mellitus (GDM), during pregnancy.Study design: A prospective case–control study was conducted. AAT levels were determined by standard human AAT ELISA according to the manufacturer's instructions. Elastase inhibition was determined by kinetic assay according to manufacturer recommendations. Assays were performed in duplicates and repeated twice for each sample in separate sessions. Patients with diabetes mellitus were excluded from the study. The Mann–Whitney U-test was performed in order to determine statistical differences between the groups, and AAT concentration and activity.Results: During the study period, 43 patients were recruited: 21 with isolated obesity and 22 non-obese parturients (control group). According to ELISA, AAT concentrations were mildly lower in obese women compared with non-obese women (8.31 ± 0.28 mg/ml versus 9.5 ± 0.37 mg/ml, p = 0.0155). However, the elastase inhibitory capacity was markedly lower in obese versus non-obese parturients (mean 27.33 ± 2.08 % versus 43.73 ± 3.1%, p < 0.001).Conclusions: Isolated obesity in pregnancy is associated with lower activity of AAT. These findings correlate with the reduced concentration and activity of AAT found in patients with GDM. Accordingly, it might suggest an inflammatory axis shared by obesity and the development of insulin resistance.

Anesthetic and obstetric outcomes in morbidly obese parturients: a 20-year follow-up retrospective cohort study

BackgroundIn 1993, Hood and Dewan published the results of a trial comparing obstetric and anesthetic outcomes of 117 morbidly obese parturients with matched controls. The authors demonstrated a higher initial epidural anesthesia failure rate, a higher cesarean delivery rate and an increased risk of obstetric complications. We replicated the previous study to provide updated information on outcomes in the morbidly obese pregnant population. We hypothesized that morbidly obese women would still have higher complication and failure rates compared to matched controls and that general anesthesia would be less commonly used than in the previous study. MethodsThe medical records of 230 patients weighing >136kg (300pounds) were compared to matched controls: the next patient delivered by the same obstetrician with a weight <113kg (250pounds). ResultsThe mean weight of the morbidly obese group was 53.4±6.6kg/m2 compared to 31.1±5.4kg/m2 in the control group. Fifty percent of morbidly obese women required cesarean delivery compared to 32% of controls (P <0.01). Morbidly obese patients had a longer first stage of labor (P <0.01), larger neonates (P <0.01), and were more likely to have a failed initial neuraxial technique for labor analgesia (P <0.01). The need for a replacement procedure for labor was 17%, significantly less than 20years ago when 42% of catheters in morbidly obese women failed (P <0.01). Failure rates of neuraxial anesthesia for cesarean delivery were similar between groups. Neuraxial procedure times were greater in morbidly obese parturients (P <0.01). Morbidly obese women were less likely to receive general anesthesia compared to 20years ago (3% vs. 24%, P <0.01). ConclusionsMorbidly obese parturients are still at increased risk for antenatal comorbidities, failed labor analgesia, longer first stage of labor and operative delivery. Replacement labor epidural catheters and general anesthesia for cesarean delivery are less commonly required anesthetic techniques compared to the original study.

Application of quality control circle activity in promoting the healing of abdominal vertical incision in obese parturient

Objective To explore the clinical effect of quality control circle activity in promoting the healing of abdominal vertical incision in obese parturients in order to shorten the time of wound healing . Methods Ninety-six abdominal vertical incisions in obese parturients were chosen and were randomly divided into the control group and the observation group , each with 48 cases.The control group received the routine postnatal nursing , and the observation group received the quality control circle activity on the basis of the routine nursing.The time of first exhaust and defecation , the hospitalization time, and the incidence rates of complication including wound infection and fatty fluidization were compared between two groups .Results The time of first exhaust and defecation , the hospitalization time in the observation group were respectively （4.6 ± 3.4） h, （12.2 ±4.8） h, （6.2 ±2.8） d, which were shorter than （13.1 ±3.9） h, （25.2 ±5.2） h, （14.3 ±3.7） d in the control group, and the differences were statistically significant （ t =8.047,12.114, 7.492, respectively;P〈0.05）.The cases of wound infection , wound dehiscence and fatty fluidization were＆amp;nbsp;respectively zero , zero, one case in the observation group , and were three , two, three cases in the control group, and the difference was found in the incidence rate of complication between two groups （χ2 =13.207,P〈0.05）.Conclusions The quality control circle activity can improve the quality of nursing , and shorten the time of first exhaust and defecation and the hospitalization time , and reduce the incidence of complication . Key words: Maternal health services; Wound healing; Quality control circle

A Randomized Controlled Comparison Between Combined Spinal-Epidural and Single-Shot Spinal Techniques in Morbidly Obese Parturients Undergoing Cesarean Delivery

There is no current consensus on the optimal technique for subarachnoid anesthesia in morbidly obese parturients even though some providers prefer the combined spinal-epidural (CSE) over single-shot spinal (SSS) technique. In this randomized controlled study, we compared the time required for initiation of subarachnoid anesthesia between SSS and CSE techniques in morbidly obese parturients undergoing elective cesarean delivery. Morbidly obese parturients presenting for elective cesarean delivery were randomized to receive subarachnoid anesthesia performed either with a SSS or a CSE technique. The spinal procedure in the sitting position was attempted by an experienced resident for up to 10 minutes, and if unsuccessful, the attending obstetric anesthesiologist assumed control of the procedure. The primary outcome was the time it took from the insertion of the introducer needle (SSS group) or insertion of the epidural needle (CSE group) to the end of intrathecal injection of drugs (procedure time). Forty-four patients were enrolled and completed the study. Three were excluded due to protocol violations. Of the remaining, 21 patients were in the SSS group and 20 in the CSE group. Demographic variables and mean (SD) body mass index (48.7 ± 7.6 kg/m for SSS; 49.9 ± 8.6 kg/m for CSE) were not different between groups. The median [interquartile range] for procedure time was 210 [116-692] seconds and 180 [75-450] seconds for SSS and CSE groups, respectively (P = 0.36), while the 95% confidence interval (CI) of the difference was -80 to +180 seconds. The first operator completed the procedure in <10 minutes in 71% of subjects in the SSS group and 95% of those in the CSE group (P = 0.09) and the 95% CI of the difference was -2% to +45%. There were more attempts to successful completion of the procedure in the SSS group (P = 0.007) with its 95% CI of the difference being +1 to +6. Our results suggest that the CSE technique is noninferior to the SS technique in morbidly obese parturients for time of initiation of subarachnoid anesthesia and may be accomplished with fewer attempts than the SSS technique with experienced residents.

255: Hemoglobin A1c as an early predictor of gestational diabetes in obese patients: a subgroup analysis

255 Hemoglobin A1c as an early predictor of gestational diabetes in obese patients: a subgroup analysis Alex Fong, Allison Serra, Lauryn Gabby, Deborah Wing, Kathleen Berkowitz University of California, Irvine, Obstetrics and Gynecology, Orange, CA, University of California, Irvine, School of Medicine, Irvine, CA, MemorialCare Center for Women at Miller Children’s Hospital, Obstetrics and Gynecology, Long Beach, CA OBJECTIVE: To assess the use of early screening hemoglobin A1c (HgbA1c) of 5.7-6.4% as a predictor of gestational diabetes (GDM) in obese patients. STUDY DESIGN: This is a subgroup analysis on obese parturients using data from a retrospective cohort study of 544 subjects who underwent early screening HgbA1c. Subjects with known pre-existing diabetes or HgbA1c values >1⁄46.5% were excluded. Obese subjects were defined as having a pre-pregnancy body mass index (BMI) >1⁄430. The primary outcome was GDM development. Secondary outcomes included route of delivery, maternal weight gain, and neonatal outcomes. Subjects with HgbA1c 5.7-6.4% were compared to those with HgbA1c 4kg), or neonatal morbidities. CONCLUSION: Obese subjects with an early screening HgbA1c of 5.76.4% have a nearly 50% chance of developing GDM and higher weight gain than those with HgbA1c <5.7%. HgbA1c should be used as a tool in identifying obese subjects who may benefit from closer glycemic surveillance, weight control, and possible early intervention.

Labor Analgesia for the Obese Parturient

Obese parturients present obstetric anesthesia providers with multiple challenges, including increased incidence of maternal coexisting disease, labor complications, and potential for difficult initiation and failure of neuraxial labor analgesia. This focused review discusses these challenges, and suggests potential methods to increase labor analgesia success in this population.

The effect of antenatal anaesthetic consultation on maternal decision-making, anxiety level and risk perception in obese pregnant women

BackgroundObese parturients are recognised as high risk and an antenatal anaesthetic consultation is recommended. The potential positive and negative effects of this consultation have not been investigated. This prospective observational study aimed to determine if antenatal anaesthetic consultation affects decisional conflict, anxiety scores or risk perception in obese women planning vaginal delivery. MethodsEligible women had a body mass index of ⩾35kg/m2, planning a vaginal delivery, aged ⩾18years and able to complete a questionnaire presented in English. Before their anaesthetic consultation, women completed a written decisional conflict questionnaire, the Six-Point Short Form of the Speilberger State-Trait Anxiety Inventory and two questions regarding risk perception. All questions were repeated by telephone consultation two weeks later. Independent samples t-tests were used to detect differences between pre and post-test scores. ResultsOf 114 women recruited, 89 completed the protocol and were analysed. Women had a mean ±SD age of 29.4±5.2years and body mass index of 43.6±5.6kg/m2. Decisional conflict scores were significantly lower after the consultation (30.04 vs. 16.54, P<0.001). Anxiety scores were lower (9.41 vs. 8.49, P=0.002) but this was not clinically significant. Only 19.1% of women felt their health was at risk in pregnancy; this did not change after the consultation. Thirteen women changed their preference toward epidural analgesia (P=0.01). DiscussionOur results support the current practice of referral of obese parturients for anaesthetic consultation, but demonstrate that most women remain unaware of the risks of obesity in pregnancy despite anaesthetic consultation.

A randomized controlled trial of preinsertion ultrasound guidance for spinal anaesthesia in pregnancy: outcomes among obese and lean parturients

The present study was conducted to examine if preinsertion lumbar ultrasound scanning helps with performance of spinal puncture, as a tool for decreasing the number of puncture attempts and spinal procedure time and increasing the success rate. We hypothesized that ultrasound can facilitate neuraxial blockade, particularly in pregnant women with difficult topographic anatomy. One hundred (50 lean, BMI <30kg/m(2), and 50 obese, BMI ≥30kg/m(2)) parturients scheduled for cesarean delivery were divided into ultrasound and control groups. Subarachnoid block was performed with prepuncture ultrasound examination in lean parturients (group 1, n=25) and in obese parturients (group 2, n=25), and subarachnoid block was performed without prepuncture ultrasound examination in lean parturients (group 3, n=25) and in obese parturients (group 4, n=25). The number of puncture attempts and puncture levels were recorded. A lower number of puncture attempts and fewer puncture levels were detected in ultrasound (US) groups (p<0.001). First attempt success rate under US guidance was 92% in comparison to 44% using a conventional technique in obese parturients (p<0.001). In 52% of the lean patients and in 54.2% of the obese patients, the intercristal line was at the L3-L4 and at the L2-L3 interspace, respectively. The duration of spinal procedure was shorter in US groups (22 vs. 52s, p=0.031). We found a high correlation between ultrasound and needle depth (r=0.709, p<0.001). We found a high level of success in the prepuncture ultrasound-determined insertion point. The ultrasound imaging technique can be a reliable guide to facilitate spinal anesthesia, especially in obese parturients.

Anestesia regional: todavía una alternativa adecuada en la parturienta con obesidad mórbida

Obesity has been identified as a significant risk factor for anaesthesia related morbidity/mortality in obstetrics. Obesity compounds most of the physiological changes in pregnancy. The obese parturients are at increased risk of having either concurrent medical problems or superimposed antenatal diseases including preeclampsia and gestational diabetes. These patients need thorough preoperative assessment, meticulous preparation and preparation for difficult airway as incidence of failed intubation is many times higher in these patients. Regional anaesthesia whenever possible is the best choice in this group of patients.