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118 Anesthetic management for cesarean section in a super morbidly obese patient
  1. H Gouveia,
  2. S Reinolds Pereira,
  3. J Freitas and
  4. R Rodrigues
  1. Serviço de Saúde da Região Autónoma da Madeira – Hospital Central do Funchal, Funchal, Portugal


Background and Aims Super morbid obesity is defined as a body mass index of >50 kg/m2. Complications from anesthesia and overall morbidity and mortality are higher in this population. Neuraxial techniques are the preferred anesthetic techniques for cesarean delivery in obese parturients but can be technically challenging.

Methods We present the successful anesthetic management of a super morbidly obese obstetric patient with BMI of 68.3 kg/m2 underwent cesarean section due to Cephalopelvic disproportion at 38 weeks gestation. A 36-year-old parturient, G2P0 with a history of spontaneous first trimester miscarriage and significant medical history of chronic arterial hypertension, limited mobility, obesity-related shortness of breath and fatigue that had been exacerbated by her pregnancy.

Results In the operating room after several failures to locate the epidural space with an 8 cm needle, we successfully located it at a depth of 9.5 cm using a 18 gauge 10 cm Tuohy needle, in the low lombar at an estimated L1-L2 interspace, but a 10 cm 24 gauge quincke neddle for the spinal block wasn’t enough. After the placement of the epidural catheter space, we successfully performed the spinal anesthesia at the L3-L4 interspace with a 12 cm 22 gauge and spinal hyperbaric bupivacaine 0.5% and sufentanyl was administer. The surgery was completed uneventfully. Postoperatively the patient was observed and a multimodal analgesia was satisfactorily provided. The patient was discharged home on postoperative day eight without complications.

Conclusions It is important to report these cases to support the development of new protocols and more adequate conducts for this population.

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