Soens Mieke A, Birnbach David J, Ranasinghe Jayanthie S, van Zundert André
Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson Memorial Hospital, Miami, FL 33136, USA.
Acta Anaesthesiol Scand. 2008 Jan;52(1):6-19. doi: 10.1111/j.1399-6576.2007.01483.x.
The incidence of obesity has been dramatically increasing across the globe. Anesthesiologists, are increasingly faced with the care for these patients. Obesity in the pregnant woman is associated with a broad spectrum of problems, including dramatically increased risk for cesarean delivery, diabetes, hypertension and pre-eclampsia. A thorough understanding of the physiology, associated conditions and morbidity, available options for anesthesia and possible complications is therefore important for today's anesthesiologist.
This is a personal review in which different aspects of obesity in the pregnant woman, that are relevant to the anesthesiologist, are discussed. An overview of maternal and fetal morbidity and physiologic changes associated with pregnancy and obesity is provided and different options for labor analgesia, the anesthetic management for cesarean delivery and potential post-partum complications are discussed in detail.
The anesthetic management of the morbidly obese parturient is associated with special hazards. The risk for difficult or failed intubation is exceedingly high. The early placement of an epidural or intrathecal catheter may overcome the need for general anesthesia, however, the high initial failure rate necessitates critical block assessment and catheter replacement when indicated.
全球肥胖症的发病率一直在急剧上升。麻醉医生越来越多地面临着对这些患者的护理工作。孕妇肥胖与一系列广泛的问题相关，包括剖宫产、糖尿病、高血压和先兆子痫的风险大幅增加。因此，对于当今的麻醉医生来说，全面了解肥胖孕妇的生理学、相关病症和发病率、可用的麻醉选择以及可能的并发症非常重要。
这是一篇个人综述，讨论了与麻醉医生相关的肥胖孕妇的不同方面。概述了与妊娠和肥胖相关的母婴发病率及生理变化，并详细讨论了分娩镇痛的不同选择、剖宫产的麻醉管理及潜在的产后并发症。
病态肥胖产妇的麻醉管理存在特殊风险。困难插管或插管失败的风险极高。早期放置硬膜外或鞘内导管可能无需全身麻醉，然而，由于初始失败率高，必要时需要进行严格的阻滞评估并更换导管。
