Hood D D, Dewan D M
Department of Anesthesia, Wake Forest University Medical Center, Winston-Salem, North Carolina 27157-1009.
Anesthesiology. 1993 Dec;79(6):1210-8. doi: 10.1097/00000542-199312000-00011.
Large studies reporting anesthetic outcome for morbidly obese parturients are lacking. This study compares the anesthetic and obstetric outcome in morbidly obese parturients and matched control parturients.
Anesthesia records were prospectively collected for all patients delivering between September 1978 and November 1989 whose weight exceeded 136.4 kg (300 pounds) at the time of delivery. A retrospective control patient group was collected by matching the first patient weighing less than 136.4 kg, delivered in the same month by the same obstertrician, to the corresponding morbidly obese parturient. Anesthetic and obstetric outcome variables were extracted from medical records and analyzed.
Sixty-two percent of 117 morbidly obese women underwent cesarean section, while only 24% of control patients delivered abdominally (P < 0.05). Forty-eight percent of all laboring morbidly obese parturients required emergency cesarean section, compared with 9% of control laboring parturients (P < 0.05). Epidural anesthesia was used successfully for labor and cesarean delivery in 74 of 79 morbidly obese women and 66 of 67 control patients. When compared with control patients, initial epidural anesthesia failure was significantly more likely in morbidly obese women, requiring epidural catheter replacement. Difficult tracheal intubation occurred in 6 of 17 morbidly obese women, compared with 0 of 8 control women (P = 0.06). Morbidly obese women had increased incidences of antepartum medical disease, prolonged cesarean section operation times, serious postoperative complications, and increased hospital stays.
The high incidences of antepartum medical disease and emergency cesarean section complicate anesthetic care in the morbidly obese parturients. Epidural anesthesia is feasible; however, the high initial failure rate necessitates early catheter placement, critical block assessment and catheter replacement when indicated, and provision for alternative airway management.
缺乏关于病态肥胖产妇麻醉结局的大型研究。本研究比较了病态肥胖产妇与匹配的对照产妇的麻醉和产科结局。
前瞻性收集了1978年9月至1989年11月间所有分娩时体重超过136.4千克（300磅）的患者的麻醉记录。通过将同月由同一位产科医生接生的体重小于136.4千克的首位患者与相应的病态肥胖产妇进行匹配，收集了一组回顾性对照患者。从病历中提取并分析麻醉和产科结局变量。
117例病态肥胖女性中有62%接受了剖宫产，而对照患者中只有24%经腹分娩（P<0.05）。所有分娩的病态肥胖产妇中有48%需要紧急剖宫产，而对照分娩产妇中这一比例为9%（P<0.05）。79例病态肥胖女性中的74例以及67例对照患者中的66例成功使用硬膜外麻醉进行分娩和剖宫产。与对照患者相比，病态肥胖女性硬膜外麻醉初次失败的可能性显著更高，需要更换硬膜外导管。17例病态肥胖女性中有6例发生困难气管插管，而8例对照女性中无1例发生（P=0.06）。病态肥胖女性产前内科疾病发生率增加、剖宫产手术时间延长、术后严重并发症增多以及住院时间延长。
产前内科疾病和紧急剖宫产的高发生率使病态肥胖产妇的麻醉护理变得复杂。硬膜外麻醉是可行的；然而，高初次失败率需要早期放置导管、关键阻滞评估以及在必要时更换导管，并做好替代气道管理的准备。
