Obez ve morbid obez gebelerde obstetrik anestezi

Öz

Obezite tüm dünyada gün geçtikçe artan önemli bir  toplum sağlık sorunu haline gelmiştir.  Anestezi pratiğimizde bu hasta grubu ile karşılaşma sıklığımız artmaktadır. Obezitenin beraberinde kendine ait bazı problemleri getirdiği düşünülürse, bu problemlerin obez bir gebede daha sık ve ciddi olacağı aşikardır. Obezite, gebelikte maternal ve fetal komplikasyonları artırmaktadır. Sezeryan, diabet, hipertansiyon ve preeklampsi, postpartum enfeksiyon, tromboembolizm riski bu problemlerden sadece birkaçını oluşturmaktadır. Obezite ve gebelikle birlikte ortaya çıkan fizyolojik değişikler ve  bunların morbidite ile ilişkilerinin  bilinmesi obez bir gebeye anestezik yaklaşımımızın planlanmasında yardımcı olacaktır.

ANAHTAR KELİMELER : Obezite, gebelik, anestezi, analjezi, komplikasyon, morbidite

Anahtar Kelimeler

• obezite, gebelik, anestezi, analjezi, komplikasyon, morbidite

Obstetric anestesia in pregnants with obesity and morbid obesity

Abstract

Obesity is a major public health problem all over the world increasing day by day. The prevalence of  encounter with this patient group is increasing in our anesthesia practice. When  we think that obesity  brings some of  problems with it, it is obvious that these problems may be more frequent and severe health problems in an obese pregnant woman.  Obesity increases maternal and fetal complications in pregnancy.  Cesarean section, diabetes, hypertension and pre-eclampsia, postpartum infection, the risk of thromboembolism are just a few of these problems. Knowing the physiologic changes in obesity and pregnancy and also their relaitons with the morbidity  will all help in planning of the anesthetic approach.

Keywords: Obesity, pregnancy, anesthesia, analgesia, complication, morbidity

Keywords

• Obesity, pregnancy, anesthesia, analgesia, complication, morbidity.

Kaynakça

1. CIO Foundation. General Overweight and Obesity Statistics. http://www.ciofoundation.org/overweight.html. [ 2009 Dec 26].
2. Sellmann S. An effective solution to the obesity epidemic. Nexus Mag 2010;17:4.
3. Rasmussen K, Yaktine A: Weight gain during pregnancy: Reexamining the guidelines (Free executive summary). Washington, DC, National Academy of Sciences, 2009. http://www.nap.edu/catalog/12584.html. Accessed June 9, 2011
4. Roofthooft E. Anesthesia for the morbidly obese parturient. Curr Opin Anaesthesiol 2009; 22:341-.S46.
5. Gupta A., Faber P. Obesity in pregnancy Continuing Education in Anaesthesia, Critical Care & Pain 2011; 11(4).
6. Robinson HE, O’Conell CM, Joseph KS. Maternal outcomes in pregnancy complicated by obesity. Obstet Gynecol 2005; 106: 1357–64.
7. Weiss JL, Malone FD, Emig D. Obesity, obstetric complications and cesarean delivery rate – A populationbased screening study. Am J Obstet Gynecol 2004; 190: 1091–7.
8. Bongain A, Isnard V, Gillet JY. Obesity in obstetrics and gynaecology. Eur J Obstet Gynecol Reprod Biol 1998; 77: 217–28

9. Watkins MI, Rasmussen SA, Honein MA. Maternal obesity and risk for birth defects. Pediatrics 2003; 111: 1152–8.
10. Murphy PG, Adams JP. The pathophysiology of obesity and its implications for anesthesia Foundations of Anesthesia: Basic Sciences for Clinical Practice second edn: Elsevier Mosby, 2006; Chap 71, 855-867
11. Soens MA, Birnbach DJ, Jayanthie S. Obstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment. Acta Anaesthesiol Scand 2008; 52: 6–19
12. Eng M, Butler J, Bonica JJ. Respiratory function in pregnant obese women. Am J Obstet Gynecol 1975; 123: 241–5.
13. Anesthesia Considerations in the Obese Gravida Terry Tan, Alex T. Sia Semin Perinatol 35:350-355 2011
14. Unterborn J. Pulmonary function testing in obesity, pregnancy, and extremes of body habitus. Clin Chest Med 2001; 22: 759–67.
15. Saravanakumar K, Rao SG, Cooper GM. Obesity and obstetric anesthesia. Anaesthesia 2006; 61: 36–48.
16. Oberg B, Poulsen TD. Obesity: an anaesthetic challenge. Acta Anaesthesiol Scand 1996; 40: 191–200.
17. Rao DP, Rao VA. Obese parturient challenges for the anaesthesiologist. Indian Journal of Anaesthesia 2010; 54(6).
18. Dempsey JA, Reddan W, Rankin J et al. Alveolar arterial gas exchange during muscle work in obesity. J Appl Physiol 1966; 21: 1807–14.
19. Parish JM, Somers VK. Obstructive sleep apnea and cardiovascular disease. Mayo Clin Proc 2004; 79: 1036–46.
20. Roush SF, Bell L. Obstructive sleep apnea in pregnancy. J Am Board Fam Pract 2004; 17: 292–4.
21. Veille JC, Hanson R. Obesity, pregnancy, and left ventricular functioning during the third trimester. Am J Obstet Gynecol 1994; 171: 980–3.
22. Tomoda S, Tamura T, Sudo Y et al. Effects of obesity on pregnant women: maternal hemodynamic change. Am J Perinat 1996; 13: 73–8.
23. Tseuda K, Debrand M, Zeok S et al. Obesity supine sudden death syndrome: report of two morbidly obese patients. Anesth Analg 1979; 58: 345–7.
24. Drennick EJ, Fisler JS. Sudden cardiac arrest in morbidly obese surgical patients unexplained after autopsy. Am J Surg 1988; 155: 720–6.
25. Wong CA, Loffredi M, Ganchiff JN, Zhao J, Wang Z, Avram MJ.Gastric emptying of water in term pregnancy. Anaesthesiology 2002;96:1395-400.
26. Mendelson CL. The aspiration of stomach contents into the lungs during obstetric anesthesia. Am J Obstet Gynaecol 1945; 52: 191–204.
27. D’Angelo R, Dewan DD. Obesity In Obstetric anesthesia: principles and practice, 3rd edn. Philadelphia: Elsevier Mosby, 2004: 893–903.
28. Mace HS, Paecht MJ, Mcdonnellt NJ. Obesity and obstetric anaesthesia. Anaesth Intensive Care 2011; 39: 5.59-570
29. Elbourne D, Wiseman RA. Types of intra-muscular opioids for maternal pain relief in labour. Cochrane Database Syst Rev 2:CD001237, 2000
30. Hood DD, Dewan DM: Anesthetic and obstetric outcome in morbidly obese parturients. Anesthesiology 79:1210-1218, 1993
31. Lee S, Lew E, Lim Y. Failure of augmentation of labor epidural analgesia for intrapartum cesarean delivery: A retrospective review. Anesth Analg 108:252-254, 2009
32. Norris MC: Are combined spinal-epidural catheters reliable? Int J Obstet Anesth 9:3-6, 2000
33. Faure E, Moreno R, Thisted R. Incidence of postdural puncture headache in morbidly obese parturients. Reg Anesth 1994; 19: 361–3.
34. Hamza J, Smida M, Benhamou D. Parturient’s posture during epidural puncture affects the distance from skin to epidural space. J Clin Anesth 1995; 7: 1–4.
35. Bahk JH, Kim JH, Lee JS. Computed tomography study of the lumbar (L3–4) epidural depth and its relationship to physical measurements in young adult men. Reg Anesth Pain Med 1998; 23: 262–5.
36. Watts RW. The influence of obesity on the relationship between body mass index and the distance to the epidural space from the skin. Anaesth Intens Care 1993; 21: 309–10.
37. Hamilton CL, Riley ET, Cohen SE: Changes in the position of epidural catheters associated with patient movement. Anesthesiology 86:778- 784; discussion: 29A, 1997
38. O’Sullivan GM, Guyton TS. Aspiration: risk, prophylaxis, and treatment. In: Chestnut DH, editor. Obstetric anesthesia. Principles and practice. 3rd ed. Philadelphia: Elsevier Mosby; 2004. p. 523-34.
39. Rocke DA, Murray WB, Route CC. Relative risk analysis of factors associated with difficult intubation in obestric anesthesia. Anesthesiology 1992; 77: 67–73.
40. Brodsky JB, Lemmens HJM, Brock-Utne JG. Morbid obesity and tracheal intubation. Anesth Analg 2002; 94: 732–6.
41. Rao DP, Rao VA. Morbidly obese parturient challenges for the anaesthesiologist, including managing the difficult airway in obstetrics. What is new? Indian Journal of Anaesthesia | 2010; 54(6).
42. Dixon BJ, Dixon JB, Carden JR. Preoxygenation is more effective in the 25 degrees head-up position than in the supine position in severely obese patients: a randomized controlled study. Anesthesiology 2005; 102: 1110–5
43. Collins JS, Lemmens HJ, Brodsky JB. Laryngoscopy and morbid obesity: a comparison of the ‘sniff’ and ‘ramped’ positions. Obes Surg 2004; 14: 1171–5.
44. von Ungern-Sternberg BS, Regli A, Bucher E. Impact of spinal anaesthesia and obesity on maternal respiratory function during elective Caesarean section. Anaesthesia 2004; 59: 743–9.
45. Ballantyne JC, Carr DB, deFerranti S. The Comparative effetcs of postoperative analgesic therapies on pulmonary outcome: cumulative meta-analysis of randomized,controlled trials. Anesth Analg 1998; 86: 598–612.
46. Perlow JH. Morgan MA. Massive maternal obesity and perioperative cesarean morbidity. Am J Obstet Gynecol 1994; 170:560-565.
47. Michota F, Merli G. Anticoagulation in special patient populations: are special dosing considerations required? Clev Clin J Med 2005; 72 (Suppl. 1): S37–42.
48. Horlocker TT, Wedel DJ, Benzon H. Regional anesthesia in the anticoagulated patient: defining the risks Reg Anest Pain Med 2003; 28: 172–97. January/February 2010; 35 : 64-101