Anesthetic Management of a Morbidly Obese Parturient for Cesarean Section / 대한마취과학회지

ABSTRACT

An obese parturient can pose considerable physiologic and technical chalenges to an anesthesiologist. The combined pulmonary changes of pregnancy and obesity commonly make for hypoventilation & hypoxemia because they have both a reduced functional residual capacity and an increased oxygen consumption. The cardiovascular system is also stressed by obesity and pregnancy; both conditions contribute to increased cardiac work. Hypotension is frequently associated with spinal anesthesia because of aortocaval compression by the enlarged uterus and sympathetic blockade. In general anesthesia, obesity is an important risk factor for difficult intubation. Pulmonary aspiration of gastric contents is another significant risk of general anesthesia. Obese parturients are at high risk for developing hypoxia during the induction of anesthesia. We successfully managed the first Cesarean section of a morbidly obese parturient (25 years old, BMI = 54.19 kg/m2) with pregnancy induced hypertension using spinal anesthesia. Then, 1 year later we also successfully managed the second Cesarean section in the same patient (26 years old, BMI = 54.95 kg/m2) using general anesthesia. We restress the importance of anesthetic management of morbidly obese parturients in this case report.