Complications of neuraxial anesthesia in an extreme morbidly obese patient for Cesarean section.
A morbidly obese patient presented for elective cesarean section. This case demonstrates the technical difficulties and potentially life-threatening complications encountered in attempting to locate an epidural space at a distance of over 11 cm from the skin. Ultrasound was used to aid in locating the space. The resources required and the logistical problems that impact on staff members in managing a morbidly obese patient presenting for cesarean section are also highlighted.
Whitty
R J
RJ
Department of Anesthesia and Pain Management, Mount Sinai Hospital, Toronto, Canada. robwhitty@rogers.com
Maxwell
C V
CV
Carvalho
J C A
JC
D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage; D000328:Adult; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000767:Anesthesia, Epidural / Q000379:methods*; D000773:Anesthesia, Obstetrical / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects; D002585:Cesarean Section / Q000379:methods*; D017558:Elective Surgical Procedures / Q000379:methods; D004562:Electrocardiography / Q000379:methods; D004824:Epidural Space / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D007022:Hypotension / Q000139:chemically induced* / Q000188:drug therapy; D017214:Laryngeal Masks; D008012:Lidocaine / Q000008:administration & dosage / Q000009:adverse effects; D008991:Monitoring, Physiologic / Q000379:methods; D009020:Morphine / Q000008:administration & dosage; D009767:Obesity, Morbid / Q000150:complications*; D010149:Postoperative Pain / Q000517:prevention & control; D010656:Phenylephrine / Q000008:administration & dosage; D011247:Pregnancy; D011248:Pregnancy Complications; D012307:Risk Factors; D014463:Ultrasonography
D000316:Adrenergic alpha-Agonists; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D010656:Phenylephrine; D009020:Morphine; D008012:Lidocaine; D002045:Bupivacaine