title: Obstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Perioperative Medicine and Pain Management, Jackson Memorial Hospital, Miami, FL 33136, USA.
authors.forename: Mieke A
authors.initials: MA
authors.lastname: Soens
authors.forename: David J
authors.initials: DJ
authors.lastname: Birnbach
authors.forename: Jayanthie S
authors.initials: JS
authors.lastname: Ranasinghe
authors.forename: André
authors.initials: A
authors.lastname: van Zundert
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D000773:Anesthesia, Obstetrical / Q000009:adverse effects / Q000379:methods*; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods; D002585:Cesarean Section; D045422:Continuous Positive Airway Pressure; D016757:Death, Sudden, Cardiac / Q000209:etiology / Q000517:prevention & control; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology; D005260:Female; D005315:Fetal Diseases / Q000517:prevention & control; D006439:Hemodynamics; D006801:Humans; D009765:Obesity / Q000503:physiopathology*; D009767:Obesity, Morbid / Q000503:physiopathology; D007744:Obstetric Labor Complications / Q000503:physiopathology; D011183:Postoperative Complications / Q000517:prevention & control; D011247:Pregnancy; D011248:Pregnancy Complications / Q000503:physiopathology*; D011644:Puerperal Disorders / Q000517:prevention & control; D053120:Respiratory Aspiration / Q000517:prevention & control; D015656:Respiratory Mechanics; D012306:Risk