title: The anesthetic approach to operative delivery of the extremely obese parturient.
abstract: Extreme obesity (BMI ≥ 40) is thought to complicate approximately 5% of deliveries in the United States. Extreme obesity puts a pregnant woman at an increased risk for cardiovascular disease, including hypertension, coronary artery disease, and congestive heart failure; respiratory disease, including obstructive sleep apnea and asthma; as well as pregnancy-specific diseases including pregnancy-induced hypertension and gestational diabetes. Extreme obesity also puts a parturient at a significantly increased risk of requiring cesarean delivery. For the anesthesiologist, the physiologic changes of obesity combined with the normal physiologic changes of pregnancy can make for a complex and challenging case. This review will focus on the anesthetic approach to the extremely obese parturient undergoing scheduled operative delivery. With proper planning and a detailed understanding of the patient's comorbidities, a safe and effective anesthetic can be achieved.
authors.affiliation: Division of Obstetric Anesthesiology, Department of Anesthesiology, Columbia University Medical Center/New York Presbyterian Hospital, 630 W 168th St, Room 12-402, New York, NY 10032. Electronic address: ler20@cumc.columbia.edu.
authors.forename: Laurence E
authors.initials: LE
authors.lastname: Ring
mesh_terms: D000328:Adult; D000773:Anesthesia, Obstetrical / Q000379:methods*; D015992:Body Mass Index; D036861:Delivery, Obstetric / Q000379:methods*; D005260:Female; D006801:Humans; D009765:Obesity / Q000150:complications*; D011247:Pregnancy; D011248:Pregnancy Complications / Q000209:etiology*
keywords: anesthesiology; cesarean delivery; high risk obstetrics; obesity; pregnancy