Anaesthetic management of obese parturients: what is the evidence supporting practice guidelines?

Eley, V. A., Van Zundert, A. A. J., Lipman, J. and Callaway, L. K. (2016) Anaesthetic management of obese parturients: what is the evidence supporting practice guidelines?. Anaesthesia and Intensive Care, 44 5: 552-559.

Author Eley, V. A.
Van Zundert, A. A. J.
Lipman, J.
Callaway, L. K.
Title Anaesthetic management of obese parturients: what is the evidence supporting practice guidelines?
Journal name Anaesthesia and Intensive Care   Check publisher's open access policy
ISSN 1448-0271
0310-057X
Publication date 2016-09-01
Sub-type Article (original research)
Open Access Status Not yet assessed
Volume 44
Issue 5
Start page 552
End page 559
Total pages 8
Place of publication North Sydney, NSW, Australia
Publisher Australian Society of Anaesthetists
Collection year 2017
Language eng
Subject 2700 Medicine
2706 Critical Care and Intensive Care Medicine
2703 Anesthesiology and Pain Medicine
Formatted abstract
Increasing rates of obesity in western populations present management difficulties for clinicians caring for obese pregnant women. Various governing bodies have published clinical guidelines for the care of obese parturients. These guidelines refer to two components of anaesthetic care: anaesthetic consultation in the antenatal period for women with a body mass index (BMI) ≥ 40 kg/m2 and the provision of early epidural analgesia in labour. These recommendations are based on the increased incidence of obstetric complications and the predicted risks and difficulties in providing anaesthetic care. The concept behind early epidural analgesia is logical—site the epidural early, use it for surgical anaesthesia and avoid general anaesthesia if surgery is required. Experts support this recommendation, but there is weak supporting evidence. It is known that the management of labour epidurals in obese women is complicated and that women with extreme obesity require higher rates of general anaesthesia. Anecdotally, anaesthetists view and apply the early epidural recommendation inconsistently and the acceptability of early epidural analgesia to pregnant women is variable. In this topic review, we critically appraise these two practice recommendations. The elements required for effective implementation in multidisciplinary maternity care are considered. We identify gaps in the current literature and suggest areas for future research. While prospective cohort studies addressing epidural extension ('top-up') in obese parturients would help inform practice, audit of local practice may better answer the question “is early epidural analgesia beneficial to obese women in my practice?”.
Keyword Epidural
Guidelines
Obesity
Obstetric anaesthesia
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

 
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