2021, Number 4
Self-identification of the waist - useful in the location of the puncture site in neuroaxial anesthesia of obstetric patient with class III obesity
PDF size: 389.12 Kb.
ABSTRACTThe neuraxial anesthetic technique in the obese class III, pregnant patient, can represent a challenge for the anesthesiologist, due to the difficulty in recognizing the anatomical landmarks. The objective of the study was to determine the difficulty and quality of combined spinal/epidural anesthesia, in 14 pregnant patients with a body mass index ≥ 40 kg/m2 scheduled for cesarean section. For the location of the puncture site, self-identification of the waist was used, a methodology that has not been previously reported. The patients straddled the surgical table, pointing to her waist with both hands. Two lines were drawn on the back. A horizontal line at the waist, indicated by the patient, and a vertical line corresponding to the midline. The intersection of the two lines was the coordinate for the neuraxial puncture. The mean ± SD of the body mass index was 47.5 ± 3.7 kg/m2. A first level success rate of 92.8% was determined, 57.1% of the patients received one puncture, and the average of punctures was 1.5. Spinal/epidural anesthesia failed in two cases, a change from anesthetic technique to epidural and supplementation with infiltration was performed, with adequate analgesia. It was not necessary to convert to general anesthesia in any case. Self-identification of the waist and coordinate marking can be a clinical aid for the identification of the lumbar puncture site, during the installation of neuraxial anesthesia, in obstetric patients with class III obesity, scheduled for cesarean section.
CMACE Centre for Maternal and Child Enquirires, RCOG Royal College of Obstetricians and Gynaecologists. CMACE/RCOG Joint Guideline. Management of women with obesity in pregnancy [Internet]. 2010. Available from: https://www.oaa-anaes.ac.uk/assets/_managed/editor/File/Reports/2010_CMACE-RCOG_guideline_obesity_in_pregnancy.pdf
Lamon A, Habib A. Managing anesthesia for cesarean section in obese patients: current perspectives. Local Reg Anesth [Internet]. 2016 [cited 2020 Aug 6];9:45-57. Available from: https://www.dovepress.com/managing-anesthesia-nbspfor-cesarean-section-in-obese-patients-current-peer-reviewed-article-LRA
Secretaría de Salud, Instituto Nacional de Salud Pública, Instituto Nacional de Estadística y Geografía. Encuesta Nacional de Salud y Nutrición ENSANUT 2018. Presentación de resultados [Internet]. 2019 [citado 7 de agosto de 2020]. Disponible en: https://ensanut.insp.mx/encuestas/ensanut2018/doctos/informes/ensanut_2018_presentacion_resultados.pdf