Obez obstetrik vakalarda nöroaksiyal anestezi ve analjezi uygulamaları

Nöroaksiyal rejyonal anestezi ve analjezi obez gebelerde tercih edilmekle beraber, normal kilolu ohstetrik olgulara kıyasla daha fazla teknik zorluk ve başarı oranında azalmayı da beraberinde getirir. Bu derlemede obezitenin giderek yaygınlaştığı günümüzde, karşılaşılan zorluklar özetlenmekle ve bunun için yeni teknolojilerin kullanılması anlatılmaktadır.

Neuraxial anesthesia and analgesia practices in obese obstetric cases

Neuroaxial regional anesthesia and analgesia, while preferred in obese parturients, is technically more difficult to establish and is associated with more failure when compared with lean parturients. In this review, difficulties encountered and their solution via new technologies is discussed.

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1. Cooper GM. McClure JH. Maternal deaths from anaesthesia. An extract from Why Mothers Die 2000-2002, lhe Confidential Enquiries inlo Maternal Deaths in the United Kingdom: Chapter 9: Anaesthesia. Br J Anaesth 2005;94(4):417-23.
2. Soon s MA, Bimbach DJ, Raııasinghe JS. van Zundert A. Obstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment. Acta Anaesthesiol Scand 2008:52(1):6-I9.
3. Bamgbade OA. Khalaf WM. Ajai O. Sharma R. Chidambaram V, Madhavan G. Obstetric anaesthesia outcome in obese and non-obese parturients undergoing caesarean delivery: an observational study, hit J Obstet Anesth 2009:l8(3):22l-5.
4. Butwiek A. Carvalho B. Danial C. Riley E. Retrospective analysis of anesthetic interventions for obese patients undergoing elective cesarean delivery. J Clin Anesth 20l0:22(7):5l9-26.
5. Chien I. Lu IC. Wang FY. Soo LY. Yu KL, Tang CS. Spinal process landmark as a predicting factor for difficult epidural block: a prospective sludy in Taiwanese patients. Kaohsiuııg J Med Sci 2003:19( 11 ):563-8.
6. Ellinas EH, Eastwood DC. Patcl SN. Maitra-D'Cruze AM, Eben TJ. The effeel of obesity on neuraxial technique difficulty in pregnant patients: a prospective, observational sludy. Anesth Analg 2009; 109(4): 1225-31.
7. Marroquin BM, Fecho K, Salo-Coombs V. Spielman FJ. Can pariurients identify the midline during neuraxial block placement? J Clin Anesth 2011;23( 1 ):3-6.
8. Sprung J. Boıırke DL. Grass J. Hanime I J, Mascha E, Thomas P, Tubin I. Predicting the difficult neuraxial block: a prospective study. Anesth Analg l999;89(2):384-9.
9. Whitty RJ. Maxwell CV. Carvalho JC. Complications of neuraxial anesthesia in an extreme morbidly obese patient for Cesarean section, hit J Obstet Anesth 2007; 16(2): 139-44.
10. Singh SP. Sagadai S. Epidural catheter markings and the morbidly obese, hit J Obstet Anesth 2010;19(3):350-1.
11. Balki M. Locating the epidural space in obstetric patients-ultrasound a useful tool: continuing professional development. Can J Anaesth 2010:57(12): 1111-26.
12. Friedman N. Fanning EL. Overweight and obesity: an overview of prevalence, clinical impact, and economic impact. Dis Manag 2004;7( Suppl l):SI-S6.
13. Soydan İ. Hipertansiyon ile ilgili TEKHARF çalışması verileri ve yorumu. In: Onat A, editor. Türk Erişkinlerde Kalp Sağlığı (TEKHARF). İstanbul: Argos iletişim;2003.
14. Tung A. Anaesthetic considerations with the metabolic syndrome. Br J Anaesth 2010:105 (Suppl l):i24-33.
15. Leith P. Sanborn R. Brock-Utne JG. Intraoperative epidural catheter malfunction in two obese patients. Acta Anaesthesiol Scand 1997:41(5):651-3.
16. Baron CM, Girling LG, Malhieson AL et al. Obstetrical and neonatal outcomes in obese parturients. J Matern Fetal Neonat Med 2010;23(8):906-13.
17. World Health Organization.Obesity and Overweight Facl Sheet No:311.Geneva. WHO. [Internet], url: http://who.int/mediacentre/ factsheets/fs3117en/print.html.
18. Lee CM. Huxley RR. Wildman RP. Woodward M. Indices of abdominal obesity are better discriminators of cardiovascular risk factors than BMI: a meta-analysis. J Clin Epidemiol 2008; 6l(7):646-53.
19. Duggleby SL. Jackson AA. Godfrey KM et al. Cut-off points for anthropometric indices of adiposity: differential classification in a large population of young women. Br J Nutr 2008:101(3):424-30.
20. Seidell JC. Flegal KM. Assessing obesity: classification and epidemiology. Br Med Bull !997;53(2):238-52.
21. Vallejo MC. Anesthetic management of the morbidly obese parturient. Curr Opin Anaesthesiol 2007;20(3): 175-80.
22. Rao DP. Rao VA. Morbidly obese parturient: Challenges for the anaesthesiologist, including managing the difficult airway in obstetrics. What is new? Indian J Anaesth 20I0;54(6):508-21.
23. Fıassanito L, Draisci G, Pinto R. Maviglia R. Maggiore SM. Successful application of helmet non-invasive ventilation in a parturient with acute respiratory distress syndrome. Minerva Anestesiol 2011:77(11): 1121-3.
24. Vasun RS. Cardiac function and obesity. Heart 2003;89( 10): 1127-9.
25. Kaufman I. Boııdy R, Benjamin A. Peripartum cardiomyopathy and thromboembolism; anesthetic management and clinical course of an obese, diabetic patient. Can J Anaesth 2003:50(2): 161-5.
26. Tsueda K. Debrand M, Zeok SS. Wright BD, Griffin WO. Obesity supine death syndrome: reports of two morbidly obese patients. Anesth Analg 1979;58(4):345-7.
27. Loubert C, Fernando R. Cesarean delivery in the obese parturient: anesthetic considerations. Women's Health (Lond Engl) 2011; 7(2): 163-79.
28. Munnur U. Suresh MS. Airway problems in pregnancy. Crit Care Clin 2004;20(4):617-42.
29. Hogan QH, Prost R. Kulier A. Taylor ML. Liu S. Mark L. Magnetic resonance imaging of cerebrospinal lluid volume and the influence of body habitus and abdominal pressure. Anesthesiology 1996: 84(6): 1341-9.
30. Wax JR. Risks and management of obesity in pregnancy: current controversies. Curr Opin Obstet Gynecol 2009:21 (2): 117-23.
31. Davics GA. Maxwell C. McLeod L et al. Obesity in Pregnancy. J Obstet Gynaecol Can 2010:32(2): 167-73.
32. Meiklejohn BH. Distance from skin to the lumbar epidural space in an obstetric population. Reg Anesth 1990:15(3): 134-6.
33. Watts RW. The influence of obesity on the relationship between body mass index and the distance to the epidural space from the skin. Anaesth Intensive Care I993:2I(3):309-10.
34. Shiroyama K. Izumi H. Kubo T. Nakamura R. Distance from the skin to the epidural space al the first lumbar interspace in a Japanese obstetric population. Hiroshima J Med Sci 2003:52(2):27-9.
35. Segal S, Beach M. Eappen S. A multivariate model to predict the distance from the skin to the epidural space in an obstetric population. Reg Anesth 1996;21 (5):451 -5.
36. Clinkscales CP. Greenfield ML, Vanarase M. Policy LS. An observational study of the relationship between lumbar epidural space depth and body mass index in Michigan parturients. Int J Obstet Anesth 2007;16(4):323-7.
37. Hamza J. Sınida M. Benhamou D. Cohen SE. Parturient's posture during epidural puncture affects the distance from skin to epidural space. J Clin Anesth I995:7( 1):1-4.
38. Balık JII, Kiın JH, Lee JS. Lee SC. Computed tomographic study of lumbar (L3-4) epidural depth and its relationship to physical measurements in young adult men. Reg Anesth Pain Med 1998:23(3):262-5.
39. Bahar M. Chanimov M. Cohen ML et al. The lateral recumbent head-down position decreases the incidence of epidural venous puncture during catheter insertion in obese parturients. Can J Anaesth 2004:51(6)377-80.
40. Margarido CB, Mikhael R, Arzola C. Balki M. Carvalho JC. The intercristal line determined by palpation is not a reliable anatomical landmark for neuraxial anesthesia. Can J Anaesth 2011;58(3):262-6.
41. Kettani A. Tachinante R. Tazi A. Evaluation of the iliac crest as anatomic landmark for spinal anaesthesia in pregnant women, Ann Fr Anesth Reanim 2006;25(3):50l-4.
42. Hood DD. Dewan DM. Anesthetic and obstetric outcome in morbidly obese parturients. Anesthesiology 1^93:79(61:1210-8.
43. Perlow JH, Morgan MA. Massive maternal obesity and perioperative cesarean morbidity. Am J Obstet Gynecol 1994;l70(2):560-5.
44. Bloom SL. Spong CY. Weiner SJ et al. Complications of anesthesia for cesarean delivery. Obstet Gynecol 2005; 106(2) :281-7.
45. Saravanakumar K, Rao SG. Cooper GM. Hie challenges of obesity mid obstetric anaesthesia. Curr Opin Obstet Gynecol 2006:18(6): 631-5.
46. Faheem M, Sarwar N. Sliding of the skin over subcutaneous tissue is another important factor in epidural calhetei migration. Can J Anesth 2002;49(6):634.
47. Kuczkowski K. Benumof J. Repeat cesarean section in a morbidly obese parturient: a new anesthetic option. Acta Anaesthesiol Scand 2002;46(6):753-4.
48. Corfe J. Length of spinal needles. Anaesthesia. 2008:63(4):444-5.
49. Greenway MW. Vickers R. Broken micro-tip spinal needle. Int J Obstet Anesth 2009:18(3)295-6.
50. Reyes M. Pan PH. Very low-dose spinal anesthesia for cesarean section in a morbidly obese preeclamptic patient and its potential implications. Int J Obstet Anesth 2004; 13(2):99-102.
51. Lim Y, Loo C. Goh E. Ultra low dose combined spinal and epidural anesthesia for cesarean section. Int J Obstet Anesth 2004:13(3): 198-200.
52. Carvalho B. Collins J. Drover DR. Atkinson Ralls L. Riley ET. ED(50) and ED(95) of intrathecal bupivacaine in morbidly obese patients undergoing cesarean delivery. Anesthesiology 2011; 114(3):529-35.
53. Lee Y. Balki M. Parkes R, Carvalho JC. Dose requirement of intrathecal bupivacaine for cesarean delivery is similar in obese and normal weighl women. Rev Bras Anestesiol 2009:59(6):674-83.
54. Palmer CM. Let's just call it "evidence-based practice". Anesthesiology 2011:114(3):481-2.
55. Faurc E, Moreno R. Thisted R. Incidence of posulural puncture headache in morbidly obese parturients. Reg Anesth 1994; l9(5):36l-3.
56. Grau T. Leipold RW, Horter J. Conradi R. Martin E. Motsch J. The lumbar epidural space in pregnancy: visualization by ultrasonography. Br J Anaesth 200l:86(6):798-804.
57. Yıldız TŞ. Balaban O, Şahin B, Solak M. Toker K.. Gebede loınber ultrasonogram eşliğinde subaraknoid blok. Anestezi Dergisi 2011; 19(4): 224-7.
58. Karmakar MK. Ultrasound for central neuraxial blocks. Techniques in Regional Anesthesia and Pain Management 2009:13:161-70.
59. Carvalho JC. Ultrasound-facilitated epidurals and spinals in obstetrics. Pain 2008:26(1): 145-58.
60. Kathirgainanathan T. Ultrasound technique for neuraxial procedures. Br J Anaesth 2(K)8:100(6):860.
61. Belavy D. Ruitenberg MJ. Brijball RB. Feasibility study of real-time three- / four-dimensional ultrasound for epidural catheter insertion. Br J Anaesth 201 l ;l07(3):438-45.
62. Chiang UK. Zhou Q. Mandell MS et al. Eyes in the Needle: novel epidural needle with embedded high-frequency ultrasound transducer-epidural access in porcine model. Anesthesiology 201 l;l 14(6): 1320-4.
63. Tsen LC. The all-seeing eye? Ultrasound technologies lor neuraxial techniques. Anesthesiology 2011;114(6): 1274-6.
64. Grau T, Leipold RW. Conradi R. Martin E. Ultrasound control for presumed difficult epidural puncture. Acta Anaesth Scand 200l;45(6):766-71.
65. Balki M, Lee Y, Halpern S. Carvalho JC. Ultrasound imaging of the lumbar spine in the transverse plane: the correlation between estimated and actual depth to the epidural space in obese parturients. Anesth Analg 2009; 108(6): 1876-81.
66. Schlotterbeck H. Schaeffer R. Dow W. Touret Y. Bailey S. Diemunsch P. Ultrasonographic control of the puncture level for lumbar neuraxial block in obstetric anaesthesia. Br J Anaesth 2008;100(2):230-4.