Novel approaches facilitating neuraxial anesthesia placement in pregnant women with morbid obesity: case descriptions.

Autor: Kodali BS; University of Maryland School of Medicine, Baltimore, MD, United States. Electronic address: bkodali@som.umaryland.edu., Zheng A; University of Maryland School of Medicine, Baltimore, MD, United States., Alton S; University of Maryland School of Medicine, Baltimore, MD, United States., Frampton K; University of Maryland School of Medicine, Baltimore, MD, United States., Bharadwaj S; University of Maryland School of Medicine, Baltimore, MD, United States., Galey J; University of Maryland School of Medicine, Baltimore, MD, United States.
Jazyk: angličtina
Zdroj: International journal of obstetric anesthesia [Int J Obstet Anesth] 2024 Nov; Vol. 60, pp. 104257. Date of Electronic Publication: 2024 Aug 24.
DOI: 10.1016/j.ijoa.2024.104257
Abstrakt: Clinical management of pregnant women with morbid obesity poses challenges in performing neuraxial anesthesia as well as positioning for cesarean delivery. Occupational injuries are also known to occur while caring for patients with morbid obesity. We describe two novel approaches to assist neuraxial anesthesia administration and positioning for cesarean delivery. With the assistance of the Institution's Safe Patient Handling and Mobility Team, a universal high-back sling can be placed to lift the patient into a sitting position before neuraxial anesthesia procedure. After placement of combined spinal epidural anesthesia, the ceiling lift is used to lift the patient into a seated position and then rotate to the appropriate location on the operating room table to facilitate supine positioning. The lifting system reduces shearing of the patient's posterior and compromising the epidural site. Team members also report reduced effort required when positioning patients from seated to supine on the operating room table. The second approach is the application of Traxi TM abdominal pannus retractor to retract fat folds encroaching on the epidural placement site in pregnant women with morbid obesity. This is particularly useful when the traditional taping of fat folds away from the site is inadequate. The pannus retractor results in a flatter surface facilitating epidural placement. We have introduced these two approaches into our clinical practice for pregnant women with morbid obesity requiring cesarean delivery under neuraxial anesthesia.
(Copyright © 2024 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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