Anesthesia for obese obstetric patients

Pregnancy is a unique physiological state reflecting significant deviations from normal physiology, requiring particular attention from the anesthesiologist. Furthermore, the anesthesiologist must consider both maternal and fetal well being when selecting and executing the anesthetic approach. Obesity is a major independent risk factor for anesthetic complications. All body systems are affected by obesity and pregnancy, but, along with the obvious effect of the enlarged uterus and presence of a placenta and fetus, the most affected systems are the respiratory system, cardiovascular system and gastrointestinal tract. The combination of these two states mandates the anesthesiologist to be aware of the unique properties of these patients and the impending complications. Successful treatment of the obese pregnant patient entails seamless teamwork between midwives and the nursing staff, obstetricians and anesthesiologists. Anticipation of cardiovascular and respiratory compromises allows the anesthesiologist to readily prepare, and take actions to avoid or minimize the consequences. This chapter reviews the major physiological alterations relevant to anesthesia, discusses morbidity linked to obesity and pregnancy, and suggests practical anesthetic approaches to different situations, based on current guidelines and consensus recommendations.