medigraphic.com

2021, Number 4

<< Back Next >>

Rev Mex Anest 2021; 44 (4)

Self-identification of the waist - useful in the location of the puncture site in neuroaxial anesthesia of obstetric patient with class III obesity

Gaona-Ramírez MI

Language: Spanish
References: 39
Page: 250-257
PDF size: 389.12 Kb.


ABSTRACT

The 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.


REFERENCES

  1. NICE National Institute for Health and Care Excellence. Obesity: identification, assessment and management. Clinical guideline CG189 [Internet]. 2014. Available from: https://www.nice.org.uk/guidance/cg189

  2. ACOG Practice Bulletin No 156: obesity in pregnancy. Obstet Gynecol. 2015;126:e112-e126.

  3. 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

  4. Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology. 2016;124:270-300.

  5. Nazar C, Bastidas J, Zamora M, Lacassie H. Obesidad y embarazo: implicaciones anestésicas. Rev Chil Obs Ginecol. 2014;79:537-545.

  6. Ellinas E, Eastwood D, Patel S, Maitra-D'Cuze A, Ebert T. The effect of obesity on neuraxial technique difficulty in pregnant patients: a prospective, observational study. Anesth Analg. 2009;109:1225-1231.

  7. Sprung J, Bourke D, Grass J, Hammel J, Mascha E, Thomas P, et al. Predicting the difficult neuraxial block: a prospective study. Anesth Analg. 1999;89:384-389.

  8. 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. Int J Obstet Anesth. 2009;18:221-225.

  9. Rodrigues FR, Brandao MJ. Regional anesthesia for cesarean section in obese pregnant women: a retrospective study. Rev Bras Anestesiol. 2011;61:13-20.

  10. Kula AO, Riess ML, Ellinas EH. Increasing body mass index predicts increasing difficulty, failure rate, and time to discovery of failure of epidural anesthesia in laboring patients. J Clin Anesth. 2017;37:154-158.

  11. Palencia M, Guasch E, Navas D, Gisanz F. Difficulty of epidural puncture for obstetric analgesia: risk factors. Rev Esp Anestesiol Reanim. 2006;53:139-144.

  12. 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

  13. Wills J, Bowie R, Bogod D. A pilot study of patient-led identification of the midline of the lumbar spine. Anaesthesia. 2002;57:390-394.

  14. Maitra A, Palmer S, Bachhuber S, Abram S. Continuous epidural analgesia for cesarean section in a patient with morbid obesity. Anesth Analg. 1979;58:348-349.

  15. Ranasinghe J, Davidson E, Birnbach D. Combined spinal-epidural anesthesia [Internet]. NYSORA - The New York School of Regional Anesthesia. [cited 2020 Aug 8]. Available from: https://www.nysora.com/regional-anesthesia-for-specific-surgical-procedures/abdomen/combined-spinal-epidural-anesthesia/

  16. Ross R, Neeland I, Yamashita S, Shai I, Seidell J, Magni P, et al. Waist circumference as a vital sign in clinical practice: a consensus statement from the IAS and ICCR working group on visceral obesity. Nat Rev Endocrinol. 2020;16:177-189.

  17. WHO World Health Organization. Physical status: the use and interpretation of anthropometry: report of a WHO Expert Committee. Geneva, Switzerland: WHO; 1995.

  18. NHLBI Obesity Education Initiative. The practical guide to the identification, evaluation and treatment of overweight and obesity in adults [Internet]. 2000. Available from: https://www.nature.com/articles/s41574-019-0310-7

  19. Spencer E, Roddam A, Key T. Accuracy of self-reported waist and hip measurements in 4492 EPIC-Oxford participants. Public Health Nutr. 2004;7:723-727.

  20. Secretaría de Salud. Norma Oficial Mexicana NOM-006-SSA3-2011 Para la práctica de la anestesiología. México; 2012.

  21. Secretaría de Salud. Norma Oficial Mexicana NOM-004-SSA3-2012 del expediente clínico. 2012.

  22. IMSS Dirección de Prestaciones Médicas. Procedimiento para la planeación, programación, atención pre-operatoria, trans-operatoria y post-operatoria en las Unidades Médicas Hospitalarias de tercer nivel de atención 2430-003-006. México; 2012.

  23. Moore P, Gómez G, Kurtz S, Vargas A. La comunicación médico - paciente: ¿Cuáles son las habilidades efectivas? Rev Med Chile. 2010;138:1047-1054.

  24. Taylor C, Dominguez J, Habib A. Obesity and obstetric anesthesia: Current insights. Local Reg Anesth. 2019;12:111-1124.

  25. Vaswani PR, Balachandran L. Pregnancy outcomes in a population with high prevalence of obesity: how bad is it? Clin Epidemiol Glob Heal [Internet]. 2013;1:5-11. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2213398412000103

  26. Chu S, Kim S, Schmid C, Dietz P, Callaghan W, Lau J, et al. Maternal obesity and risk of cesarean delivery: A meta-analysis. Obes Rev. 2007;8:385-394.

  27. Fisher K, Arnholt A, Douglas M, Vandiver S, Nguyen D. A randomized trial of the traditional sitting position versus the hamstring stretch position for labor epidural needle placement. Anesth Analg. 2009;109:532-534.

  28. Afolayan JM, Areo PO, Adegun PT, Ogundipe KO, Filani AB. Comparison of ease of induction of spinal anaesthesia in sitting with legs parallel on the table versus traditional sitting position. Pan Afr Med J. 2017;28:223.

  29. de Vignemont F. Body schema and body image--pros and cons. Neuropsychologia. 2010;48:669-680.

  30. Morasso P, Casadio M, Mohan V, Rea F, Zenzeri J. Revisiting the body-schema concept in the context of whole-body postural-focal dynamics. Front Hum Neurosci. 2015;9:83.

  31. Cooperstein R, Truong F. Systematic review and meta-analyses of the difference between the spinal level of the palpated and imaged iliac crests. J Can Chiropr Assoc. 2019;63:26-35.

  32. Cooperstein R, Truong F. Would adopting a revised landmark rule for the spinal level of the iliac crests improve the accuracy of lumbar level identification? J Can Chiropr Assoc. 2017;61:106-120.

  33. Sahin T, Balaban O, Sahin L, Solak M, Toker K. A randomized controlled trial of preinsertion ultrasound guidance for spinal anesthesia in pregnancy: outcomes among obese and lean parturients: ultrasound for spinal anesthesia in pregnancy. J Anesth. 2014;28:413-419.

  34. Sahin T, Balaban O. Lumbar ultrasonography for obstetric neuraxial blocks: sonoanatomy and literature review. Turk J Anaesthesiol Reanim. 2018;46:257-267.

  35. 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

  36. Choi J, Germond L, Santos A. Obstetric Regional Anesthesia [Internet]. NYSORA - The New York School of Regional Anesthesia. [cited 2020 Aug 18]. Available from: https://www.nysora.com/foundations-of-regional-anesthesia/sub-specialties/obstetric/obstetric-regional-anesthesia/

  37. Faure E, Moreno R, Thisted R. Incidence of postdural puncture headache in morbidly obese parturients. Reg Anesth. 1994;19:361-363.

  38. Loubert C, Fernando R. Cesarean delivery in the obese parturient: anesthetic considerations. Women's Heal. 2011;7:163-179.

  39. Arnolds D. COVID-19 and Obstetric Anesthesia [Internet]. ASRA American Society of Regional Anesthesia and Pain Medicine. 2020. Available from: https://www.asra.com/guidelines-articles/original-articles/article-item/asra-news/2020/07/02/covid-19-and-obstetric-anesthesia




2020     |     www.medigraphic.com