A super morbidly obese (230 kg, body mass index 76 kg/m2) patient presented to our service for a planned elective caesarean section for twin delivery. She subsequently underwent a non-elective caesarean section after normal working hours under combined spinal epidural anaesthesia with invasive monitoring. Complex cases such as this, especially in the obstetric setting, require thorough multidisciplinary planning, communication and expertise but can be safely and successfully performed in dedicated stand-alone centres.
LeviD., GoodmanE.Critical care of the obese and bariatric surgical patient.Crit Care Clin2003; 19: 11–32.
2.
AlexanderC.I., ListonW.A.Operating on the obese woman—a review.BJOG2006; 113: 1167–1172.
3.
CameronA.J., WelbornT.A., ZimmetP.Z.Overweight and obesity in Australia.Med J Aust2003; 178: 427–432.
4.
FlegalK.M.Carroll MD, Ogden CL, Johnson CL. Prevalence and trends in obesity among US adults, 1999-2000.JAMA2002; 288: 1723–1727.
5.
CatalanoP., EhrenbergH.The short- and long-term implications of maternal obesity on the mother and her offspring.BJOG2006; 113: 1126–1133.
6.
CallawayL.K., PrinsJ.B., ChangA.M., McIntyreH.D.The prevalence and impact of overweight and obesity in an Australian obstetric population.Med J Aust2006; 184: 56–59.
7.
D'AngeloR., DewanD.D.Obesity. In: ChestnutD.H., eds. Obstetric Anesthesia: Principles and Practice.Philadelphia: Elsevier Mosby2004. p. 893–903.
8.
RobertsR.B., ShirleyM.A.Reducing the risk of acid aspiration during ceasarean section.Anesth Analg1974; 53: 859–868.
9.
UnterbornJ.Pulmonary function testing in obesity, pregnancy and extremes of body habitus.Clin Chest Med2001; 22: 759–767.
10.
GinsbergN.A., LevineE.M.Delivery of the second twin.Int J Gynaecol Obstet2005; 91: 217–220.
11.
KanaziG.E., AouadM.T., Jabbour-KhouryS.I., Al JazzarM.D., AlameddineM.M., Al-YamanR.Effect of low-dose dexme-detomidine or clonidine on the characteristics of bupivacaine spinal block.Acta Anaesthesiol Scand2006; 50: 222–227.
12.
JohnstoneC., StoneP., ReidJ.Does the presence of a midline gutter make regional techniques easier in mothers with body mass indices >40kg/m2?Abstract. Int J Obstet Anesth2006; 15(Suppl) S32: P40.
13.
GrauT., LeipoldR.W., ConradiR., MartinE., MötschJ.Efficacy of ultrasound imaging in obstetric epidural anesthesia.J Clin Anesth2002; 14: 169–175.
14.
DresnerM., BrocklesbyJ., BamberJ.Audit of the influence of body mass index on the performance of epidural analgesia in labour and the subsequent mode of delivery.BJOG2006; 113: 1178–1181.
15.
HamiltonC.L., RileyE.T., CohenS.E.Changes in the position of epidural catheters associated with patient movement.Anesthesiology1997; 86: 778–784.
16.
PalmerC.M., EmersonS., VolgoropolousD., AlvesD.Dose-response relationship of intrathecal morphine for postcesarean analgesia.Anesthesiology1999; 90: 437–444.
17.
PaechM.J., PavyT.J., OrlikowskiC.E., YeoS.T., BanksS.L., EvansS.F.Postcesarean analgesia with spinal morphine, clonidine, or their combination.Anesth Analg2004; 98: 1460–1466.
