Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2014.05.011
Brazilian Journal of Anesthesiology
Clinical Informations

Perioperative management of a morbidly obese pregnant patient undergoing cesarean section under general anesthesia - case report

Controle perioperatório de gestante obesa mórbida submetida a parto cesariano sob anestesia geral - relato de caso

Márcio Luiz Benevides; Verônica Cristina Moraes Brandão; Jacqueline Ivonne Arenas Lovera

http://dx.doi.org/10.1016/j.bjane.2014.05.011 Braz J Anesthesiol, vol.66, n4, p.418-422, 2016
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Abstract

Abstract Background and objectives: The increased prevalence of obesity in the general population extends to women of reproductive age. The aim of this study is to report the perioperative management of a morbidly obese pregnant woman, body mass index >50 kg/m2, who underwent cesarean section under general anesthesia. Case report: Pregnant woman in labor, 35 years of age, body mass index 59.8 kg/m2. Cesarean section was indicated due to the presumed fetal macrosomia. The patient refused spinal anesthesia. She was placed in the ramp position with cushions from back to head to facilitate tracheal intubation. Another cushion was placed on top of the right gluteus to create an angle of approximately 15° to the operating table. Immediately before induction of anesthesia, asepsis was carried out and sterile surgical fields were placed. Anesthesia was induced in rapid sequence, with Sellick maneuver and administration of remifentanil, propofol, and succinilcolina. Intubation was performed using a gum elastic bougie, and anesthesia was maintained with sevoflurane and remifentanil. The interval between skin incision and fetal extraction was 21 min, with the use of a Simpson's forceps scoop to assist in the extraction. The patient gave birth to a newborn weighing 4850 g, with Apgar scores of 2 in the 1st minute (received positive pressure ventilation by mask for about 2 min) and 8 in the 5th minute. The patient was extubated uneventfully. Multimodal analgesia and prophylaxis of nausea and vomiting was performed. Mother and newborn were discharged on the 4th postoperative day.

Keywords

Morbid obesity, Cesarean section, General anesthesia: remifentanil

Resumo

Resumo Justificativa e objetivos: O aumento na prevalência da obesidade na população geral se estende para mulheres na idade reprodutiva. O objetivo deste estudo é relatar o controle perioperatório de uma gestante obesa mórbida com índice de massa corporal > 50 Kg/m2, submetida a parto cesariano sob anestesia geral. Relato do caso: Gestante de 35 anos com índice de massa corporal de 59,8 Kg/m2. Estava em trabalho de parto. Foi indicado parto cesariano devido a macrossomia fetal presumida. A paciente recusou raquianestesia. Ela foi posicionada em rampa com coxins no dorso até a cabeça para facilitar a intubação traqueal. Outro coxim foi colocado na parte superior do glúteo direito para criar uma angulação próxima de 15° com a mesa cirúrgica. Imediatamente antes da indução anestésica, procedeu-se a assepsia e colocação de campos cirúrgicos estéreis. Foi feita indução em sequência rápida com manobra de Sellick, com remifentanil, propofol e succinilcolina. A intubação foi feita com auxílio de gum elastic bougie. A anestesia foi mantida com remifentanil e sevoflurano. O intervalo entre a incisão na pele e a extração fetal foi de 21 minutos e foi usada uma das colheres do fórceps de Simpson para auxílio na extração. Paciente concebeu recém-nascido com peso de 4.850 g, apresentou índice de Apgar de 2 no primeiro minuto (recebeu ventilação com pressão positiva sob máscara por aproximadamente dois minutos) e 8 no quinto minuto. A paciente foi extubada, sem intercorrências. Foi feita analgesia multimodal e profilaxia de náuseas e vômitos. Mãe e récem-nascido receberam alta no quarto dia de pós-operatório.

Palavras-chave

Obesidade mórbida, Parto cesariano, Anestesia geral: remifentanil

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