العلاقة بين وزن الحامل و مستوى حصار التخدير القطني للعملية القيصرية

الملخص EN

Background: Many anesthesiologists worry that obesity may result in an unpredictable, exaggerated spread of the local anesthetic agent during administration of either spinal or epidural anesthesia.

Magnetic resonance imaging (MRI)has confirmed that CSF volume is reduced in obese patients .

A separate study using MRI demonstrated an inverse correlation between block level and lumbar CSF volume.

Other have performed studies that suggest that the maximal spread of anesthesia does not correlate with weight or Body Mass Index.

Objective : We analyzed retrospectively 409 Parturient who underwent cesarean section under spinal anesthesia and were received the same dose of Heavy Bupivacaine 11.5mg&Fentanil 25Mg .

Methods: The patients were divided into tow groups :first one obese parturient 208 patients ,where there BMI>35kg/m2 ,and second group 201 patients ,where there BMI<25kg/m2 .

The level of the block ,and the mother and newborn vital signs, were observed and compared.

Results: The patients' age in the tow group were the same, BMI was(40+/-5kg/m2 )in first group, and BMI was(22.5+/-2.5kg/m2 )in second one.

The newborns were in a good ship as Agar score(7-9/10 at first Minute) in both group(no statically differences p>0.9 ) The level of sensory and motor block was fit for cesarean section in both group ,the 4th thoracic dermatome in both group (no statically differences p>0.9).But it reached the 3rd thoracic dermatome more in obese group(p=0.01).Also hypotension occurred more in obese group(p<0.001).

Obese parturients suffer more difficulty in breath (p<0.003) Conclusion: Spinal anesthesia is the first choice for cesarean section anesthesia in obese parturient.

The heavy Bupivacaine dose(11.5mg)were used in obese and none obese parturient, without any adverse effects on the newborn or mother ,because of high level of block.

If intravenous fluids were given, parturient positioned to prevent cephalic spread of anesthesia ,and prevent of the aortocaval compression by pregnant uterus.

Hypotension should not happened and should treat aggressively if it starts.

The obese parturient should evaluate thoroughly preoperative ,for airway difficulties and coexisting diseases.

And all facilities of the general anesthesia should be available during regional anesthesia.

As there are possibility to get high sensory and motor block in obese parturient precaution is mandatory .Spinal anesthesia doses lower than 11.5mg of heavy Bupivacaine need to test in future studies in cesarean section.