Anesthetic Management of a Super Morbidly Obese Parturient (BMI 78 kg/m2) for LSCS: A Case Report

Abstract

Obesity is a major global crisis associated with significantly increased perioperative morbidity and mortality in pregnancy. As per World Health Organisation, obesity is classified according to body mass index (BMI) as class I (30–34.9 kg/m ² ), class II (35–39.9 kg/m ² ) and class III (40 kg/m ² and above). A BMI of 50 kg/m ² and above is termed as super morbid obesity. Challenges include management of a difficult airway, obscure landmarks for regional anesthesia, patient positioning, venous cannulation, blood pressure recording, equipment inadequacy and increased surgical duration and complexity and co-morbid conditions like hypertension, diabetes mellitus, obstructive sleep apnea, cardiovascular disease notably associated with increased obstetric and perinatal morbidity and mortality. The article describes one such case with BMI of 78 kg/m ² presenting with many of these challenges which we were able to overcome with meticulous planning, multidisciplinary therapeutic team, active patient engagement and employing Ultrasound guidance for regional anesthesia.