过度肥胖和病理性肥胖患者的产科麻醉：1分预防胜于10分治疗

Obstetric anesthesia for the obese and morbidly obese patient： an ounce of prevention is worth more than a pound of treatment

全球肥胖人数剧增．麻醉医师越来越多的面临这类患者。孕妇过度肥胖与许多问题相关．如割富产分娩．糖尿病、高血压和先兆子痛等。因此麻醉医师对生理、相关情况和发瘸率．可选的麻醉方法、可能的并发症的全面理解非常重要。本文讨论了与麻醉医师相关的肥胖孕妇的许多方面。提供了对产妇和胎儿发病率、与妊娠和肥胖相关的生理变化的特点，并对分娩镇痛的不同选择、剖宫产的麻醉管理和潜在的产后并发症进行了讨论。结论是，病理性肥胖产妇的麻醉管理存在特殊风险，插管困难或失败的风险极高．早期放置硬膜外或鞘内导管可减少对全麻的需要。

The incidence of obesity has been dramatically increasing across the globe. Anesthesiologists, are increasingly faced with the care for these patients. Obesity in the pregnant woman is associated with a broad spectrum of problems, including dramatically increased risk for cesarean delivery, diabetes, hypertension and pre-eciampsia. This is our reviews in which different aspects of obesity in the pregnant woman, that are relevant to the anesthesiologist, are discussed. An overview of maternal and fetal morbidity and physiologic changes associated with pregnancy and obesity is provided and different options for labor analgesia, the anesthetic management for cesarean delivery and potential post-partum complications are discussed in detail. The conclusions are that anesthetic management of the morbidly obese parturient is associated with special hazards. The risk for difficult or failed intubation is exceedingly high. The early placement of an epidural or intrathecal catheter may overcome the need for general anesthesia.