Anesthetic management of the morbidly obese parturient

Regional analgesia for labor pain and general anesthesia for cesarean section in the morbidly obese parturient is associated with increased maternal and perinatal complications. The purpose of this review is to describe the anesthetic management of the morbidly obese parturient. Compared to the lean parturient, the morbidly obese parturient has an increased likelihood for initial failed epidural, subsequent epidural replacement, inadvertent dural puncture, and cesarean section with difficult intubation under emergent conditions. Early preoperative assessment, epidural insertion, and replacement for failed regional anesthesia/analgesia along with preparation for general anesthesia and difficult airway intubation is advocated to decrease potential complications in the morbidly obese parturient.