Autoidentificación de la cintura-útil en la ubicación del sitio de punción en anestesia neuroaxial de paciente obstétrica con obesidad clase III

Abstract

The neuraxial anesthetic technique in the obese class III, pregnant patient, can represent a challenge for the anesthesiologist, due to the difficulty in recognizing the anatomical landmarks. The objective of the study was to determine the difficulty and quality of combined spinal/epidural anesthesia, in 14 pregnant patients with a body mass index ≥ 40 kg/m2 scheduled for cesarean section. For the location of the puncture site, self-identification of the waist was used, a methodology that has not been previously reported. The patients straddled the surgical table, pointing to her waist with both hands. Two lines were drawn on the back. A horizontal line at the waist, indicated by the patient, and a vertical line corresponding to the midline. The intersection of the two lines was the coordinate for the neuraxial puncture. The mean ± SD of the body mass index was 47.5 ± 3.7 kg/m2. A first level success rate of 92.8% was determined, 57.1% of the patients received one puncture, and the average of punctures was 1.5. Spinal/epidural anesthesia failed in two cases, a change from anesthetic technique to epidural and supplementation with infiltration was performed, with adequate analgesia. It was not necessary to convert to general anesthesia in any case. Self-identification of the waist and coordinate marking can be a clinical aid for the identification of the lumbar puncture site, during the installation of neuraxial anesthesia, in obstetric patients with class III obesity, scheduled for cesarean section. Citar como: Gaona-Ramírez MI. Autoidentificación de la cintura-útil en la ubicación del sitio de punción en anestesia neuroaxial de paciente obstétrica con obesidad clase III. Rev Mex Anestesiol. 2021; 44 (4): 250-257. https://dx.doi.