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The excess 3213 weight of the abdominal wall can compress the vena cava, causing decreased cardiac preload, reflex tachycardia, and decreased cardiac output. In a large series of obese patients undergoing nonobstetric surgery who had received spinal anesthesia, more than one-third developed hypotension. There are other reports of cardiac arrest after supine positioning in morbidly obese patients. Despite these important considerations, use of neuraxial techniques can offer important advantages when compared to general anesthesia alone.
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Neuraxial anesthetic placement can be particularly difficult, especially when bony landmarks are nonpalpable, cheap is limited back flexion,146 and there are false losses of resistance due to fat deposition. Future development of ultrasound technologies may incorporate the use of ultrasound-guided needle techniques to aid epidural placement in challenging patients. The order is often helpful in determining whether needle placement is midline or lateral and directing the needle to the midline e. A recent study demonstrated that obese women were less likely to identify the midline by pinprick compared to nonobese.
These needles can cause serious injury so they should only be used after careful assessment of the midline when standard needles are inadequate. Single injection spinal anesthesia is a popular neuraxial anesthetic technique but there are concerns about technical difficulties, exaggerated spread of local anesthetic, hypotension, and an Motrin to prolong the block, Cheap Motrin Order, especially in the obese patient.
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