Novel approaches facilitating neuraxial anesthesia placement in pregnant women with morbid obesity: case descriptions

• Published in: International journal of obstetric anesthesia 2024-11, Vol.60, p.104257, Article 104257
• Main Authors: Kodali, B.S., Zheng, A., Alton, S., Frampton, K., Bharadwaj, S., Galey, J.
• Format: Article
• Language: English
• Subjects: Ceiling lift; High back sling; Neuraxial anesthesia; Pannus retractor; Pregnant women with Morbid Obesity
• ISSN: 0959-289X; 1532-3374; 1532-3374
• DOI: 10.1016/j.ijoa.2024.104257

•Occupational injuries occur while caring for pregnant patients with morbid obesity.•We describe two novel approaches to assist neuraxial anesthesia administration and positioning for cesarean delivery.•High back sling in conjunction with ceiling lifts facilitate positioning patients.•TraxiTM helps retracting folds away from neuraxial placement site. Clinical management of pregnant women with morbid obesity poses challenges in performing neuraxial anesthesia as well as positioning for cesarean delivery. Occupational injuries are also known to occur while caring for patients with morbid obesity. We describe two novel approaches to assist neuraxial anesthesia administration and positioning for cesarean delivery. With the assistance of the Institution’s Safe Patient Handling and Mobility Team, a universal high-back sling can be placed to lift the patient into a sitting position before neuraxial anesthesia procedure. After placement of combined spinal epidural anesthesia, the ceiling lift is used to lift the patient into a seated position and then rotate to the appropriate location on the operating room table to facilitate supine positioning. The lifting system reduces shearing of the patient’s posterior and compromising the epidural site. Team members also report reduced effort required when positioning patients from seated to supine on the operating room table. The second approach is the application of TraxiTM abdominal pannus retractor to retract fat folds encroaching on the epidural placement site in pregnant women with morbid obesity. This is particularly useful when the traditional taping of fat folds away from the site is inadequate. The pannus retractor results in a flatter surface facilitating epidural placement. We have introduced these two approaches into our clinical practice for pregnant women with morbid obesity requiring cesarean delivery under neuraxial anesthesia.