References
Video for ultrasound for neuraxial technique. Skip to 13ish minutes in for the meat and potatoes.
Bourlier RA, Birnbach DJ. Anesthetic management of the parturient with ankylosing spondylitis. International Journal of Obstetric Anesthesia. 1995; (4): 244-247.
Woodward LJ, Kam PCA. Ankylosing spondylitis: recent developments and anaesthetic implications. Journal of the Association of Anaesthetists of Great Britain and Ireland. 2009; 64(5): 540-548.
Reveille JD. Epidemiology of Spondyloarthritis in North America. The American Journal of the Medical Sciences. 2011; 341(4): 284-286.
Stoelting RK, Hines RL, Marschall KE. Stoeltings Anesthesia and Co-Existing Disease. Philadelphia, PA: Saunders Elsevier; 2012.
Midorikawa A, Wang L, Kuwata T, et al. Management of pregnancy complicated by ankylosing spondylitis: A case report and literature review. Clinical Case Reports. 2019; 7: 766-769. doi:10.1002/ccr3.2085.
Lai HY, Chen IH, Chen A, Hwang FY, Lee Y. The use of the GlideScope for tracheal intubation in patients with Ankylosing Spondylitis. British Journal of Anaesthesia. 2006; 97: 419-422. 1.Riveros-Perez E, Mcclendon J, Xiong J, Cheriyan T, Rocuts A. Anesthetic and obstetric outcomes in pregnant women undergoing cesarean delivery according to body mass index: Retrospective analysis of a single-center experience. Annals of Medicine and Surgery. 2018;36:129-134. doi:10.1016/j.amsu.2018.10.023. In a restrospective study from 2015-2016, 721 patients 25% of the patients were evaluated for obstetric complications. Intraoperative blood loss was significantly higher in morbidly obese group. Sixty one percent of the patients with morbidly obese had at least one co-morbidity (p<0.01) 2. Mccall SJ, Li Z, Kurinczuk JJ, Sullivan E, Knight M. Maternal and perinatal outcomes in pregnant women with BMI >50: An international collaborative study. Plos One. 2019;14(2). doi:10.1371/journal.pone.0211278 International cohort study using data from UK and Australia with 1232 pregnant women. Extremely obese patients had a ninefold increase in odds of thrombotic events compared to those with a BMI <50. Increased odds of preeclampsia/eclampsia, cesarean delivery, induction of labor, post cesarean wound infection, macrosomia. Twelve of the infants born to women in extremely obese cohort died early in neonatal period or were stillborn. 3.Rao D, Rao V. Morbidly obese parturient challenges for the anaesthesiologist, including managing the difficult airway in obstetrics. What is new? Indian Journal of Anaesthesia. 2010;54(6):508. doi:10.4103/0019-5049.72639. 4.Marshall N, Guild C, Cheng YW, Caughey A, Halloran D. 597: Maternal super-obesity and perinatal outcomes. American Journal of Obstetrics and Gynecology. 2011;204(1). doi:10.1016/j.ajog.2010.10.617 Retrospective cohort Missouri residents born between 2000-2006 included 64,272 births. Of those, 1,185 were in the Super obese category (BMI > 50). Super obesity parturients were more likely to have preeclampsia, macrosomia, neonatal hypoglycemia, increased risk neonatal morbidity (even when compared to morbidly obese women), risk of cesarean delivery regardless of parity, 31% of super obese delivered vaginally compared to 53% of obese women. Nulliparous super-obese women were significantly less likely than nulliparous obese women to have a vaginal delivery and more likely to undergo a scheduled or emergency cesarean. Dose response relationship between worsening obesity and cesarean, macrosomia, neonatal hypoglycemia, and preeclampsia. More likely to use intensive prenatal care 5.Crane JM, Murphy P, Burrage L, Hutchens D. Maternal and Perinatal Outcomes of Extreme Obesity in Pregnancy. Journal of Obstetrics and Gynaecology Canada. 2013;35(7):606-611. doi:10.1016/s1701-2163(15)30879-3. 5788 women in a cohort study 2002-2011. Extremely obese women more likely to have gestational hypertension, gestational diabetes, shoulder dystocia, cesarean section, length of stay more than 5 days, birth weight > 4000g, NICU admission, still birth, composite adverse outcomes. 6.Tonidandel A, Booth J, D’Angelo R, Harris L, Tonidandel S. Anesthetic and Obstetric Outcomes in Morbidly Obese Parturients. Obstetric Anesthesia Digest. 2015;35(4):212-213. doi:10.1097/01.aoa.0000472733.35350.93 Retrospective cohort study of 230 patients. 50% of morbidly obese group required cesarean delivery, longer first stage of labor, larger neonates, more likely to have a failed initial neuraxial technique for labor analgesia, the need for replacement was 17%, neuraxial procedure times were greater in morbidly obese parturient.
References for Ankylosing Spondylitis
Bourlier RA, Birnbach DJ. Anesthetic management of the parturient with ankylosing spondylitis. International Journal of Obstetric Anesthesia. 1995; (4): 244-247.
Woodward LJ, Kam PCA. Ankylosing spondylitis: recent developments and anaesthetic implications. Journal of the Association of Anaesthetists of Great Britain and Ireland. 2009; 64(5): 540-548.
Reveille JD. Epidemiology of Spondyloarthritis in North America. The American Journal of the Medical Sciences. 2011; 341(4): 284-286.
Stoelting RK, Hines RL, Marschall KE. Stoeltings Anesthesia and Co-Existing Disease. Philadelphia, PA: Saunders Elsevier; 2012.
Midorikawa A, Wang L, Kuwata T, et al. Management of pregnancy complicated by ankylosing spondylitis: A case report and literature review. Clinical Case Reports. 2019; 7: 766-769. doi:10.1002/ccr3.2085.
Lai HY, Chen IH, Chen A, Hwang FY, Lee Y. The use of the GlideScope for tracheal intubation in patients with Ankylosing Spondylitis. British Journal of Anaesthesia. 2006; 97: 419-422.
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