American Society of Anesthesiologists Practice Guidelines for Perioperative Management of Patients with Obstructive Sleep Apnea
Obesity is a worldwide health problem, with the prevalence in the general population growing at an alarming rate. Data from the National Health and Nutrition Examination Survey show that in 2015 to 2016, 36.5% of women of reproductive age (20 to 39 years of age) were obese, compared with a prevalence of 28.3% in 1999 to 2000. Although no definition of obesity specific to pregnancy exists, a pregnant woman is generally considered overweight when her body mass index (BMI) is 25.0 to 29.9 kg/m2, and obese when her BMI is 30 kg/m2 or greater. The prevalence of class III obesity (BMI 40 kg/m2 or greater) among women of reproductive age has significantly increased in recent years, with a prevalence of 10% in 2013 to 2014, compared with 5% in 1999 to 2000. To allow for the weight gain of pregnancy, some groups have suggested adding 5 kg/m2 to the World Health Organization classes to define pregnancy thresholds. Obesity is associated with an increased risk for maternal morbidity and mortality. The care of obese parturients poses significant challenges to the anesthesia provider as a result of common comorbidities, an increased cesarean delivery rate, and technical difficulties associated with both neuraxial and general anesthesia. Understanding the pathophysiologic changes and comorbidities associated with obesity and pregnancy is crucial for the safe conduct of anesthesia in these high-risk patients.
