Anesthetic considerations in the obese parturient

The provision of anesthesia to the morbidly obese parturient is technically challenging. The anesthesia provider anticipates difficulty with intravenous access, positioning, monitoring, and placement of neuraxial anesthesia. There is a higher incidence of hypotension in obese parturients during neuraxial anesthesia most likely due to concealed aortocaval compression as positioning these patients is difficult. Mostproviderswillprovideeitherepiduralorcombined spinal/epidural anesthesia for cesarean delivery due to the variable duration of the surgical procedure.Among obese gravidas, there is a lower risk of the development of a headache from an accidental dural puncture, due not to thebody habitus, but rather to the group's higher cesarean delivery rate. It is the process of bearing down during delivery that increases thechance of thedevelopment of a headache following dural puncture.