High BMI

Selected Guideline Examples Date
Dartford and Gravesham
August 2019
North Bristol
January 2020
University Hospital Coventry
January 2020
What we liked
  • Clear criteria for referral to anaesthetist antenatally.
  • Documented anaesthetic review and care plans in patient notes.
  • Provision of OAA information leaflet to patient antenatally.
  • Need to inform duty anaesthetist when patient admitted to delivery suite.
  • List of equipment which may be required, eg large BP cuff, hover mattress, Oxford pillow, arm boards, long spinal needles, use of ultrasound to scan back.
  • Use of CSE for potentially long, complex surgical intervention.
  • 2 anaesthetists if possible, especially for GA.
  • Avoidance of implying to patient that GA is unsafe as higher failure rate of RA in obese parturient so GA may be only option.
  • Guidance on administration of GA including increased dose of suxamethonium, awake extubation.
What we didn't like
  • Anaesthetic considerations as addendum or appendix to general guideline written for obstetricians and midwives.
  • Suggestion that only patient with BMI>50 must be seen antenatally by anaesthetist.
Other comments
  • We would recommend consideration of Optiflow or similar for obese patient requiring GA – for preoxygenation and in recovery.
  • Note increasing use of aspirin at dose of 150 mg od po as recommended now by RCOG for prevention of PET. Concur with advice to stop this or reduce to 75mg at 36/40 or 34/40 in woman at increased risk of preterm delivery, in order to minimise risk of platelet dysfunction and enable safe RA.

Information for expectant
parents and midwives’

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