• D V Marshalov, E M Shifman, I A Salov, and A P Petrenko.
• Anesteziol Reanimatol. 2014 Nov 1;59(6):19-23.

IntroductionIntra-abdomninal pressure (IAP) is one of the reasons for reducing the volume of the subarachnoid space, the cerebrospinal fluid of pregnant iwomnen with obesity and as a result, a high spinal block in spinal anesthesia (SA), clinical manifestation of which is marked arterial hypotension.ObjectiveTo decrease the frequency and severity of arterial hypotension related to the conduct of SA due to the correction dose of local anesthetic with the level of intra-abdomninal pressure and timing of operative deliveryMaterial And MethodsThe study involved 252 women. To determine the physiological level of IAP at different stages of gestation used to study the level of IAP in 118 pregnant women with normal body weight. To explore the relationship of frequency of hypotension in the SA and the development of methodology for calculating the dose of local anesthetic in pregnant women examined 92 patients, 62 of whom were obese. To assess the adequacy of the developed technique further examined 42 obese women.Resultsit was determined that the gestation 38-40 weeks, the mean physiological IAP corresponds to 20 mm Hg, at the term of 35-37 weeks - 18 mm Hg at 32-34 weeks of pregnancy - 16 mnm Hg. Studies have shown that an adequate dose of local anesthetic for spinal anesthesia for operative delivery in pregnant women with obesity depends on the level of IAP The required dosage is determined by the percentage reduction for the difference between the actual level of IAP and the predicted IAP The required dosage 5.5% per mm Hg IAP is higher than the physiological norm.ConclusionThe developed method of calculating the dose of local anesthetic with the levels of IAP and gestational age prevents development of arterial hypertension, the optimum level of sensory block during SA for operative delivery obese women.

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