Date: 29 Aug 2009

Ultrasound-assisted spinal anesthesia in obese patients

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To the Editor,

We write to share our experience of lumber ultrasonography to assist spinal anesthesia in an obese patient undergoing complex surgery. A 67-yr-old male with a body mass index (BMI) of 44, hypertension, diabetes mellitus and obstructive sleep apnea presented for total hip arthroplasty. Spinal anesthesia was deemed the most appropriate technique after considering the advantages and disadvantages of general versus regional anesthesia and acquiring patient agreement. Marked central obesity and a large umbilical hernia made it very difficult for this patient to achieve the optimal position for spinal anesthesia. Bony landmarks were impalpable on examination, and the landmark-guided approach was abandoned following several unsuccessful attempts at what was believed to be the L2-3 and L3-4 interspaces. With the patient remaining in the sitting position, an ultrasonographic survey of the lumbar spine was performed (Philips HD 11XE ultrasound unit, Philips Medical Systems, Bothwel ...