Diagnosis and Management of Obesity Hypoventilation Syndrome during Labor
Obesity hypoventilation syndrome (OHS) is a disorder in which patients with a body mass index ≥30 kg/m2 develop awake hypercapnia with a partial pressure of carbon dioxide ≥45 mm Hg, in the absence of other diseases that may produce alveolar hypoventilation. Additional clinical features include slee...
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Wiley
2021-01-01
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| Series: | Case Reports in Anesthesiology |
| Online Access: | http://dx.doi.org/10.1155/2021/8096212 |
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| author | Brandon M. Togioka Sarah S. McConville Rachael M Penchoen-Lind Katie J. Schenning |
| author_facet | Brandon M. Togioka Sarah S. McConville Rachael M Penchoen-Lind Katie J. Schenning |
| author_sort | Brandon M. Togioka |
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| description | Obesity hypoventilation syndrome (OHS) is a disorder in which patients with a body mass index ≥30 kg/m2 develop awake hypercapnia with a partial pressure of carbon dioxide ≥45 mm Hg, in the absence of other diseases that may produce alveolar hypoventilation. Additional clinical features include sleep disordered breathing, restrictive lung disease, polycythemia, hypoxemia, and an increased serum bicarbonate concentration (≥27 mEq/L). Anesthesia providers should be familiar with OHS because it is often undiagnosed, it is associated with a higher mortality rate than obstructive sleep apnea, and it is projected to increase in prevalence along with the obesity epidemic. In this case, a 33-year-old obese woman with presumed OHS developed respiratory acidosis during induction of labor. Continuous positive airway pressure treatment was initiated, but the patient continued to have hypercapnia. A cesarean delivery was recommended. The patient had baseline orthopnea due to her body habitus; thus, despite adequate labor analgesia, a cesarean delivery was completed with general endotracheal anesthesia. We believe this patient had OHS despite a serum bicarbonate <27 mEq/L, a partial pressure of oxygen >70 mm Hg, and a hemoglobin <16 g/dL, which would typically rule out OHS. Pregnant women experience a decrease in serum bicarbonate concentration due to progesterone-mediated hyperventilation, an increase in arterial oxygenation from increased minute ventilation and higher cardiac output, and a decrease in hemoglobin due to the physiologic anemia of pregnancy. Thus, OHS may be defined differently in pregnant than in non-pregnant patients. |
| format | Article |
| id | doaj-art-32057920e19a4a038944dea0bf29d5b5 |
| institution | Kabale University |
| issn | 2090-6382 2090-6390 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
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| series | Case Reports in Anesthesiology |
| spelling | doaj-art-32057920e19a4a038944dea0bf29d5b52025-02-03T01:26:58ZengWileyCase Reports in Anesthesiology2090-63822090-63902021-01-01202110.1155/2021/80962128096212Diagnosis and Management of Obesity Hypoventilation Syndrome during LaborBrandon M. Togioka0Sarah S. McConville1Rachael M Penchoen-Lind2Katie J. Schenning3Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USADepartment of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USADepartment of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USADepartment of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, OR, USAObesity hypoventilation syndrome (OHS) is a disorder in which patients with a body mass index ≥30 kg/m2 develop awake hypercapnia with a partial pressure of carbon dioxide ≥45 mm Hg, in the absence of other diseases that may produce alveolar hypoventilation. Additional clinical features include sleep disordered breathing, restrictive lung disease, polycythemia, hypoxemia, and an increased serum bicarbonate concentration (≥27 mEq/L). Anesthesia providers should be familiar with OHS because it is often undiagnosed, it is associated with a higher mortality rate than obstructive sleep apnea, and it is projected to increase in prevalence along with the obesity epidemic. In this case, a 33-year-old obese woman with presumed OHS developed respiratory acidosis during induction of labor. Continuous positive airway pressure treatment was initiated, but the patient continued to have hypercapnia. A cesarean delivery was recommended. The patient had baseline orthopnea due to her body habitus; thus, despite adequate labor analgesia, a cesarean delivery was completed with general endotracheal anesthesia. We believe this patient had OHS despite a serum bicarbonate <27 mEq/L, a partial pressure of oxygen >70 mm Hg, and a hemoglobin <16 g/dL, which would typically rule out OHS. Pregnant women experience a decrease in serum bicarbonate concentration due to progesterone-mediated hyperventilation, an increase in arterial oxygenation from increased minute ventilation and higher cardiac output, and a decrease in hemoglobin due to the physiologic anemia of pregnancy. Thus, OHS may be defined differently in pregnant than in non-pregnant patients.http://dx.doi.org/10.1155/2021/8096212 |
| spellingShingle | Brandon M. Togioka Sarah S. McConville Rachael M Penchoen-Lind Katie J. Schenning Diagnosis and Management of Obesity Hypoventilation Syndrome during Labor Case Reports in Anesthesiology |
| title | Diagnosis and Management of Obesity Hypoventilation Syndrome during Labor |
| title_full | Diagnosis and Management of Obesity Hypoventilation Syndrome during Labor |
| title_fullStr | Diagnosis and Management of Obesity Hypoventilation Syndrome during Labor |
| title_full_unstemmed | Diagnosis and Management of Obesity Hypoventilation Syndrome during Labor |
| title_short | Diagnosis and Management of Obesity Hypoventilation Syndrome during Labor |
| title_sort | diagnosis and management of obesity hypoventilation syndrome during labor |
| url | http://dx.doi.org/10.1155/2021/8096212 |
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