ANESTHETIC EVALUATION IN OBESE PREGNANT WOMEN: REFLECTIVE PERSPECTIVES ON SAFETY AND CHALLENGES

Abstract

This reflective study analyzes the anesthetic challenges in obese pregnant women, addressing technical, pharmacological and ethical aspects. The methodology was based on a narrative review of recent scientific literature, with a careful selection of articles published between 2019 and 2024 in databases such as PubMed, SciELO, and LILACS. The analysis was structured in three axes: (1) physiological and anatomical changes that interfere with obstetric anesthesiology, (2) technical and ethical challenges in anesthetic management, and (3) impacts on maternal and neonatal outcomes. Obesity makes it difficult to perform neuraxial blocks, increases the risk of anesthetic failures, and complicates intraoperative monitoring. In addition, it influences the pharmacokinetics of anesthetics, requiring dosage adjustments and close monitoring. In the postoperative period, there is a higher incidence of respiratory complications, venous thromboembolism, and inadequate pain control, reinforcing the need for multimodal protocols and a multiprofessional approach. It is concluded that the individualization of anesthetic management and the improvement of evidence-based guidelines are essential to minimize risks and optimize maternal-fetal safety. Continuous staff training and the adoption of advanced strategies, such as ultrasound to guide blockages and preventive measures for complications, are key to improving obstetric outcomes.