Anaesthetic management of labour and caesarean delivery for a morbidly obese parturient with subglottic stenosis


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Tan, A. K., & Mohd Najid, N. (2022). Anaesthetic management of labour and caesarean delivery for a morbidly obese parturient with subglottic stenosis. Malaysian Journal of Anaesthesiology, 1(1), 45–51. Retrieved from

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Copyright (c) 2022 Dr Tan Aik Keat, Dr Nazuha Mohd Najid


caesarean section; combined spinal epidural; labour analgesia; morbid obesity; subglottic stenosis


A 31-year-old parturient with body mass index of 52 kg/m2 and subglottic stenosis, complicated with obstructive sleep apnoea and history of cardiac failure presented in labour. With prior multidisciplinary antenatal and anaesthetic assessment and counselling already in place, epidural was started in early labour via combined spinal-epidural (CSE) technique. The epidural was efficacious in providing labour analgesia and later successfully used for extension of anaesthesia for emergency caesarean delivery for failure to progress. Effective postoperative analgesia via multimodal non-opioid strategy enabled early mobilization and breathing exercises to prevent potential complications during the postpartum period. We present a case to highlight the versatility of the CSE technique in providing effective analgesia in various clinical situations, especially in patients with potential disastrous airway. Early multidisciplinary antenatal assessment and planning by obstetric, otorhinolaryngologic, cardiology, and anaesthetic teams facilitated optimal management of this complicated case.



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