Anaesthesia for emergency caesarean section in a morbidly obese achondroplastic patient with PIH: Feasibility of Neuraxial anaesthesia?

A 25‐year‐old primigravida was referred to our hospital at 38 ± 3 week gestation with meconium stained liquor for emergency caesarean section (CS). She weighed 90 Kg with a height of 104 cm and body mass index (BMI 80 kg/m2, morbid obesity). She was a diagnosed case of pregnancy induced hypertension (PIH), not on medications. She had complaints of fever, productive cough and dyspnea (NYHA III) since10 days and was on antibiotics. She was afebrile, pale with stable vitals. Systemic examination revealed lumbar lordosis, pedal edema and crepitations in lung bases. She had an anticipated difficult airway in view of short neck, limited neck extension, large tongue and Mallampatti grade 3. Her haemoglobin was 7 gm% but coagulation, renal and liver functions were normal. Chest X‐ray demonstrated bilateral lower zones haziness, and increased bronchovesicular markings. ECG showed sinus rhythm and 2‐D echocardiography revealed left ventricular ejection fraction 55‐60%.