A 28-year-old pregnant patient, gravida 1, para 0, presented in active labor, requesting epidural analgesia. She was morbidly obese (188 kg; BMI, 70 kg/m2), and had a medical history of hypertension, obstructive sleep apnea and discectomy at the L4-L5 level.
The patient’s pregnancy was complicated by preeclampsia. At admission, her blood pressure was 145/96 mm Hg and platelet count was 120,000 × 109/L. The first two attempts to