Agnes M Lamon1, Lisa M Einhorn1, Mary Cooter1, Ashraf S Habib2. 1. Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA. 2. Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA. ashraf.habib@dm.duke.edu.
Abstract
PURPOSE: To investigate the hypothesis that the risk of high spinal block is not increased in obese parturients undergoing cesarean delivery compared to non-obese parturients. METHODS: This is a retrospective study at an academic center. We searched the perioperative database for women who underwent cesarean delivery under spinal or combined spinal epidural anesthesia with hyperbaric bupivacaine ≥10.5 mg. A body mass index (BMI) ≥30 kg/m2 was defined as obese. We categorized obesity into: obesity class I (BMI = 30-34.9 kg/m2), obesity class II (BMI = 35-39.9 kg/m2), obesity class III (BMI = 40-49.9 kg/m2), and super obese (BMI ≥50 kg/m2). The primary outcome was high spinal block defined as need to convert to general anesthesia within 20 min of spinal placement as a result of altered mental status, weakness, or respiratory distress resulting from the high block, or a recorded block height ≥T1. RESULTS: The analysis included 5015 women. High spinal blocks occurred in 29 patients (0.6%). The risk of high spinal was significantly different according to BMI (p = 0.025). In a multivariate model, BMI (p = 0.008) and cesarean delivery priority (p = 0.009) were associated with high blocks. BMI ≥50 kg/m2 was associated with greater odds of high block compared to BMI <30 kg/m2 [odds ratio (95% confidence interval): 6.3 (2.2, 18.5)]. Scheduled cesarean delivery was also associated with greater odds of high block compared with unscheduled delivery. CONCLUSIONS: At standard spinal doses of hyperbaric bupivacaine used in our practice (≥10.5 mg), there were greater odds of high block in those with BMI ≥50 kg/m2.
PURPOSE: To investigate the hypothesis that the risk of high spinal block is not increased in obese parturients undergoing cesarean delivery compared to non-obese parturients. METHODS: This is a retrospective study at an academic center. We searched the perioperative database for women who underwent cesarean delivery under spinal or combined spinal epidural anesthesia with hyperbaric bupivacaine ≥10.5 mg. A body mass index (BMI) ≥30 kg/m2 was defined as obese. We categorized obesity into: obesity class I (BMI = 30-34.9 kg/m2), obesity class II (BMI = 35-39.9 kg/m2), obesity class III (BMI = 40-49.9 kg/m2), and super obese (BMI ≥50 kg/m2). The primary outcome was high spinal block defined as need to convert to general anesthesia within 20 min of spinal placement as a result of altered mental status, weakness, or respiratory distress resulting from the high block, or a recorded block height ≥T1. RESULTS: The analysis included 5015 women. High spinal blocks occurred in 29 patients (0.6%). The risk of high spinal was significantly different according to BMI (p = 0.025). In a multivariate model, BMI (p = 0.008) and cesarean delivery priority (p = 0.009) were associated with high blocks. BMI ≥50 kg/m2 was associated with greater odds of high block compared to BMI <30 kg/m2 [odds ratio (95% confidence interval): 6.3 (2.2, 18.5)]. Scheduled cesarean delivery was also associated with greater odds of high block compared with unscheduled delivery. CONCLUSIONS: At standard spinal doses of hyperbaric bupivacaine used in our practice (≥10.5 mg), there were greater odds of high block in those with BMI ≥50 kg/m2.
Entities:
Keywords:
Cesarean delivery; High block; Obesity; Spinal anesthesia
Authors: Mieke A Soens; David J Birnbach; Jayanthie S Ranasinghe; André van Zundert Journal: Acta Anaesthesiol Scand Date: 2008-01 Impact factor: 2.105
Authors: Ronald B George; Dolores M McKeen; Jennifer E Dominguez; Terrence K Allen; Patricia A Doyle; Ashraf S Habib Journal: Can J Anaesth Date: 2017-12-05 Impact factor: 5.063