The impact of body mass index on the risk of high spinal block in parturients undergoing cesarean delivery: a retrospective cohort study

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 c...

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Bibliographic Details
Published in:Journal of anesthesia 2017-08, Vol.31 (4), p.552-558
Main Authors: Lamon, Agnes M., Einhorn, Lisa M., Cooter, Mary, Habib, Ashraf S.
Format: Article
Language:English
Subjects:
Adult
Anesthesia
Anesthesia, Epidural - methods
Anesthesia, Obstetrical - methods
Anesthesia, Spinal - methods
Anesthesiology
Body Mass Index
Bupivacaine
Bupivacaine - administration & dosage
Cesarean section
Cesarean Section - methods
Critical Care Medicine
Emergency Medicine
Female
Humans
Intensive
Medicine
Medicine & Public Health
Obesity
Obesity - complications
Odds Ratio
Original Article
Pain Medicine
Pregnancy
Retrospective Studies
Risk
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Summary: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/m 2 was defined as obese. We categorized obesity into: obesity class I (BMI = 30–34.9 kg/m 2 ), obesity class II (BMI = 35–39.9 kg/m 2 ), obesity class III (BMI = 40–49.9 kg/m 2 ), and super obese (BMI ≥50 kg/m 2 ). 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/m 2 was associated with greater odds of high block compared to BMI
ISSN:0913-8668
1438-8359
DOI:10.1007/s00540-017-2352-0