Anesthetic management of patients with class 3 obesity undergoing elective Cesarean delivery: a single-centre historical cohort study
van den Bosch, Oscar F C; Fiset, Marie-Eve; Downey, Kristi; Maxwell, Cynthia; Carvalho, Jose C A
(2023) Canadian Journal of Anaesthesia, volume 70, issue 2, pp. 202 - 210
(Article)
Abstract
PURPOSE: The preferred neuraxial anesthetic technique for patients with class 3 obesity undergoing elective Cesarean delivery is still under debate. We aimed to describe the anesthetic technique used in our tertiary institution across body mass index (BMI) groups and different surgical incisions. METHOD: In this historical cohort study, we reviewed
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medical records of patients with a BMI ≥ 40 kg·m-2 undergoing elective Cesarean delivery between July 2014 and December 2020. We collected data on patient characteristics, anesthetic and surgical technique, and procedural times. For data analysis, we stratified patients by BMI into three different groups: 40.0-49.9 kg·m-2, 50.0-59.9 kg·m-2, and ≥ 60.0 kg·m-2. RESULTS: We included 396 deliveries, distributed as follows: 258 with a BMI 40.0-49.9 kg·m-2, 112 with a BMI 50.0-59.9 kg·m-2, and 26 with a BMI ≥ 60.0 kg·m-2. For patients with a BMI 40.0-49.9 kg·m-2, the anesthetic technique of first choice was predominantly spinal anesthesia (71%), whereas for those with a BMI ≥ 60.0 kg·m-2, spinal anesthesia was never used as the anesthetic of first choice. With regard to the surgical incision, spinal anesthesia was almost exclusively used for patients undergoing Pfannenstiel incision and was rarely used for a higher supra- or infraumbilical transverse or midline incision. The overall incidence of general anesthesia was low (7/396, 1.8%). Anesthetic time, surgical time, and operating room time increased almost twofold in patients with a BMI ≥ 60.0 kg·m-2 compared with those with a BMI of 40.0-49.9 kg·m-2. CONCLUSION: Neuraxial anesthesia was successfully used in approximately 98% of patients with class 3 obesity undergoing elective Cesarean delivery. The choice of regional anesthesia technique varied with increasing BMI and with the planned surgical incision. Procedural times increased with increasing BMI. This information should prove useful for comparing anesthetic choices and outcomes in this challenging population.
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Keywords: Cesarean delivery, epidural anesthesia, obesity, obstetrical anesthesia, spinal anesthesia, Anesthesiology and Pain Medicine
ISSN: 0832-610X
Publisher: Springer New York
Note: Funding Information: Oscar van den Bosch contributed to all aspects of this manuscript, including conception and design; acquisition, analysis, and interpretation of data; and drafting the article. Marie-Eve Fiest and Kristi Downey contributed to the study design and acquisition of data. Cynthia Maxwell contributed to the study design and interpretation of data. Jose Carvalho contributed to the conception and design of the study, analysis and interpretation of data, and drafting the article. The authors declare no conflicts of interest. This study was presented in part at the 54th Annual Meeting of the Society for Obstetric Anesthesia and Perinatology, Chicago, IL, USA, 11–14 May 2022. Dr. Jose C.A. Carvalho is supported by the Merit Awards Program from the Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. This submission was handled by Dr. Vishal Uppal, Associate Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie. Funding Information: Dr. Jose C.A. Carvalho is supported by the Merit Awards Program from the Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada. Publisher Copyright: © 2022, The Author(s).
(Peer reviewed)
