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

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A Letter to the Editor to this article was published on 23 September 2019

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.

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Authors and Affiliations

  1. Department of Anesthesiology, Duke University Medical Center, Box 3094, Durham, NC, 27710, USA

    Agnes M. Lamon, Lisa M. Einhorn, Mary Cooter & Ashraf S. Habib

Authors
  1. Agnes M. Lamon
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  2. Lisa M. Einhorn
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  3. Mary Cooter
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  4. Ashraf S. Habib
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Corresponding author

Correspondence to Ashraf S. Habib.

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None of the authors have any financial disclosures or relevant conflicts of interest.

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Lamon, A.M., Einhorn, L.M., Cooter, M. et al. The impact of body mass index on the risk of high spinal block in parturients undergoing cesarean delivery: a retrospective cohort study. J Anesth 31, 552–558 (2017). https://doi.org/10.1007/s00540-017-2352-0

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  • DOI: https://doi.org/10.1007/s00540-017-2352-0

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