Maternal obesity increases anesthesia complication at Cesarean Delivery(CD). We sought to evaluate the contribution of technical factors to anesthesia complications during scheduled CD.METHODS:
All patients undergoing scheduled CD under spinal anesthesia at 37-41 weeks from 2015-2017 were included. Exclusion criteria included planned general anesthesia. Primary outcome was total spinal procedure time. Secondary outcomes: number of spinal placement attempts, spinal needle > 3.5 inches, failed placement of spinal with conversion to general anesthesia, high spinal blockade, and additional intravenous analgesics.RESULTS:
Of 575 included patients, 131 (23%) had BMI <30 kg/m2 (Group I), 275 (48%) had BMI 30.0-39.9 kg/m2 (Group II), and 169 (29%) had BMI > 40.0 kg/m2 (Group III). Total spinal time increased with BMI (I:5±4 min, II:6±9 min, III:8±7 min, P < .01). More than 1 spinal placement attempt was more frequent among obese patients [I:7/122 (6%), II:27/248 (11%), III:36/157 (23%), P < .001], as was needle length > 3.5 cm [I:2/122 (2%) vs. II:13/238(6%), III:39/158(25%), P = .04]. More obese patients required additional intravenous analgesics [I:12(9%), II: 31(11%), III:20(12%), P = .03] to complete the surgery. Failed placement of spinal with conversion to general (n = 3,2,2, P = 1) and high spinal blockade (n = 0,2,2, P = 1) were both uncommon and similar between groups.CONCLUSION:
Although spinal anesthesia placement was more complicated among obese patients, the incidence of serious anesthesia complications remained low. Spinal anesthesia remains an acceptable choice for scheduled CD in obese patients.