The impact of gestational age and fetal weight on the risk of failure of spinal anesthesia for cesarean delivery.
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BACKGROUND: There are limited data about spinal dosing for cesarean delivery in preterm parturients. We investigated the hypothesis that preterm gestation is associated with an increased incidence of inadequate spinal anesthesia for cesarean delivery compared with term gestation. METHODS: We searched our perioperative database for women who underwent cesarean delivery under spinal or combined spinal-epidural anesthesia with hyperbaric bupivacaine ⩾10.5mg. The primary outcome was the incidence of inadequate surgical anesthesia needing conversion to general anesthesia or repetition or supplementation of the block. We divided patients into four categories: <28, 28 to <32, 32 to <37 and ⩾37weeks of gestation. The chi-square test was used to compare failure rates and a multivariable regression analysis was performed to investigate potential confounders of the relationship between gestational age and failure. RESULTS: A total of 5015 patients (3387 term and 1628 preterm) were included. There were 278 failures (5.5%). The incidence of failure was higher in preterm versus term patients (6.4% vs. 5.1%, P=0.02). Failure rates were 10.8%, 7.7%, 5.3% and 5% for <28, 28 to <32, 32 to <37 and ⩾37weeks of gestation, respectively. In the multivariable model, low birth weight (P<0.0001), gestational age (P=0.03), ethnicity (P=0.02) and use of combined spinal-epidural anesthesia (P<0.0001) were significantly associated with failure. CONCLUSIONS: At standard spinal doses of hyperbaric bupivacaine used in our practice (⩾10.5mg), there were higher odds of inadequate surgical anesthesia in preterm parturients. When adjusting for potential confounders, low birth weight was the main factor associated with failure.
Published Version (Please cite this version)10.1016/j.ijoa.2016.01.007
Publication InfoAdesope, O; Einhorn, Lisa; Olufolabi, Adeyemi John; Cooter, Mary; & Habib, Ashraf Samir (2016). The impact of gestational age and fetal weight on the risk of failure of spinal anesthesia for cesarean delivery. Int J Obstet Anesth, 26. pp. 8-14. 10.1016/j.ijoa.2016.01.007. Retrieved from https://hdl.handle.net/10161/12959.
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Assistant Professor of Anesthesiology
Professor of Anesthesiology
Postoperative nausea and vomiting. Acute postoperative pain Optimizing hemodynamic support during cesarean section performed under neuraxial anesthesia Prevention of nausea and vomiting during and after cesarean section performed under neuraxial anesthesia Predictors of severe acute pain and persistent pain following breast surgeryRisk factors for postoperative respiratory depression
Professor of Anesthesiology
My interests include obstetric and gynecological anesthesia research. This includes the use of opioids in obstetric population. I also have an interest in the management of the difficult airway in general anesthesia and in the Obstetric population. More recently, I have been engaged in global health and the role of anesthesia in resolving the disparity gap. I have a particular interest in anesthesia in sub-sahara Africa and have been involved in capacity building, research and educat
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