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The impact of gestational age and fetal weight on the risk of failure of spinal anesthesia for cesarean delivery.

dc.contributor.author Adesope, OA
dc.contributor.author Einhorn, LM
dc.contributor.author Olufolabi, AJ
dc.contributor.author Cooter, M
dc.contributor.author Habib, AS
dc.coverage.spatial Netherlands
dc.date.accessioned 2016-10-19T12:46:13Z
dc.date.issued 2016-05
dc.identifier http://www.ncbi.nlm.nih.gov/pubmed/27020240
dc.identifier S0959-289X(16)00028-5
dc.identifier.uri https://hdl.handle.net/10161/12959
dc.description.abstract 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.
dc.language eng
dc.publisher Elsevier BV
dc.relation.ispartof Int J Obstet Anesth
dc.relation.isversionof 10.1016/j.ijoa.2016.01.007
dc.subject Anesthesia
dc.subject Cesarean delivery
dc.subject Combined spinal-epidural
dc.subject Failed anesthesia
dc.subject Gestation age
dc.subject Spinal
dc.title The impact of gestational age and fetal weight on the risk of failure of spinal anesthesia for cesarean delivery.
dc.type Journal article
duke.contributor.id Einhorn, LM|0595130
duke.contributor.id Olufolabi, AJ|0188327
duke.contributor.id Habib, AS|0272049
pubs.author-url http://www.ncbi.nlm.nih.gov/pubmed/27020240
pubs.begin-page 8
pubs.end-page 14
pubs.organisational-group Anesthesiology
pubs.organisational-group Anesthesiology, Pediatrics
pubs.organisational-group Anesthesiology, Women's
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Duke
pubs.organisational-group Global Health Institute
pubs.organisational-group Institutes and Provost's Academic Units
pubs.organisational-group Obstetrics and Gynecology
pubs.organisational-group School of Medicine
pubs.organisational-group University Institutes and Centers
pubs.publication-status Published
pubs.volume 26
dc.identifier.eissn 1532-3374
duke.contributor.orcid Olufolabi, AJ|0000-0001-8902-7805
duke.contributor.orcid Habib, AS|0000-0002-0289-7793|0000-0002-6980-1856


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