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.





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Adesope, OA, LM Einhorn, AJ Olufolabi, M Cooter and AS Habib (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

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Lisa Einhorn

Assistant Professor of Anesthesiology

Through my clinical expertise as a pediatric anesthesiologist and pain specialist, I am reminded every day of the challenges our pediatric patients and their families face when undergoing a surgical procedure. Acute pain management in pediatrics is associated with numerous age-specific complexities, and unfortunately, many interventions that are easily accessible in adults remain out of reach for children due to lack of clinical knowledge and missing pharmacologic data. I am passionate about advancing our understanding of existing and novel analgesics to provide safe, effective, and precision therapeutics for children in the perioperative period. My work is largely focused on developing innovative approaches to address acute perioperative pain in children, reviewing opioid pharmacology and utilization, and improving functional outcomes after surgery through interventional clinical trials. 


Adeyemi John Olufolabi

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 educational endeavors in that sphere.


Ashraf Samir Habib

Professor of Anesthesiology

Ashraf Habib is a Professor of Anesthesiology, Professor in Obstetrics and Gynecology and Chief of the Division of Women’s Anaesthesia at Duke University Medical Center. He received his medical degree from Ain Shams University in Cairo, Egypt. He completed his anesthetic training in the UK, subsequently finished fellowship training in Obstetric Anesthesia at Duke University Medical Center and stayed there as faculty. He has published over 250 peer-reviewed manuscripts, book chapters and editorials. His research interests include enhanced recovery after surgery including cesarean delivery, optimizing labor analgesia and postoperative outcomes such as postoperative pain and postoperative nausea and vomiting, persistent pain after surgery and optimizing hemodynamic management of women undergoing caesarean delivery. Dr. Habib is currently a senior Editor for Anesthesia and Analgesia and is on the Editorial Board of the International Journal of Obstetric Anesthesia and BJA Education. He has also been a member of the expert panel that generated the ASER/SAMBA consensus guidelines for the management of postoperative nausea and vomiting, the Society for Obstetric Anesthesia and Perinatology (SOAP) consensus statement and recommendations for enhanced recovery after cesarean delivery, the SOAP consensus statement for respiratory monitoring after neuraxial morphine administration for caesarean delivery analgesia, and the SASM/SOAP guidelines for the screening, diagnosis and treatment of obstructive sleep apnea during pregnancy. He is currently the Chair of SOAP research Committee and serves on SOAP’s Board of Directors.

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