Anesthesia complications during scheduled cesarean delivery for morbidly obese women.
OBJECTIVE
We sought to estimate the morbidity associated with regional anesthesia in morbidly obese women undergoing scheduled cesarean delivery.


METHODS
This was a retrospective cohort study of women undergoing elective scheduled cesarean delivery from September 2004 through December 2008.


RESULTS
A total of 142 morbidly obese, 251 overweight and obese, and 185 normal-weight women met inclusion criteria. Differences between groups were identified regarding: complicated placement (5.6%, 2.8%, and 0%, respectively; P = .007), failure to establish (2%, 0%, and 0%, respectively; P = .047), and insufficient duration (4%, 0%, and 0%, respectively; P = .02) of regional anesthesia. The groups differed in the frequency of general anesthesia (6%, 0%, and 0%, respectively; P = .003), intraoperative hypotension (3%, 0%, and 0%, respectively; P = .01), and overall anesthetic complications (8.4%, 0%, and 0%, respectively; P < .0001). Prepregnancy body mass index > or = 40 kg/m(2) (receiver operating characteristic area under the curve, 0.856; positive likelihood ratio, 4.0) and delivery body mass index > or = 45 kg/m(2) (receiver operating characteristic area under the curve, 0.877; positive likelihood ratio, 4.1) were predictive of anesthetic complications.


CONCLUSIONS
Morbidly obese women have significant risk for anesthesia complications during cesarean delivery.
Vricella
Laura K
LK
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
Louis
Judette M
JM
Mercer
Brian M
BM
Bolden
Norman
N
D000700:Analgesics / Q000627:therapeutic use; D000765:Anesthesia, Conduction / Q000009:adverse effects*; D000768:Anesthesia, General / Q000009:adverse effects*; D015992:Body Mass Index; D002585:Cesarean Section; D015331:Cohort Studies; D004363:Drug Utilization; D005260:Female; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007431:Intraoperative Complications; D007649:Ketamine / Q000627:therapeutic use; D016013:Likelihood Functions; D009767:Obesity, Morbid / Q000150:complications*; D051299:Post-Dural Puncture Headache / Q000209:etiology; D011247:Pregnancy; D012372:ROC Curve; D012189:Retrospective Studies; D013997:Time Factors
D000700:Analgesics; D007649:Ketamine