title: Anesthesia complications during scheduled cesarean delivery for morbidly obese women.
abstract: 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.
authors.affiliation: Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Laura K
authors.initials: LK
authors.lastname: Vricella
authors.forename: Judette M
authors.initials: JM
authors.lastname: Louis
authors.forename: Brian M
authors.initials: BM
authors.lastname: Mercer
authors.forename: Norman
authors.initials: N
authors.lastname: Bolden
mesh_terms: 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
chemical_list: D000700:Analgesics; D007649:Ketamine