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What is the failure rate in extending labour analgesia in patients with a body mass index ≥ 40 kg/m(2)compared with patients with a body mass index < 30 kg/m(2)? a retrospective pilot study.

Eley VA, van Zundert A, Callaway L - BMC Anesthesiol (2015)

Bottom Line: The results will be used to calculate the sample size of a planned prospective study.The combination of respiratory co-morbidity and gestational diabetes significantly predicted extension failure.The presence of respiratory co-morbidity and gestational diabetes were significant predictors of extension failure; their clinical relevance requires further evaluation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Butterfield St, Herston, 4006, Queensland, Australia. victoria_eley@health.qld.gov.au.

ABSTRACT

Background: Early utilisation of neuraxial anaesthesia has been recommended to reduce the need for general anaesthesia in obese parturients. The insertion and management of labour epidurals in obese women is not straight-forward. The aim of this pilot study was to compare the failure rate of extension of epidural analgesia for emergency caesarean section, in pregnant women with a body mass index (BMI) ≥ 40 kg/m(2), to those with a BMI < 30 kg/m(2). The results will be used to calculate the sample size of a planned prospective study.

Methods: In this retrospective, (1:1) case-control pilot study, obese subjects and control subjects were selected from the obstetric database, if they delivered between January 2007 and December 2011. All subjects used epidural analgesia during labour and subsequently required anaesthesia for Category 1 or 2 Caesarean Section. Data was extracted from the patient medical record. Failure to extend was analysed using liberal and restrictive definitions. Chi-square or Fisher's exact tests were used to detect differences between groups. Multiple logistic regression was used to examine variables predictive of extension failure.

Results: There were 63 subjects in each group. The mean BMI of the obese group was 45.4 (5.8) kg/m(2) and 23.9 (3.0) kg/m(2) in the control group. The odds ratio for failure to extend the existing epidural blockade (liberal definition) was 2.48 (95 % CI:1.02 - 6.03) for the obese group compared with the control group (adjusted for age, parity and gestation). Using the restrictive definition, the odds ratio for failure in the obese group was 6.78 (95 % CI:1.43 - 32.2). The combination of respiratory co-morbidity and gestational diabetes significantly predicted extension failure. Surgical time and epidural complications on labour ward were significantly greater in the obese group.

Conclusions: In this small retrospective cohort, patients with a BMI ≥ 40 kg/m(2) were significantly more likely to fail epidural extension for caesarean section. The presence of respiratory co-morbidity and gestational diabetes were significant predictors of extension failure; their clinical relevance requires further evaluation.

No MeSH data available.


Related in: MedlinePlus

Control Group. Flow chart of anaesthetic management in 63 women presenting for emergency caesarean section with an epidural catheter in situ, body mass index < 30 kg/m2. CS = caesarean section GA = general anaesthesia
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Fig1: Control Group. Flow chart of anaesthetic management in 63 women presenting for emergency caesarean section with an epidural catheter in situ, body mass index < 30 kg/m2. CS = caesarean section GA = general anaesthesia

Mentions: A total of 63 subjects were identified for the obese group; data was collected for 63 subjects in the control group who delivered within the same month. The mean (SD) BMI of 23.9 (3.0) kg/m2 in the control group and 45.4 (5.8) kg/m2 in the obese group. Ultrasound localisation was not utilised in any patient. Figures 1 and 2 describe the management of subjects in the obese group and control group when they presented for caesarean section with a neuraxial catheter in situ. The baseline variables and co-morbidities are shown in Table 1. Of the twenty-six obese subjects with a respiratory co-morbidity, twenty-two had a self-reported history of asthma.Fig. 1


What is the failure rate in extending labour analgesia in patients with a body mass index ≥ 40 kg/m(2)compared with patients with a body mass index < 30 kg/m(2)? a retrospective pilot study.

Eley VA, van Zundert A, Callaway L - BMC Anesthesiol (2015)

Control Group. Flow chart of anaesthetic management in 63 women presenting for emergency caesarean section with an epidural catheter in situ, body mass index < 30 kg/m2. CS = caesarean section GA = general anaesthesia
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4522121&req=5

Fig1: Control Group. Flow chart of anaesthetic management in 63 women presenting for emergency caesarean section with an epidural catheter in situ, body mass index < 30 kg/m2. CS = caesarean section GA = general anaesthesia
Mentions: A total of 63 subjects were identified for the obese group; data was collected for 63 subjects in the control group who delivered within the same month. The mean (SD) BMI of 23.9 (3.0) kg/m2 in the control group and 45.4 (5.8) kg/m2 in the obese group. Ultrasound localisation was not utilised in any patient. Figures 1 and 2 describe the management of subjects in the obese group and control group when they presented for caesarean section with a neuraxial catheter in situ. The baseline variables and co-morbidities are shown in Table 1. Of the twenty-six obese subjects with a respiratory co-morbidity, twenty-two had a self-reported history of asthma.Fig. 1

Bottom Line: The results will be used to calculate the sample size of a planned prospective study.The combination of respiratory co-morbidity and gestational diabetes significantly predicted extension failure.The presence of respiratory co-morbidity and gestational diabetes were significant predictors of extension failure; their clinical relevance requires further evaluation.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Butterfield St, Herston, 4006, Queensland, Australia. victoria_eley@health.qld.gov.au.

ABSTRACT

Background: Early utilisation of neuraxial anaesthesia has been recommended to reduce the need for general anaesthesia in obese parturients. The insertion and management of labour epidurals in obese women is not straight-forward. The aim of this pilot study was to compare the failure rate of extension of epidural analgesia for emergency caesarean section, in pregnant women with a body mass index (BMI) ≥ 40 kg/m(2), to those with a BMI < 30 kg/m(2). The results will be used to calculate the sample size of a planned prospective study.

Methods: In this retrospective, (1:1) case-control pilot study, obese subjects and control subjects were selected from the obstetric database, if they delivered between January 2007 and December 2011. All subjects used epidural analgesia during labour and subsequently required anaesthesia for Category 1 or 2 Caesarean Section. Data was extracted from the patient medical record. Failure to extend was analysed using liberal and restrictive definitions. Chi-square or Fisher's exact tests were used to detect differences between groups. Multiple logistic regression was used to examine variables predictive of extension failure.

Results: There were 63 subjects in each group. The mean BMI of the obese group was 45.4 (5.8) kg/m(2) and 23.9 (3.0) kg/m(2) in the control group. The odds ratio for failure to extend the existing epidural blockade (liberal definition) was 2.48 (95 % CI:1.02 - 6.03) for the obese group compared with the control group (adjusted for age, parity and gestation). Using the restrictive definition, the odds ratio for failure in the obese group was 6.78 (95 % CI:1.43 - 32.2). The combination of respiratory co-morbidity and gestational diabetes significantly predicted extension failure. Surgical time and epidural complications on labour ward were significantly greater in the obese group.

Conclusions: In this small retrospective cohort, patients with a BMI ≥ 40 kg/m(2) were significantly more likely to fail epidural extension for caesarean section. The presence of respiratory co-morbidity and gestational diabetes were significant predictors of extension failure; their clinical relevance requires further evaluation.

No MeSH data available.


Related in: MedlinePlus