Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Anesthesiology
Published in: BMC Anesthesiology 1/2015

Open Access 01-12-2015 | Research article

What is the failure rate in extending labour analgesia in patients with a body mass index ≥ 40 kg/m2compared with patients with a body mass index < 30 kg/m2? a retrospective pilot study

Authors: Victoria A. Eley, Andre van Zundert, Leonie Callaway

Published in: BMC Anesthesiology | Issue 1/2015

Login to get access

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/m2, to those with a BMI < 30 kg/m2. 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/m2 and 23.9 (3.0) kg/m2 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/m2 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.
Literature
1.
Soens MA, Birnbach DJ, Ranasinghe JS, van Zundert A. Obstetric anesthesia for the obese and morbidly obese patient: an ounce of prevention is worth more than a pound of treatment. Acta Anaesthesiol Scand. 2008;52(1):6–19.CrossRefPubMed
2.
Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia. United States of America: American Society of Anesthesiologists; 2007.
3.
4.
5.
Davies GAL, Maxwell C, McLeod L, Gagnon R, Basso M, Bos H, et al. SOGC Clinical Practice Guidelines: Obesity in pregnancy. No. 239, February 2010. Int J Gynaecol Obstet. 2010;110(2):167–73.CrossRefPubMed
6.
Dresner M, Brocklesby J, Bamber J. Audit of the influence of body mass index on the performance of epidural analgesia in labour and the subsequent mode of delivery. BJOG. 2006;113(10):1178–81.CrossRefPubMed
7.
Saravanakumar K, Rao SG, Cooper GM. The challenges of obesity and obstetric anaesthesia. Curr Opin Obstet Gynecol. 2006;18(6):631–5.CrossRefPubMed
8.
Mace HS, Paech MJ, McDonnell NJ. Obesity and obstetric anaesthesia. Anaesth Intensive Care. 2011;39(4):559–70.PubMed
9.
Bauer ME, Kountanis JA, Tsen LC, Greenfield ML, Mhyre JM. Risk factors for failed conversion of labor epidural analgesia to cesarean delivery anesthesia: a systematic review and meta-analysis of observational trials. Int J Obstet Anesth. 2012;21(4):294–309.CrossRefPubMed
10.
Campbell DC, Tran T. Conversion of epidural labour analgesia to epidural anesthesia for intrapartum Cesarean delivery. Can J Anaesth. 2009;56(1):19–26.CrossRefPubMed
11.
Halpern SH, Soliman A, Yee J, Angle P, Ioscovich A. Conversion of epidural labour analgesia to anaesthesia for Caesarean section: a prospective study of the incidence and determinants of failure. Br J Anaesth. 2009;102(2):240–3.CrossRefPubMed
12.
Orbach-Zinger S, Friedman L, Avramovich A, Ilgiaeva N, Orvieto R, Sulkes J, et al. Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section. Acta Anaesthesiol Scand. 2006;50(8):1014–8.CrossRefPubMed
13.
Lee S, Lew E, Lim Y, Sia AT. Failure of augmentation of labor epidural analgesia for intrapartum cesarean delivery: a retrospective review. Anesth Analg. 2009;108(1):252–4.CrossRefPubMed
14.
Hillyard SG, Bate TE, Corcoran TB, Paech MJ, O'Sullivan G. Extending epidural analgesia for emergency Caesarean section: a meta-analysis. Br J Anaesth. 2011;107(5):668–78.CrossRefPubMed
15.
Bamgbade O, Khalaf W, Ajai O, Sharma R, Chidambaram V, Madhavan G. Obstetric anaesthesia outcome in obese and non-obese parturients undergoing caesarean delivery: an observational study. Int J Obstet Anesth. 2009;18(3):221–5.CrossRefPubMed
16.
17.
Pan PH, Bogard TD, Owen MD. Incidence and characteristics of failures in obstetric neuraxial analgesia and anesthesia: a retrospective analysis of 19,259 deliveries. Int J Obstet Anesth. 2004;13(4):227–33.CrossRefPubMed
18.
Raising the standard. A compendium of audit receipes. 3rd ed. United Kingdom: Royal College of Anaesthetists; 2012. p. 220–1.
19.
20.
Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. Am J Respir Crit Care Med. 2007;175(7):661–6.CrossRefPubMedPubMedCentral
21.
O'Brien PE, Dixon JB, Brown W, Schachter LM, Chapman L, Burn AJ, et al. The laparoscopic adjustable gastric band (Lap-Band®): a prospective study of medium-term effects on weight, health and quality of life. Obes Surg. 2002;12(5):652–60.CrossRefPubMed
22.
Chu SY, Callaghan WM, Kim SY, Schmid CH, Lau J, England LJ, et al. Maternal obesity and risk of gestational diabetes mellitus. Diabetes Care. 2007;30(8):2070–6.CrossRefPubMed
23.
Garry M, Davies S. Failure of regional blockade for caesarean section. Int J Obstet Anesth. 2002;11(1):9–12.CrossRefPubMed
24.
Kinsella SM. A prospective audit of regional anaesthesia failure in 5080 Caesarean sections. Anaesthesia. 2008;63(8):822–32.CrossRefPubMed
25.
Iwama H, Katayama T. Back skin movement also causes “walking” epidural catheter. J Clin Anesth. 1999;11(2):140–1.CrossRefPubMed
26.
Gorman D, Birnbach D. In: Cousins M, Phillip B, editors. Cousins and Bridenbaugh's neural blockade in clinical anesthesia and pain medicine. Fourth ed.: Lippincott Williams & Wilkins; 2009. p. 544–5.
27.
Knight M. Extreme obesity in pregnancy in the United Kingdom. Obstet Gynecol. 2010;115(5):989–97.CrossRefPubMed
28.
Perlow JH, Morgan MA. Massive maternal obesity and perioperative cesarean morbidity. Am J Obstet Gynecol. 1994;170(2):560–5.CrossRefPubMed
29.
Hood DD, Dewan DM. Anesthetic and obstetric outcome in morbidly obese parturients. Anesthesiology. 1993;79(6):1210–8.CrossRefPubMed
30.
Orbach-Zinger S, Friedman L, Avramovich A, Ilgiaeva N, Orvieto R, Sulkes J, et al. Risk factors for failure to extend labor epidural analgesia to epidural anesthesia for Cesarean section. Acta Anaesthesiol Scand. 2006;50(7):793–7.CrossRefPubMed
Metadata
Title
What is the failure rate in extending labour analgesia in patients with a body mass index ≥ 40 kg/m2compared with patients with a body mass index < 30 kg/m2? a retrospective pilot study
Authors
Victoria A. Eley
Andre van Zundert
Leonie Callaway
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Anesthesiology / Issue 1/2015
Electronic ISSN: 1471-2253
DOI
https://doi.org/10.1186/s12871-015-0095-8

Other articles of this Issue 1/2015

BMC Anesthesiology 1/2015 Go to the issue

Research article

Continuous central venous oxygen saturation assisted intraoperative hemodynamic management during major abdominal surgery: a randomized, controlled trial

Research article

Agreement of measured and calculated serum osmolality during the infusion of mannitol or hypertonic saline in patients after craniotomy: a prospective, double-blinded, randomised controlled trial

Case report

Sudden hypoxemia after uneventful laparoscopic cholecystectomy: another form of SAM presentation

Research article

Preoperative and postoperative analgesic techniques in the treatment of patients undergoing transabdominal hysterectomy: a preliminary randomized trial

Research article

Temperature control in critically ill patients with a novel esophageal cooling device: a case series

Research article

Computerized physician order entry of a sedation protocol is not associated with improved sedation practice or outcomes in critically ill patients