Tags

Type your tag names separated by a space and hit enter

Comparison of perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section.
Ann Med. 2023 Dec; 55(1):1037-1046.AM

Abstract

OBJECTIVE

To compare the perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section.

METHODS

A retrospective analysis of 6 years of data was performed. Exclusions were cases with gestational ages <24 weeks, placenta accreta spectrum, polyhydramnios, or multiple gestations.

RESULTS

The study included 494 patients whose body mass index (BMI) exceeded 40 kg/m2 at delivery. Of these, 469 were morbidly obese (BMI 40-49.9; mean, 42.9 ± 2.4), and 25 were super obese (BMI >50; mean, 54.5 ± 4.2). Twenty-four (5.1%) morbidly obese women received general anesthesia. The other 445 patients (94.9%) in the morbid obesity group underwent cesarean delivery under regional anesthesia; however, some (2.2%; 10/445) received general anesthesia after regional anesthesia failed. In the super-obesity group, 23 patients (92.0%) received regional anesthesia, while two patients (8.0%) received general anesthesia. There were no cases of pulmonary aspiration, maternal deaths, or difficult or failed intubation. There was one episode of cardiac arrest in a patient with a BMI of 47.9. Among the morbidly obese and super-obese women given regional anesthesia, the super-obese patients had significantly greater volumes of ephedrine and norepinephrine consumption (p = 0.027 and 0.030), intravenous fluids (p = 0.006), and bleeding during surgery (p = 0.017). They also had more hypotensive episodes (p = 0.038). The two groups' incidences of neonatal birth asphyxia, postpartum hemorrhage, blood transfusion, and uterine atony did not differ significantly. The lengths of stay in the hospital were also comparable.

CONCLUSIONS

Among the women receiving regional anesthesia, the super-obese parturients had greater intraoperative bleeding, a higher proportion of hypotensive episodes, and a greater vasopressor requirement than the morbidly obese parturients. Anesthesiologists must prepare for the adverse perioperative events that such women risk experiencing during a delivery by cesarean section.

www.clinicaltrials.gov ID: NCT04657692.

Links

PMC Free PDF

Authors+Show Affiliations

Nivatpumin P
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Lertbunnaphong T
Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Maneewan S
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
Vittayaprechapon N
Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.

MeSH

FemaleHumansInfantInfant, NewbornPregnancyAnesthesia, EpiduralAnestheticsBody Mass IndexCesarean SectionObesity, MorbidRetrospective Studies

Pub Type(s)

Clinical Trial
Comparative Study
Journal Article

Language

eng

PubMed ID

36947155

Clinical Trial Links

Clinical trial which this article describes

Citation

Nivatpumin, Patchareya, et al. "Comparison of Perioperative Outcomes and Anesthetic-related Complications of Morbidly Obese and Super-obese Parturients Delivering By Cesarean Section." Annals of Medicine, vol. 55, no. 1, 2023, pp. 1037-1046.
Nivatpumin P, Lertbunnaphong T, Maneewan S, et al. Comparison of perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section. Ann Med. 2023;55(1):1037-1046.
Nivatpumin, P., Lertbunnaphong, T., Maneewan, S., & Vittayaprechapon, N. (2023). Comparison of perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section. Annals of Medicine, 55(1), 1037-1046. https://doi.org/10.1080/07853890.2023.2187877
Nivatpumin P, et al. Comparison of Perioperative Outcomes and Anesthetic-related Complications of Morbidly Obese and Super-obese Parturients Delivering By Cesarean Section. Ann Med. 2023;55(1):1037-1046. PubMed PMID: 36947155.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Comparison of perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section. AU - Nivatpumin,Patchareya, AU - Lertbunnaphong,Tripop, AU - Maneewan,Siritorn, AU - Vittayaprechapon,Nutha, PY - 2023/3/22/entrez PY - 2023/3/23/pubmed PY - 2023/3/25/medline KW - Anesthesia KW - cesarean delivery KW - complications KW - morbid obesity KW - perioperative outcomes KW - super obesity SP - 1037 EP - 1046 JF - Annals of medicine JO - Ann Med VL - 55 IS - 1 N2 - OBJECTIVE: To compare the perioperative outcomes and anesthetic-related complications of morbidly obese and super-obese parturients delivering by cesarean section. METHODS: A retrospective analysis of 6 years of data was performed. Exclusions were cases with gestational ages <24 weeks, placenta accreta spectrum, polyhydramnios, or multiple gestations. RESULTS: The study included 494 patients whose body mass index (BMI) exceeded 40 kg/m2 at delivery. Of these, 469 were morbidly obese (BMI 40-49.9; mean, 42.9 ± 2.4), and 25 were super obese (BMI >50; mean, 54.5 ± 4.2). Twenty-four (5.1%) morbidly obese women received general anesthesia. The other 445 patients (94.9%) in the morbid obesity group underwent cesarean delivery under regional anesthesia; however, some (2.2%; 10/445) received general anesthesia after regional anesthesia failed. In the super-obesity group, 23 patients (92.0%) received regional anesthesia, while two patients (8.0%) received general anesthesia. There were no cases of pulmonary aspiration, maternal deaths, or difficult or failed intubation. There was one episode of cardiac arrest in a patient with a BMI of 47.9. Among the morbidly obese and super-obese women given regional anesthesia, the super-obese patients had significantly greater volumes of ephedrine and norepinephrine consumption (p = 0.027 and 0.030), intravenous fluids (p = 0.006), and bleeding during surgery (p = 0.017). They also had more hypotensive episodes (p = 0.038). The two groups' incidences of neonatal birth asphyxia, postpartum hemorrhage, blood transfusion, and uterine atony did not differ significantly. The lengths of stay in the hospital were also comparable. CONCLUSIONS: Among the women receiving regional anesthesia, the super-obese parturients had greater intraoperative bleeding, a higher proportion of hypotensive episodes, and a greater vasopressor requirement than the morbidly obese parturients. Anesthesiologists must prepare for the adverse perioperative events that such women risk experiencing during a delivery by cesarean section. : www.clinicaltrials.gov ID: NCT04657692. SN - 1365-2060 UR - https://www.unboundmedicine.com/medline/citation/36947155/Comparison_of_perioperative_outcomes_and_anesthetic_related_complications_of_morbidly_obese_and_super_obese_parturients_delivering_by_cesarean_section_ DB - PRIME DP - Unbound Medicine ER -