Impact of spinal anaesthesia and obesity on maternal respiratory function during elective Caesarean section*

Ungern‐Sternberg, Britta S. von; Regli, Adrian; Bucher, Evelyne; Reber, A.; Schneider, Markus

doi:10.1111/j.1365-2044.2004.03832.x

Cited by 60 publications

(42 citation statements)

References 26 publications

(53 reference statements)

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“…This is consistent with observations made in parturients receiving spinal anaesthesia for elective Caesarean section [10].…”

Section: Effect Of Obesitysupporting

confidence: 92%

Impact of spinal anaesthesia on peri‐operative lung volumes in obese and morbidly obese female patients*

Regli¹,

Ungern‐Sternberg²,

Reber

et al. 2006

Anaesthesia

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SummaryAlthough obesity predisposes to postoperative pulmonary complications, data on the relationship between body mass index (BMI) and peri-operative respiratory performance are limited. We prospectively studied the impact of spinal anaesthesia, obesity and vaginal surgery on lung volumes measured by spirometry in 28 patients with BMI 30-40 kg.m )2 and in 13 patients with. Vital capacity, forced vital capacity, forced expiratory volume in 1 s, midexpiratory and peak expiratory flows were measured during the pre-operative visit (baseline), after effective spinal anaesthesia with premedication, and after the operation at 20 min, 1 h, 2 h, and 3 h (after mobilisation). Spinal anaesthesia and premedication were associated with a significant decrease in spirometric parameters. Spinal anaesthesia and premedication were associated with a significant decrease in spirometric parameters; mean (SD) vital capacities were ) 19% (6.4) in patients with BMI 30-40 kg.m )2 and ) 33% (9.0) in patients with BMI > 40 kg.m )2. The decrease of lung volumes remained constant for 2 h, whereas 3 h after the operation and after mobilisation, spirometric parameters significantly improved in all patients. This study showed that both spinal anaesthesia and obesity significantly impaired peri-operative respiratory function.

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“…This is consistent with observations made in parturients receiving spinal anaesthesia for elective Caesarean section [10].…”

Section: Effect Of Obesitysupporting

confidence: 92%

Impact of spinal anaesthesia on peri‐operative lung volumes in obese and morbidly obese female patients*

Regli¹,

Ungern‐Sternberg²,

Reber

et al. 2006

Anaesthesia

Self Cite

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“…In a cohort of patients with prolonged desaturations, Taenzer et al found that manual recordings of SpO 2 were higher than those recorded by the automated system by 6.5% on average, and did not reflect physiologic patient state when compared with continuous automated sampling (22). However, at the time of our study, such automated continuous monitoring of SpO 2 was not yet available at our obstetric operating theatre.…”

Section: Discussionmentioning

confidence: 47%

“…It can be envisaged that spinal anaesthesia in an obese patient may contribute to further deterioration of respiratory function (2,3).…”

Section: Introductionmentioning

confidence: 99%

“…In the third patient, desaturation resolved spontaneously as normotension was restored, and no oxygen therapy was administered. All three newborns recorded Apgar scores of 9/10 despite a lower umbilical cord pH and higher PCO 2 Six patients, two of whom in the obese group, received rescue oxygen therapy following intraoperative events such as deteriorating SpO in UA and UV compared to the general pool. 2 or hypotension.…”

mentioning

confidence: 99%

“…All three newborns recorded Apgar scores of 9/10 despite a lower umbilical cord pH and higher PCO 2 Six patients, two of whom in the obese group, received rescue oxygen therapy following intraoperative events such as deteriorating SpO in UA and UV compared to the general pool. 2 or hypotension. Five of these episodes occurred within 15 minutes following neuraxial blockade.…”

mentioning

confidence: 99%

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Incidence of Maternal Desaturation among Patients Undergoing Elective Caesaraen Section under Regional Anaesthesia

Yee¹

2017

JSA

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This was a prospective observational study to identify the incidence and possible risk factors for maternal desaturation following neuraxial blockade for elective caesarean section (CS). Patients with body mass index (BMI) ≥ 30 kg/m 2 at the first antenatal consultation were identified and classified into the obese group. Neuraxial blockade in the form of subarachnoid block (SAB) or combined spinal-epidural (CSE) was performed. Mean arterial pressure (MAP) and oxygen saturation (SpO 2 ) were recorded at baseline and at 5-minute intervals following neuraxial blockade. Desaturation, defined as SpO 2 < 94% for more than 30 seconds without artifacts, was managed with oxygen therapy and other appropriate measures. Newborn Apgar score and umbilical cord blood gases were analysed. Among a total of 254 recruited patients, 69 (27.2%) were obese and were associated with significantly higher age, parity, previous CS and pre-existing diabetes mellitus. The incidence of oxygen desaturation was 1.2%, involving three patients in the non obese group. These desaturation episodes were short-lived and associated with intraoperative hypotension. Six patients, two of whom in the obese group, received rescue oxygen therapy following intraoperative events such as deteriorating SpO 2 or hypotension. The mean MAP was significantly lower at baseline and at 5 minutes post neuraxial blockade in the non obese group, which could account for the occurrence of desaturation in this group only. There were no significant inter-group differences in terms of neonatal outcome, umbilical cord blood gases and changes in mean SpO 2 post neuraxial blockade. In conclusion, the current practice of not routinely giving supplementary oxygen to patient during elective CS at our institution is deemed to be safe, provided continuous SpO 2 monitoring is available throughout the surgery. Further randomised clinical trials are indicated to investigate the impact of maternal obesity and of labouring patients presenting for urgent or emergency CS on intraoperative oxygen desaturation.

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Pulmonary Disease in Pregnancy

Larson

Mehta

Paglia

et al. 2010

De Swiet's Medical Disorders in Obstetric Practice

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Impact of spinal anaesthesia and obesity on maternal respiratory function during elective Caesarean section*

Cited by 60 publications

References 26 publications

Impact of spinal anaesthesia on peri‐operative lung volumes in obese and morbidly obese female patients*

Impact of spinal anaesthesia on peri‐operative lung volumes in obese and morbidly obese female patients*

Incidence of Maternal Desaturation among Patients Undergoing Elective Caesaraen Section under Regional Anaesthesia

Pulmonary Disease in Pregnancy

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