Key result
Parturients with a BMI > 45 kg/m2 experienced significantly more hypotensive episodes (5.98 vs 3.28) and required higher doses of vasopressors compared to those with a BMI < 30 kg/m2.
Why the study?
It remains controversial whether the dose of spinal hyperbaric bupivacaine should be further reduced in obese parturients undergoing cesarean delivery.
Does BMI affect vasopressor requirements and block height in parturients receiving 12.5 mg hyperbaric bupivacaine for elective cesarean section?
Cohort (n=120)
Single-blind
No
Does BMI affect vasopressor requirements and block height in parturients receiving 12.5 mg hyperbaric bupivacaine for elective cesarean section?
Absolute Event Rate: 5.98% vs 3.28%
p-value: p=<0.001
A standard dose of 12.5 mg hyperbaric bupivacaine for spinal anesthesia in cesarean section causes significantly more hypotension and requires more vasopressors in parturients with BMI > 45 kg/m2 compared to those with lower BMI.
May prompt closer hemodynamic monitoring in super-obese parturients; leaves open whether BMI-specific vasopressor protocols improve outcomes.
Background: There is a debate about the dose of hyperbaric bupivacine for spinal anesthesia for cesarean delivery in obese parturients. While it is concessive that the dose of spinal bupivacine is reduced in pregnant compared with non-pregnant parturient due to many factors. But it is still controversial whether local anesthetic should further reduce in obese patients or not. In this perspective, observation study, we tested the influence of BMI on vasopressor requirements and block height. Methods: Three groups of 40 parturients, group A (Body mass index (BMI) 2), group B (BMI 30 - 45 Kg/m2) and group C (BMI > 45 kg/m2) requiring elective cesarean section were recruited all patients received 12.5 mg subarachnoid hyperbaric bupivacine combined with 20 ug fentanyl. Dermatomal levels were assessed after subarachnoid injection using touch sensation at 2 minutes interval for first 10 minutes then every 5 minutes. Vasopressor requirements in the first 45 minutes after subarachnoid injection, and maximum block heights using touch sensation were assessed as primary outcomes. Secondary outcomes were extent of motor block (peak flow rate), technique difficulty (number of attempts), maternal side effects and neonatal outcomes. Results: There was no significant difference in mean blood pressure (MBP) between group A and B but the difference was significant in group C in relation to other two groups, mean number of hypotensive episodes was significantly higher in group C than group A, B with no significant difference in incidence between group A and B (P 2 with no need for dose reduction but caution and dose adjustment recommended in parturients with BMI > 45 Kg/m2.
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Mohamed Fouad Mohamed Elmeliegy (2020) conducted a cohort in Elective Cesarean Section (n=120). Body Mass Index > 45 kg/m2 vs. Body Mass Index < 45 kg/m2 was evaluated on Mean number of hypotensive episodes in the first 45 minutes after subarachnoid injection (p=<0.001). Parturients with a BMI > 45 kg/m2 experienced significantly more hypotensive episodes (5.98 vs 3.28) and required higher doses of vasopressors compared to those with a BMI < 30 kg/m2.
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