Anaesthesia for caesarean delivery in women with class 3 obesity: a retrospective cohort study from the north-west of England (2022–2023)

IF 2.6 3区医学 Q2 ANESTHESIOLOGY

International journal of obstetric anesthesia Pub Date : 2025-02-13 DOI:10.1016/j.ijoa.2025.104343

K. Bhatia , M. Columb , B. Roberts , K. Turner , E. Coffey , H. Moxon , M. Baker , C. Pollington , J. Lie , S. Dixon , W. Musselbrook , M. Hulgur , T. Markey , S. Kumari , M. Burrow , A. Sashankar , on behalf of Group of Obstetric Anesthetists of Lancashire, Greater Manchester, Mersey GOAL-GM Study Collaborators

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Abstract

Background

The Royal College of Anaesthetists (RCOA) and the Royal College of Obstetricians and Gynaecologists (RCOG) have recommended standards for pregnant women with a body mass index (BMI) ≥40 kg/m². These include achieving specified rates for neuraxial anaesthesia and conversion from neuraxial to general anaesthesia (GA) during caesarean delivery (CD), 100% attendance at the anaesthesia antenatal clinic, re-weighing in the third trimester, and anaesthesia provision by a specialty trainee year 6 (ST6) or above.

Methods

Records of 760 women with BMI ranging from 40.0-49.99 kg/m² (89.7%), 50.0–59.99 kg/m² (8.9%) and ≥ 60 kg/m² (1.4%) undergoing a CD were reviewed across nine maternity units in the north-west of England. We aimed to analyse the variations in anaesthetic technique across the BMI cohorts, assess adherence with the proposed standards and explore the documented incidence of pain during CD (PDCD).

Results

Neuraxial anaesthesia was successfully utilised in 92.6% women. Spinal anaesthesia rates declined as BMI increased from ≥40–49.99 kg/m² (81.1%) to ≥50–59.99 kg/m² (67.2%) to ≥60 kg/m² (45.5%), (P =0.0001), whilst combined spinal epidural (CSE) use increased (4% vs 19.4% vs 45.5%, P <0.0001). No differences were observed in the primary GA (3.7%; P =0.12) or the neuraxial to GA conversion rates (3.8%; P =0.54) across the BMI cohorts. The neuraxial anaesthesia standards for all CD categories were met by at least 66.7% of all hospitals, whilst the neuraxial to GA conversion standards for elective CD were met by only 33.3%. PDCD was documented in 6.1% and only 24.9% of women were re-weighed in the third trimester. Anaesthetic clinic attendance was recorded in 57% whilst a ST6 or above provided anaesthesia to 87.1% of women.

Conclusion

As BMI increases, anaesthetists tend to favour a CSE technique over spinal anaesthesia. Maternity units found it challenging to comply with the specified RCOA/RCOG standards.

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来源期刊

International journal of obstetric anesthesia 医学-妇产科学

CiteScore

4.70

自引率

7.10%

发文量

285

审稿时长

58 days

期刊介绍： The International Journal of Obstetric Anesthesia is the only journal publishing original articles devoted exclusively to obstetric anesthesia and bringing together all three of its principal components; anesthesia care for operative delivery and the perioperative period, pain relief in labour and care of the critically ill obstetric patient. • Original research (both clinical and laboratory), short reports and case reports will be considered. • The journal also publishes invited review articles and debates on topical and controversial subjects in the area of obstetric anesthesia. • Articles on related topics such as perinatal physiology and pharmacology and all subjects of importance to obstetric anaesthetists/anesthesiologists are also welcome. The journal is peer-reviewed by international experts. Scholarship is stressed to include the focus on discovery, application of knowledge across fields, and informing the medical community. Through the peer-review process, we hope to attest to the quality of scholarships and guide the Journal to extend and transform knowledge in this important and expanding area.