الفهرس 
IntroductionOnly 14 pages are availabe for public view
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Abstract
In an area of anaesthetic practice with high medico-legal liability, Obstetric anaesthesiologists strive to make childbirth, including caesarean delivery, safer and less painful.
Ante-partum complications of obesity may largely account for higher cesarean delivery rate. Maternal obesity itself influences the route of delivery, independent of co-morbid conditions.
Obese pregnant women have increased morbidity & mortality associated with caesarean delivery and general anaesthesia for caesarean delivery in particular, especially in the emergency setting. This awareness, together with a reported safety of regional anaesthesia, was responsible for the move towards more use of regional anaesthesia for caesarean section.
Regional anaesthesia for caesarean section allows the parturient to be awake to enjoy the birthing experience, significantly lowers estimated maternal blood loss, causes less drowsiness, nausea and respiratory depression, and allows earlier normalization of bowel motility & improved pulmonary function with reduced hospital stay.
Compared to epidural anaesthesia, spinal anaesthesia offers simple, fast and reliable block of all the nerves, which allows neuraxial anaesthesia in urgent Caesarean sections, with smaller doses of local anaesthetics reducing the risks of systemic toxicity to zero. With longer total operating room times for epidural blocks & a higher complication rate of epidurals in obese patients, spinal blocks are more cost-effective. When both techniques were compared in a systematic review, there was no significant difference in the need for additional intra-operative analgesia, need for conversion to general anaesthesia or maternal satisfaction.
Prediction and control of local anesthetics spread in the cerebrospinal fluid is crucial in the obese patients; inadequate spread of local anesthetics which fails to provide a satisfactory surgical condition, or contrarily, an excessively high block, will threaten to expose patients to general anaethesia with its drawbacks.
It is often said that raised intra-abdominal pressure, (such as with obesity or pregnancy), increases blood flow through the epidural veins, which then distend and compress the theca to decrease CSF volume & produce more extensive neuraxial blockade through diminished dilution of anesthetic.
In this research we investigated the relationship of each of BMI and abdominal circumference with the sensory level of spinal anaesthesia in obstetric patients during caesarean section.
Eighty adult parturients, presenting to Ain Shams University hospitals, scheduled for caesarean section under spinal anaesthesia, were chosen and divided into two equal groups according to BMI:
Study group (group S) (n = 40): With BMI equal to or greater than 30 Kg/m2. All were ASA physical status I or II and all were at term.
Control group (group C) (n = 40): With BMI less than 30 Kg/m2.All were ASA physical status I or II and all were at term.
All the patients were anaesthetized under an aseptic technique then, the highest cephalad spread (upper level of sensory blockage) was determined by the pinprick at mid-axillary line after intrathecal injection of the anaesthetic mixture.
Data were calculated and comparison between both groups was done.
Both groups showed no significant statistical difference as regards age, parity, gestational age, and ASA status so they were considered as matched groups).
Body mass index and abdominal circumference were 32.35 ± 1.2 Kg/m2 and 120.2± 4.4 Cm in group (S), and 27.83 ± 1.01 Kg/m2 and 106.7± 5.65 Cm in group (C) with highly significant statistical difference.
There was nonsignificant statistical difference as regards amount of preload fluids given for both groups.
Both groups showed nonsignificant statistical difference as regards baseline measurement of systolic blood pressure (SBP) (before starting spinal anaesthesia), but SBP values were significantly lower in (group S) than (group C) at 4, 7, 10, 15, 20, 30 minute during spinal anaesthesia and at arrival to PACU.
Both groups showed nonsignificant statistical difference as regards baseline measurement of diastolic blood pressure ( before starting spinal anaesthesia ) , but (group S) showed significant statistical higher measurement of diastolic blood pressure at 4,7,10,15, 20, 30 minute after starting spinal anaesthesia and at arrival to PACU.
Both groups showed nonsignificant statistical difference as regards baseline measurement of mean blood pressure (MABP) (before starting spinal anaesthesia), as well as 1, 4, 10, 15, 20, 30 minute after starting spinal anaesthesia and at arrival to PACU.
Both groups showed nonsignificant statistical difference as regards baseline measurement of heart rate (HR) before starting spinal anaesthesia, but (group S) showed significant statistical higher measurement of heart rate at 1, 4, 7, 10, 15, 20, 30 minute after starting spinal anaesthesia and at arrival to PACU.
- Both groups showed nonsignificant statistical difference as regards baseline measurement of arterial oxygen saturation (before starting spinal anaesthesia), as well as 1, 4, 7, 10, 15, 20, 30 minute after starting spinal anaesthesia and at arrival to PACU.
Both groups showed non-significant statistical difference as regards fluid maintenance during spinal anaesthesia, but studied group (group (S) showed significant statistical lower measurement of urinary output during spinal anesthesia
There were no significant differences between the two groups regarding the occurrence of shivering during surgery, occurrence of epigastric discomfort during uterine manipulation or exteriorization, the occurrence of pain, the use of pethidine, midazolam or ketamine, the duration of operation the motor block achieved by spinal anaethesia.
There were no significant differences between the two groups regarding the need for and total amount of additional fluid and total dose of ephedrine required for treatment of hypotension or the need for and total dose of atropine required to treat bradycardia.
As regards sensory level during spinal anaesthesia and at arrival to PACU, both groups showed nonsignificant statistical difference.
There was no correlation between BMI and highest level of sensory block achieved by spinal anaethesia in both groups.
There was no correlation between abdominal circumference and highest level of sensory block achieved by spinal anaethesia in both groups.
In conclusion, there was no correlation between BMI or abdominal circumference of parturients and the sensory level achieved by spinal anaethesia for caesarean section.
Recommendations:
There is a need for more thorough investigation of the correlation between intra-abdominal pressure & cephalad spread by spinal anaethesia as well as CSF volume dynamics.