Does obesity complicate regional anesthesia and result in longer decision to delivery time for emergency cesarean section?

Background Maternal obesity can cause problems with anesthesia and surgery which may be reflected in emergency cesarean sections (CS) as an increased decision‐to‐delivery interval (DDI). Aim To study the association of elevated maternal BMI with DDI and the failure of regional anesthesia. Methods Eight hundred and forty‐two consecutive emergency CSs during a period of 1 year in a tertiary hospital were studied retrospectively. DDIs were analyzed in Crash and < 30‐min urgency categories (n = 528), while the time required to establish regional anesthesia and its success were analyzed for all emergency CS cases. Results The urgency distribution of the CSs was 11%, 52%, and 37% in Crash, < 30‐min, and > 30‐min urgency categories respectively. Increased BMI was associated with longer DDI time in the < 30‐min urgency category (33(13–176) vs. 38(18–118) min; P < 0.05 for BMI < 30 and > 35 group respectively). Regional anesthesia failures (new regional anesthesia, conversion to general anesthesia, or complaint of pain during surgery) took place in 3.7%, 6.8%, and 8.5% in the BMI < 30, 30–35, and > 35 groups respectively (P = 0.021). Epidural top‐up resulted in shorter DDI and time delay between arrival at the operating room and skin incision across all urgency and BMI groups than combined spinal epidural (CSE) anesthesia. Conclusion Higher BMI was associated with longer DDI and more regional anesthesia failures. Epidural top‐up was faster than CSE for establishing CS anesthesia.