Relationship of abdominal circumference and trunk length with spinal anesthesia level in the term parturient

Lee, Yi-Hui; Wang, Yi-Chia; Wang, Manling; Lin, Pei-Lin; Huang, Cheng‐Han; Huang, Hui-Hsun

doi:10.1007/s00540-013-1715-4

Cited by 16 publications

(27 citation statements)

References 13 publications

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“…Lee et al . found that parturients with low trunk length/(abdominal circumference) 2 values tended to have higher dermatomal levels during spinal anesthesia [ 15 ]. Therefore, a higher identified intervertebral level, combined with a higher dermatomal spread level of spinal anesthetic, could theoretically be dangerous in clinical practice and ought to be considered.…”

Section: Discussionmentioning

confidence: 99%

Abdominal circumference but not the degree of lumbar flexion affects the accuracy of lumbar interspace identification by Tuffier’s line palpation method: an observational study

Lin

Bebawy

et al. 2015

BMC Anesthesiol

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BackgroundLumbar puncture for spinal or epidural anesthesia is commonly performed by palpating bony landmarks, but identification of the desired intervertebral level is often inaccurate. It is unclear whether such inaccuracy is related to patient factors, such as body mass index and degree of lumbar flexion. We hypothesized that overweight patients and patients with less of an ability to hyperflex their lumbar spines are prone to inaccurate lumbar spinous intervertebral level identification.Methods52 adult volunteers were included in this study. 7 anesthesiologists with different years of experience identified and marked subjects’ levels of the iliac crests, then marked the presumed interspaces. Lumbar X-ray was then performed with metal markers, and actual radiographic findings were identified and compared to the initial markings.ResultsPatients with larger abdominal circumferences (mean (SD), 94.0(12.1) cm), higher body mass indices (25.9(3.9) kg/m2), and aged between 50 and 70 years old had lumbar interspaces that were higher than the presumed level; patients with smaller abdominal circumferences (82.8(13.5) cm) and lower body mass indices (21.6(4.1) kg/m2) had intervertebral levels that were lower than the presumed level. Cobb’s angle, indicating the degree of lumbar flexion, did not affect the accuracy obtained.ConclusionsPatients’ abdominal circumference, body mass index, and age are factors that may impact the accuracy of lumbar level identification. Tuffier’s line, as identified by palpation, does not seem to be a reliable landmark for proper lumbar interspace identification in all cases.

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Section: Discussionmentioning

confidence: 99%

Abdominal circumference but not the degree of lumbar flexion affects the accuracy of lumbar interspace identification by Tuffier’s line palpation method: an observational study

Lin

Bebawy

et al. 2015

BMC Anesthesiol

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“…[ 20 ] In agreement, a recent study showed that the trunk length/abdominal circumference [ 2 ] (TL/AC 2 ) is corrected with the maximal spinal spread level, which suggests that a parturient with a shorter TL and a larger AC tends to obtain a higher spinal level. [ 15 ] However, the equation from their study only yielded a R 2 equal to 0.2.…”

Section: Discussionmentioning

confidence: 93%

“…Previous studies have explored the factors that affect the cephalad spread of spinal anesthesia. [ 1 , 2 , 6 – 16 ] The parturient characteristics that are typically considered when determining the dosage of local anesthetics for cesarean section include height, [ 17 ] weight, [ 17 – 19 ] body mass index, [ 2 ] vertebral column length, [ 6 , 15 ] abdominal circumference (AC), [ 15 ] and twin pregnancies. [ 8 ] Despite these studies, it remains a challenge to calculate the optimal intrathecal bupivacaine dose for cesarean section.…”

Section: Introductionmentioning

confidence: 99%

Abdominal girth and vertebral column length aid in predicting intrathecal hyperbaric bupivacaine dose for elective cesarean section

Wei¹,

Zhou

Wang³

2017

Medicine

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Currently, there is no consensus on how to determine the optimal dose of intrathecal bupivacaine for an individual undergoing an elective cesarean section. In this study, we developed a regression equation between intrathecal 0.5% hyperbaric bupivacaine volume and abdominal girth and vertebral column length, to determine a suitable block level (T5) for elective cesarean section patients.In phase I, we analyzed 374 parturients undergoing an elective cesarean section that received a suitable dose of intrathecal 0.5% hyperbaric bupivacaine after a combined spinal-epidural (CSE) was performed at the L3/4 interspace. Parturients with T5 blockade to pinprick were selected for establishing the regression equation between 0.5% hyperbaric bupivacaine volume and vertebral column length and abdominal girth. Six parturient and neonatal variables, intrathecal 0.5% hyperbaric bupivacaine volume, and spinal anesthesia spread were recorded. Bivariate line correlation analyses, multiple line regression analyses, and 2-tailed t tests or chi-square test were performed, as appropriate. In phase II, another 200 parturients with CSE for elective cesarean section were enrolled to verify the accuracy of the regression equation.In phase I, a total of 143 parturients were selected to establish the following regression equation: YT5 = 0.074X1 − 0.022X2 − 0.017 (YT5 = 0.5% hyperbaric bupivacaine volume for T5 block level; X1 = vertebral column length; and X2 = abdominal girth). In phase II, a total of 189 participants were enrolled in the study to verify the accuracy of the regression equation, and 155 parturients with T5 blockade were deemed eligible, which accounted for 82.01% of all participants.This study evaluated parturients with T5 blockade to pinprick after a CSE for elective cesarean section to establish a regression equation between parturient vertebral column length and abdominal girth and 0.5% hyperbaric intrathecal bupivacaine volume. This equation can accurately predict the suitable intrathecal hyperbaric bupivacaine dose for elective cesarean section.

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“…Chun et al (10) also found that IAP did not correlate with SAD. Although most of the studies have assessed abdominal obesity by measuring the abdominal girth in parturients (6,(12)(13)(14), Katulanda et al (15) suggested that the distance between the lower border of the xiphisternum and the center of the umbilicus could be used as an anthropometric measure to define abdominal obesity. Therefore, we decided to include the SPX as well as the SPF in our study.…”

Section: Discussionmentioning

confidence: 99%

“…Studies on patient characteristics such as body weight, height, and BMI show controversial spinal level and hypotension results (7,10,11,13,24,32). Norris et al (24) found that weight, height, BMI, and vertebral column length were not correlated with the spread of the sensory block.…”

Section: Discussionmentioning

confidence: 99%

The effects of uterine size with or without abdominal obesity on spinal block level and vasopressor requirement in elective cesarean section: a prospective observational study

Günüşen¹,

Sargın²,

Akdemir³

et al. 2019

Turk J Med Sci

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Introduction Spinal anesthesia is a safe, simple, rapid, effective, and easy-to-apply anesthetic technique for cesarean sections. Despite the advantages of spinal anesthesia, hypotension is a common complication with an incidence of 70%-85% in parturients (1-4). Many factors including the characteristics of the injected solution, patient position, age, height, weight, pregnancy, intraabdominal pressure (IAP), length of the vertebral column, and lumbosacral cerebrospinal fluid (CSF) volume determine the intrathecal spread of local anesthetics. In obstetric patients, physiological changes due to pregnancy, including changes in spinal curvature, venous pooling secondary to progesterone-induced decreases in vascular tone and aortocaval compression by the gravid uterus, contribute to hypotension during cesarean section under regional anesthesia (1-6). Many recent studies have addressed the effects of uterine size, abdominal girth, and IAP on sensory block level, ephedrine dose, and the incidence of hypotension in pregnant women. Large abdominal girth, big uterus, and increased IAP may be significant factors in greater cephalad spread of local anesthetics. The mechanisms explained in these studies are that the increased IAP secondary to the compression of the inferior vena cava due to the growing uterus leads to a reduction in CSF in the spinal canal (1,7-14). We hypothesized that there may be differences in the sensory block level and ephedrine requirements among pregnant women based on uterine size and the presence of abdominal obesity. The primary purpose of this study was to determine whether there is a relationship between uterine size and sensory block level and ephedrine dose in parturients receiving spinal anesthesia. Since Katulanda et al. (15) reported that the distance between the lower border of the xiphisternum and the center of the umbilicus could be used as an anthropometric measure to define abdominal obesity, we considered SPX to be a marker of both abdominal obesity and uterine size that contains abdominal obesity, easily identified anatomical landmarks Background/aim: Hypotension is a serious complication caused by spinal anesthesia that places both the mother and fetus at increased risk. We aimed to investigate the effects of uterine size with or without abdominal obesity on sensory block level of pregnant women receiving spinal anesthesia. Materials and methods: This study included 125 term parturients who underwent cesarean section. Motor and sensory block characteristics, the distance between the symphysis pubis and the fundus (SPF), the distance between the symphysis pubis and the xiphoid (SPX), newborn and placental weights, adverse effects, and doses of ephedrine were recorded. Results: Sensory block level and ephedrine dose were significantly correlated with the SPX and the combined newborn and placenta weights (P < 0.05). The incidence of hypotension was related to the SPX and the combined newborn and placenta weight (P < 0.05). There was no correlation between the SPF and sensory block leve...

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Relationship of abdominal circumference and trunk length with spinal anesthesia level in the term parturient

Abstract: TL/AC2, which simulated the ratio of the long axis and transection area of the abdomen, was correlated with maximal spinal level, and parturients with low TL/AC2 values tended to have higher dermatomal levels during spinal anesthesia.

Cited by 16 publications

References 13 publications

Abdominal circumference but not the degree of lumbar flexion affects the accuracy of lumbar interspace identification by Tuffier’s line palpation method: an observational study

Abdominal circumference but not the degree of lumbar flexion affects the accuracy of lumbar interspace identification by Tuffier’s line palpation method: an observational study

Abdominal girth and vertebral column length aid in predicting intrathecal hyperbaric bupivacaine dose for elective cesarean section

The effects of uterine size with or without abdominal obesity on spinal block level and vasopressor requirement in elective cesarean section: a prospective observational study

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