Considerations for the Parturient of Short Stature a Retrospective Review
Abstract Number: F-15
Abstract Type: Original Research
Introduction: Reported complications associated with maternal short stature (height less than 148cm) include: increased risk of respiratory compromise, increased risk of cesarean delivery and unpredictable degree of analgesia and anesthesia with neuraxial techniques. Dwarfism and short stature are frequently used interchangeably, however dwarfism is a subset of short stature with multiple etiologies. The literature of the anesthetic management of parturients of short stature is sparse and limited to isolated case reports of parturients with a diagnosis of dwarfism. Therefore, we conducted this retrospective review to evaluate outcomes in short stature parturients.
Methods: Short stature women who underwent a cesarean delivery between May 1, 2008 and May 1, 2013, were identified through a query of billing data and then the electronic medical record was hand searched for qualifying patients with heights of <148cm. Data extracted included: patient demographics, obstetric and anesthetic information. Patients were stratified into parturients with a diagnosis of dwarfism and parturients of short stature not otherwise specified (NOS). Categorical data were compared using a chi-squared test, and continuous data were compared using a t-test or Wilcoxon rank sum test. Bupivacaine doses used for spinal anesthesia were compared to 11.25 mg (standard dose for parturients at our institution), using a one-sided t-test. P<0.05 was considered significant.
Results: Patients with a diagnosis of dwarfism were more likely to be obese and more likely to be scheduled for an elective cesarean delivery than short-stature women (NOS) (Table 1). Additionally, more attempts at neuraxial anesthesia were necessary in women with dwarfism, but there were no differences in anesthetic complications including difficult airway between the groups. The mean dose of bupivacaine used for spinal anesthesia (9.5 +/- 0.3 mg) was less than that used in non-short-stature women P<0.001.
Conclusions: These data suggest that women with a diagnosis of dwarfism are at increased risk for difficult neuraxial placement. However, we were limited by our small sample size. No patient had a high spinal and adequate surgical levels were obtained with lower doses of bupivacaine in short stature women compared to standard dose used for normal stature patients. Outcomes between short stature women should be compared to non-short stature women in order to better define risks for this patient population.