Journal of Cellular & Molecular Anesthesia
Factors Associated with Inadequate Spinal Anesthesia and Conversion to General Anesthesia During Elective Cesarean Delivery: A Retrospective Observational Study from Southwestern Iran
By Mehdi Kiaee and Arghavan Afra.
Abstract
Background
Spinal anesthesia is the predominant anesthetic technique for elective cesarean delivery; however, inadequate spinal anesthesia remains a significant challenge in obstetric anesthesia. It may cause maternal pain and discomfort, delay surgery, and necessitate conversion to general anesthesia. Identifying perioperative risk factors may improve clinical decision-making and enhance maternal and neonatal safety.
Objectives
This study aimed to determine the incidence of inadequate spinal anesthesia and conversion to general anesthesia and to investigate the factors associated with these outcomes among women undergoing elective cesarean delivery.
Methods
In this retrospective observational study, the medical records of 370 pregnant women who underwent elective cesarean delivery in 2025 at hospitals affiliated with Abadan University of Medical Sciences were consecutively reviewed. Spinal anesthesia was used as the primary anesthetic technique in all patients. Demographic, obstetric, clinical, and anesthesia-related data were extracted from medical records, anesthesia charts, and surgical reports. Patients were categorized according to whether spinal anesthesia was successful or inadequate. Factors associated with inadequate spinal anesthesia were assessed using multivariable logistic regression, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. The cumulative effect of three factors—body mass index (BMI), spinal anatomical abnormalities, and anesthesia duration ≥ 45 minutes—on anesthetic outcomes was also evaluated.