Our anesthesia experiences in COVID-19 positive patients delivering by cesarean section: A retrospective single-center cohort study.
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ABSTRACT: Aim
Pregnancy increases susceptibility to respiratory complications of viral diseases. This study aims to evaluate our anesthesia practices in pregnant women with COVID-19 undergoing cesarean section.Methods
A total of 61 patients who underwent cesarean section and had positive Polymerase chain reaction (PCR) testing for COVID-19 with nasopharyngeal swabs were included in the study. Patient demographics and information about anesthesia were analyzed retrospectively from the patient medical files.Results
A total of 61 parturients undergoing cesarean section that had positive SARS-CoV-2 PCR tests were assessed. General anesthesia was applied to only three patients (4.9%), while spinal anesthesia was administered to the remaining 58 patients (95.1%). The incidence of hypotension was 25.9% in the spinal anesthesia group. Forty-one (67.2%) parturients were asymptomatic. While the rate of pneumonia in symptomatic patients was 45% (9/20), the pneumonia incidence among all SARS-CoV-2 PCR (+) parturients was 14% (9/61). Three (4.9%) COVID-19 patients required intensive care in the perioperative period. The overall mortality rate was 1.6% (1/61) among parturients with COVID-19 undergoing cesarean section, while it was 11.1% (1/9) in patients with pneumonia.Conclusion
It was observed that COVID-19 is associated with mortality in pregnant women undergoing cesarean section. Spinal anesthesia was safely and effectively administered in COVID-19 parturients, especially in patients with pneumonia.
SUBMITTER: Karasu D
PROVIDER: S-EPMC8242427 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background:Local anesthetics for spinal anesthesia in one-single injection are known to induce more severe hypotension than a fractionated dose in healthy obstetric patients. Hypotension in obstetric patients with pregnancy-induced hypertension, including preeclampsia, during spinal anesthesia, could compromise fetal well-being. Objectives:This study aimed to compare the mean arterial pressure (MAP), the total dose of ephedrine required, and level of sensory blockade between the fractionated-dose and single-dose spinal anesthesia injection in obstetric patients with pregnancy-induced hypertension who underwent a cesarean section. Methods:This single-blind randomized clinical trial was conducted from January to April 2018 after being approved by the Research Ethics Committee of Universitas Indonesia (No. 1174/UN2.F1/ETIK/2017) and recorded at ClinicalTrials.gov (NCT03693638). After obtaining informed consent, 42 parturients with hypertension in pregnancy (gestational hypertension or preeclampsia), ASA II-III, aged 18 - 40 years, and BMI of 18.5 - 35 kg/m2 with singleton pregnancy, who were planned for spinal anesthesia for emergency or semi-emergency cesarean section with hyperbaric bupivacaine 0.5% (MarcaineTM, Hospira) and fentanyl, were included in this study. All subjects were randomly divided into two groups including fractionated-dose (FD) and single-dose (SD). Results:There was no significant difference between the two groups in MAP in the first 15 minutes after anesthesia (P > 0.05) and median total dose of ephedrine required (10 (0 - 25) mg in the FD group vs. 15 (0 - 30) mg in the SD group, P = 0.30). However, in the FD group, MAP tended to be higher in the first three minutes compared to the SD group. The level of sensory blockade was mostly at T4, which was not significantly different between the groups (52.4% in FD vs. 42.9% in SD, P = 0.59). Conclusions:In obstetric patients with pregnancy-induced hypertension who underwent a cesarean section, the mean arterial pressure after spinal anesthesia was not significantly different between the fractionated dose of spinal anesthesia injection and single-dose injection. Total ephedrine required and levels of sensory blockade were not significantly different between the groups.
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Project description:During the coronavirus disease 2019 (COVID-19) pandemic, many guidelines have recommended postponing non-emergency operations. However, cesarean sections cannot be indefinitely delayed. Our institution has established a COVID-19 screening strategy for patients undergoing cesarean section. We evaluated the usefulness of this screening strategy. Parturients undergoing cesarean section at our center during the first peak of the COVID-19 outbreak were retrospectively analyzed. Each parturient underwent a questionnaire survey evaluating epidemiological correlation and symptoms at admission. Reverse transcriptase-polymerase chain reaction (RT-PCR) testing and/or chest radiography were performed. In total, 296 parturients underwent cesarean section. All elective and 37 emergency cesarean sections were performed in general operating rooms because they were considered to have a low risk of COVID-19 infection through the screening process. However, 42 emergency cases were performed in negative-pressure operating rooms with full personal protective equipment (PPE) because the RT-PCR results could not be confirmed in a timely manner. None of them were positive for RT-PCR, and there were no cases of nosocomial infection. A comprehensive preoperative screening strategy, including symptomatic and epidemiological correlation, PCR, and/or imaging test, should be performed in patients undergoing cesarian section. Further, cesarean sections in parturients with unconfirmed COVID-19 status should be performed in a negative-pressure operating room with appropriate PPE.
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