Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients

Chen, Rong; Zhang, Yuan; Huang, Lei; Cheng, Biheng; Xia, Zhongyuan; Meng, Qingtao

doi:10.1007/s12630-020-01630-7

Cited by 265 publications

(380 citation statements)

References 24 publications

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“…Parturients were considered to be susceptible of SARS-CoV-2 virus and COVID-19 can threaten to the health of maternal and infant. Although the clinical characteristics of COVID-19 in pregnant women are similar with non-pregnant females, COVID-19 resulted in additional challenges for obstetric anaesthesia under cesarean delivery as reported in our previous study 8 . However, the comparison between parturients undergoing cesarean delivery with versus without COVID-19 are still undefined and the clinical features of parturients with COVID-19 require further investigation.…”

Section: Introductionsupporting

confidence: 57%

Anaesthetic managment and clinical outcomes of parturients with COVID-19: a multicentre, retrospective, propensity score matched cohort study

Zhang

Chen

Wang

et al. 2020

Preprint

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Objective: To analyse the clinical features of COVID-19 parturients, and to compare anaesthetic regimen and clinical outcomes in parturients with or without COVID-19 undergoing cesarean delivery.Methods: Data were extracted from the electronic medical record of 3 medical institutions in Hubei Province, China, from June 1, 2019 to March 20, 2020 according to inclusion and exclusion criteria. After propensity score matching with demographics, the clinical and laboratory characteristics of parturients with or without COVID-19 were analysed. The anaesthetic regimen and clinical outcomes of themselves and their infants were compared in these two groups of parturients.Results: A total of 1,588 patients without SARS-CoV-2 infection undergoing cesarean delivery were retrospectively included. After achieving a balanced cohort through propensity score matching, 89 patients (COVID-19 group), who were diagnosed with COVID-19 by SARS-CoV-2 nucleic acid test and CT scan matched with 173 patients without COVID-19 (Control group). The SARS-CoV-2 infected parturients in the early stages of COVID-19 outbreak was much more than during the later stage. The main clinical characteristics of parturients with COVID-19 were fever (34.8%), cough (33.7%), an increased plasma CRP (52.8%) and a decreased lymphocyte counting (33.7%). A high rate of emergency and a high incidence of anaesthesia-related complications, such as pharyngalgia, multiple puncture, intraoperative hypotension, nausea, vomiting, vertigo and chills in the COVID-19 parturients. In addition, the parturients with COVID-19 had a long duration of operation and hospital stay, and an increased intraoperative oxytocin utilization and postoperative oxygen therapy. The newborns from the SARS-CoV-2 infected mothers, who received general anaesthesia, had a high risk of Apgar score ≤ 8 at 1 and 5 minutes after delivery and a higher rate of neonatal intensive care unit (NICU) admission.Conclusions: Anaesthesia-related complications occur more frequently in the COVID-19 parturients and their newborns have a high risk of distress.

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Section: Introductionsupporting

confidence: 57%

Anaesthetic managment and clinical outcomes of parturients with COVID-19: a multicentre, retrospective, propensity score matched cohort study

Zhang

Chen

Wang

et al. 2020

Preprint

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“…The health questionnaire has to cover signs of acute infection such as fever, dry cough, fatigue, sore throat, anosmia, skin rash or other gastrointestinal symptoms such as diarrhea, anorexia, vomiting, nausea, abdominal pain and/or gastrointestinal bleeding [40,42,45,[48][49][50][51][52][53].…”

Section: Pre-anesthetic Processmentioning

confidence: 99%

“…The standard preoperative laboratory workup should include a full blood count to identify COVID-19-related alterations such as leukocytopenia and lymphopenia as well as coagulation tests, kidney-liver function and CRP levels, as well as blood sugar levels to exclude diabetes [40,42,47,49,50,52,57,58].…”

Section: Pre-anesthetic Processmentioning

confidence: 99%

Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS–COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management

Kaye¹,

Paprottka²,

Escudero³

et al. 2020

Aesth Plast Surg

101

145

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Background The worldwide spread of a novel coronavirus disease has led to a near total stop of nonurgent, elective surgeries across all specialties in most affected countries. In the field of aesthetic surgery, the selfimposed moratorium for all aesthetic surgery procedures recommended by most international scientific societies has been adopted by many surgeons worldwide and resulted in a huge socioeconomic impact for most private practices and clinics. An important question still unanswered in most countries is when and how should elective/aesthetic procedures be scheduled again and what kind of organizational changes are necessary to protect patients and healthcare workers when clinics and practices reopen. Defining manageable, evidence-based protocols for testing, surgical/ procedural risk mitigation and clinical flow management/contamination management will be paramount for the safety of non-urgent surgical procedures. Methods We conducted a MEDLINE/PubMed research for all available publications on COVID-19 and surgery and COVID-19 and anesthesia. Articles and referenced literature describing possible procedural impact factors leading to exacerbation of the clinical evolution of COVID-19positive patients were identified to perform risk stratification for elective surgery. Based on these impact factors, considerations for patient selection, choice of procedural complexity, duration of procedure, type of anesthesia, etc., are discussed in this article and translated into algorithms for surgical/anesthesia risk management and clinical management. Current recommendations and published protocols on contamination control, avoidance of crosscontamination and procedural patient flow are reviewed. A COVID-19 testing guideline protocol for patients planning to undergo elective aesthetic surgery is presented and recommendations are made regarding adaptation of current patient information/informed consent forms and patient health questionnaires. Conclusion The COVID-19 crisis has led to unprecedented challenges in the acute management of the crisis, and the wave only recently seems to flatten out in some countries. The adaptation of surgical and procedural steps for a riskminimizing management of potential COVID-19-positive patients seeking to undergo elective aesthetic procedures in the wake of that wave will present the next big challenge for the aesthetic surgery community. We propose a clinical algorithm to enhance patient safety in elective surgery in the context of COVID-19 and to minimize cross-contamination between healthcare workers and patients. New evidence-based guidelines regarding surgical risk stratification, testing, and clinical flow management/contamination management are proposed. We believe that only the continuous development and broad implementation of guidelines like the ones proposed in this paper will allow an early reintegration of all aesthetic procedures into the scope of surgical care currently performed and to prepare

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“…We read with interest the study by Chen et al, 1 which describes a series of 17 patients with coronavirus disease (COVID-19) who underwent Cesarean delivery within a three-week period in a single maternity unit. Their experience is of utmost importance as the disease has spread worldwide and many countries will face (or already have faced) this situation in pregnant women.…”

Section: To the Editormentioning

confidence: 99%

Spinal anesthesia for Cesarean delivery in women with COVID-19 infection: questions regarding the cause of hypotension

Benhamou

Meyer

Morau

et al. 2020

Can J Anesth/J Can Anesth

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Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing Cesarean delivery: a case series of 17 patients

Cited by 265 publications

References 24 publications

Anaesthetic managment and clinical outcomes of parturients with COVID-19: a multicentre, retrospective, propensity score matched cohort study

Anaesthetic managment and clinical outcomes of parturients with COVID-19: a multicentre, retrospective, propensity score matched cohort study

Elective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS–COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management

Spinal anesthesia for Cesarean delivery in women with COVID-19 infection: questions regarding the cause of hypotension

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