Spinal anaesthesia for patients with coronavirus disease 2019 and possible transmission rates in anaesthetists: retrospective, single-centre, observational cohort study

Abstract

Background: The safety of performing spinal anaesthesia for both patients and anaesthetists alike in the presence of active infection with the novel coronavirus disease 2019 (COVID-19) is unclear. Here, we report the clinical characteristics and outcomes for both patients with COVID-19 and the anaesthetists who provided their spinal anaesthesia. Methods: Forty-nine patients with radiologically confirmed COVID-19 for Caesarean section or lower-limb surgery undergoing spinal anaesthesia in Zhongnan Hospital, Wuhan, China participated in this retrospective study. Clinical characteristics and perioperative outcomes were recorded. For anaesthesiologists exposed to patients with COVID-19 by providing spinal anaesthesia, the level of personal protective equipment (PPE) used, clinical outcomes (pulmonary CT scans), and confirmed COVID-19 transmission rates (polymerase chain reaction [PCR]) were reviewed. Results: Forty-nine patients with COVID-19 requiring supplementary oxygen before surgery had spinal anaesthesia (ropivacaine 0.75%), chiefly for Caesarean section (45/49 [91%]). Spinal anaesthesia was not associated with cardiorespiratory compromise intraoperatively. No patients subsequently developed severe pneumonia. Of 44 anaesthetists, 37 (84.1%) provided spinal anaesthesia using Level 3 PPE. Coronavirus disease 2019 infection was subsequently confirmed by PCR in 5/44 (11.4%) anaesthetists. One (2.7%) of 37 anaesthetists who wore Level 3 PPE developed PCR-confirmed COVID-19 compared with 4/7 (57.1%) anaesthetists who had Level 1 protection in the operating theatre (relative risk reduction: 95.3% [95% confidence intervals: 63.7e99.4]; P<0.01). Conclusions: Spinal anaesthesia was delivered safely in patients with active COVID-19 infection, the majority of whom had Caesarean sections. Level 3 PPE appears to reduce the risk of transmission to anaesthetists who are exposed to mildly symptomatic surgical patients.

Neuraxial anaesthesia and peripheral nerve blocks during the COVID‐19 pandemic: a literature review and practice recommendations

“…The literature search identified 987 articles. After title and abstract screening, 16 papers were selected for full‐text review; among those, there was one retrospective cohort study [14]; four case series [15‐18]; four case reports [19‐22]; and seven expert opinion articles [1, 12, 23‐27] (Table 1). Backward citation identified additional reports; however, the information relevant to regional anaesthesia was already presented in original papers in the initial search.…”

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

“…This anesthesia modality should be performed whenever complexity of surgery and anatomic location allow, and may include the following categories: neuraxial anesthesia, ultrasound-guided peripheral nerve block and tumescent anesthesia. The equipment used for visualization, such as ultrasound probes, must be efficiently protected/isolated and disinfected after use following the COVID-19 decontamination guidelines discussed in this article [41,50,[65][66][67].…”

“…If local anesthetic systemic toxicity (LAST) occurs, treatment must occur in accordance with the guidelines of the American Society of Regional Anesthesia and Pain Medicine [65,68].…”

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

“…Alternatively, choosing to bypass the use of PPE could be associated with healthcare worker contamination. 5 French anesthesia teams are also being confronted with an increasing number of COVID-19 pregnant women requiring delivery and we would benefit from this additional information.…”