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Mohamed RHB, Al-Ghamdi W, Al-Marri A, Al-Abdullah B, Al-Hajji N, Al-Shaybe A. Anesthetic management of obstetric patients with COVID-19: A scoping review. EGYPTIAN JOURNAL OF ANAESTHESIA 2022. [DOI: 10.1080/11101849.2022.2105071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Affiliation(s)
- Radwa Hamdi Bakr Mohamed
- Department of Quality and Development, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Waad Al-Ghamdi
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Aldanah Al-Marri
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bayan Al-Abdullah
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Nebras Al-Hajji
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Alkawthar Al-Shaybe
- Department of Anesthesia Technology, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Sangroula D, Maggard B, Abdelhaleem A, Furmanek S, Clemons V, Marsili B, Stikes R, Hill M, Sigdel A, Clifford SP, Huang J, Akca O, Logsdon MC. Hemodynamic changes associated with neuraxial anesthesia in pregnant women with covid 19 disease: a retrospective case-control study. BMC Anesthesiol 2022; 22:179. [PMID: 35681119 PMCID: PMC9178224 DOI: 10.1186/s12871-022-01719-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
Background Neuraxial blocks is the recommended mode of analgesia and anesthesia in parturients with Coronavirus 19 (COVID-19). There is limited data on the hemodynamic responses to neuraxial blocks in COVID-19 patients. We aim to compare the hemodynamic responses to neuraxial blocks in COVID-19 positive and propensity-matched COVID-19 negative parturients. Methods We conducted retrospective, cross-sectional case–control study of hemodynamic changes associated with neuraxial blocks in COVID-19 positive parturients in a Tertiary care academic medical center. Fifty-one COVID-19 positive women confirmed by nasopharyngeal reverse transcription–polymerase chain reaction (RT-PCR), were compared with propensity-matched COVID negative controls (n = 51). Hemodynamic changes after neuraxial block were recorded by electronic medical recording system and analyzed using paired and unpaired T- test and Wilcoxon-Mann–Whitney Rank Sum tests. The primary outcome was ≥ 20% change in MAP and HR after neuraxial block placement. Results In the epidural group, 7% COVID-19 positive parturients had > 20% decrease in mean arterial pressure (MAP) from baseline compared to 15% COVID-19 negative parturients (P = 0.66). In the spinal group, 83% of COVID-19 positive parturients had a decrease in MAP more than 20% from baseline compared to 71% in control (P = 0.49). MAP drop of more than 40% occurred in 29% COVID positive parturients in the spinal group versus 17% in COVID-19 negative parturients (P = 0.5465). In COVID-19 positive spinal group, 54% required vasopressors whereas 38% in COVID-19 negative spinal group required vasopressors (P = 0.387). We found a significant correlation between body mass index (BMI) > 30 and hypotension in COVID ( +) parturient with odds ratio (8.63; 95% CI-1.93 – 37.21) (P = 0.007). Conclusion Incidence and severity of hypotension after neuraxial blocks were similar between COVID-19 positive and COVID-19 negative parturients. BMI > 30 was a significant risk factor for hypotension as described in preexisting literature, this correlation was seen in COVID-19 positive parturients. The likely reason for parturients with BMI > 30 in COVID negative patients not showing similar correlation, is that the sample size was small.
Supplementary information The online version contains supplementary material available at 10.1186/s12871-022-01719-0.
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Affiliation(s)
- D Sangroula
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA. .,Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.
| | - B Maggard
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA
| | - A Abdelhaleem
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA
| | - S Furmanek
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA
| | - V Clemons
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA
| | - B Marsili
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA
| | - R Stikes
- Center for Women, and Infants, University of Louisville Hospital, 530 S. Jackson Street, Louisville, KY, 40202, USA
| | - M Hill
- Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA
| | - A Sigdel
- Department of Surgery, University of Louisville School of Medicine, 530 S. Jackson, Louisville, KY, 40202, USA
| | - S P Clifford
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA
| | - J Huang
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA
| | - O Akca
- Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA.,Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21218, USA
| | - M C Logsdon
- School of Nursing, University of Louisville, 555 South Floyd Street, Louisville, KY, 40292USA, USA
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Giorgini C, Simonte R, Cammarota G, DE Robertis E. What's new on the management of obstetric patients who tested positive for Covid-19? Minerva Anestesiol 2022; 88:516-523. [PMID: 35199974 DOI: 10.23736/s0375-9393.22.16283-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To date, there is still partial data on the effects of COVID-19 on pregnant women. The constant collection of information results in a continuous updating of the knowledge about the best management of pregnant patients affected by COVID-19. This work aims to summarize the state of the art on prevention and management of SARSCoV-2 infection in obstetric patients. This was enabled by a comprehensive literature search for the most recent and relevant publications on the subject, including guidelines and recommendations. Management of these women by a multidisciplinary team is of crucial importance, given the extreme clinical complexity of this condition. Every health worker involved must put in place all possible procedures to protect themselves from contagion. Neuraxial anesthesia should be favored in the management of labor and caesarean section over other modalities, unless there are contraindications based on the patient's status. There is still no standardized drug treatment in pregnant women with COVID-19 due to their exclusion from studies conducted to evaluate pharmacological therapies. Nevertheless, various drugs have been used to treat this disease in pregnancy, although the data at our disposal are still few. As regards mRNA vaccines, it seems that their immunogenicity, safety and tolerability in pregnant women are comparable to those of non-pregnant women of the same age. More studies are certainly needed in infected pregnant women to establish treatment and prevention protocols for this special category of patients.
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Affiliation(s)
- Carla Giorgini
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Rachele Simonte
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Gianmaria Cammarota
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Edoardo DE Robertis
- Division of Anaesthesia, Analgesia, and Intensive Care, Department of Medicine and Surgery, Hospital S. Maria della Misericordia, University of Perugia, Perugia, Italy -
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Ring L, Landau R, Delgado C. The Current Role of General Anesthesia for Cesarean Delivery. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:18-27. [PMID: 33642943 PMCID: PMC7902754 DOI: 10.1007/s40140-021-00437-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 12/20/2022]
Abstract
Purpose of the Review The use of general anesthesia for cesarean delivery has declined in the last decades due to the widespread utilization of neuraxial techniques and the understanding that neuraxial anesthesia can be provided even in urgent circumstances. In fact, the role of general anesthesia for cesarean delivery has been revisited, because despite recent devices facilitating endotracheal intubation and clinical algorithms, guiding anesthesiologists facing challenging scenarios, risks, and complications of general anesthesia at the time of delivery for both mother and neonate(s) remain significant. In this review, we will discuss clinical scenarios and risk factors associated with general anesthesia for cesarean delivery and address reasons why anesthesiologists should apply strategies to minimize its use. Recent Findings Unnecessary general anesthesia for cesarean delivery is associated with maternal complications, including serious anesthesia-related complications, surgical site infection, and venous thromboembolic events. Racial and socioeconomic disparities and low-resource settings are major contributing factors in the use of general anesthesia for cesarean delivery, with both maternal and perinatal mortality increasing when general anesthesia is provided. In addition, more significant maternal pain and higher rates of postpartum depression requiring hospitalization are associated with general anesthesia for cesarean delivery. Summary Rates of general anesthesia for cesarean delivery have overall decreased, and while general anesthesia no longer is a contributing factor to anesthesia-related maternal deaths, further opportunities to reduce its use should be emphasized. Raising awareness in identifying situations and patients at risk to help avoid unnecessary general anesthesia remains crucial.
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Affiliation(s)
- Laurence Ring
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY USA
| | - Ruth Landau
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY USA
| | - Carlos Delgado
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA USA
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