General Approach to Pregnant Patients Diagnosed with Covid 19: Our Experiences about Anesthesia in Cesarean Section

Year 2023, Volume: 20 Issue: 2, 408 - 412, 31.08.2023

Ahmet Kaya , Alev Esercan , Mehmet Tercan , Mahmut Alp Karahan

https://doi.org/10.35440/hutfd.1342864

Abstract

Background: Pregnancy increases susceptibility to respiratory complications of viral diseases. Managing obstetric emergencies in the Covid-19 pandemic poses a challenge as timely care and intervention are needed to save the life of mother and baby. This study aims to evaluate our anesthesia practices in pregnant women with Covid-19 undergoing cesarean section.
Materials and Methods: A total of 69 patients who under went cesarean section and had positive Polymerase Chain Reaction (PCR) testing for Covid-19 with nasopharyngeal swabs were included in the study. Patient demog-raphics and information about anesthesia were analyzed retrospectively from the patient medical files.
Results: A total of 69 parturients undergoing cesarean section that had positive SARS-CoV-2 PCR tests were assessed. General anesthesia was applied to only one patients ,while spinal anesthesia was administered to there maining 68 patients . While the rate of pneumonia in symptomatic patients was %31,88 (22/69) parturients. Twelve Covid-19 patients required intensive care in the perioperative period. The overall mortality rate was 8,69 % (6/69) among parturients with Covid-19 undergoing cesarean section.
Conclusions: 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.

Key Words: Anesthesia, Cesarean Section, Covid-19

Covid 19 Tanılı Gebe Hastalara Genel Yaklaşım: Sezaryende Anestezi Deneyimlerimiz

Abstract

Ülkemizi ve tüm dünyayı etkisi altına alan Covid-19 pandemisi döneminde ötelenemeyen cerrahi prosedürler arasında yer alan sezaryen operasyonunda anestezik yaklaşım ve olası yoğun bakım süreci nitelikli bakım gerektirmektedir . Gebe kadınlar, modüle edilmiş bağışıklık ve kardiyopulmoner sistemleri nedeniyle solunum yolu patojenlerine ve şiddetli pnömoniye karşı özellikle savunmasız olabilirler. Viral pnömoni, küresel olarak gebelik ölümlerinin önde gelen nedenlerinden biridir. Hücre aracılı bağışıklıktaki değişiklikler, bu duyarlılıkta merkezi bir rol oynar, çünkü bu, hamile kadının allojenik fetüse karşı toleranslı kalmasını sağlar, ancak virüsler gibi hücre içi patojenlere karşı savunma yeteneğini azaltır. Ayrıca gebelik sırasında kardiyopulmoner sistemlerde meydana gelen oksijen tüketiminde artış, toplam akciğer hacimlerinde azalma, gebe uterusa bağlı diyafram yükselmesi, üst solunum yollarında mukozal ödem ve sekresyonlarda artışa yol açan vazodilatasyon gibi fizyolojik değişiklikler, hamile kadının hipoksiye karşı daha savunmasız olmasına neden olmaktadır. Tüm bu özellikler düşünüldüğünde Covid-19 pozitif tanılı gebe hastaların sezaryen anestezisinin tipi ve yönetiminin önemi ön plana çıkmaktadır. Çalışmamızda COVID-19 tanılı gebelerde sezaryen anestezisi deneyimlerimizi, uygulanan anestezi yöntemlerinin ve olası yoğun bakım süreçlerinin maternofetal sonuçlara etkilerini görmek istemekteyiz.

Keywords

Covid, anestezi, sezaryen

References

• 1. Rasmussen SA, S.J., Lednicky JA, Wen TS, Jamieson DJ. , Coronavirus disease 2019 (COVID-19) and pregnancy: what obstetricians need to know.Am J Obstet Gynecol 2020;222(5):415-426.
• 2. Maxwell C, M.A., Tai KFY, Sermer M., Management guide-lines for obstetric patients and neonates born to mothers with suspected or probable severe acute respiratory syn-drome (SARS). J Obstet Gynaecol Can. 2009;31(4):358-364., 2020.
• 3. Favre G, Pomar L, Musso D, Baud D. 2019-nCoV epidemic: what about pregnancies? Lancet. 2020;22;395(10224):e40.
• 4. Midwives., R.C.o.O.a.G.a.T.R.C.o., Coronavirus (covid-19) infection in pregnancy: information for healthcare profes-sionals. Royal College of Obstetricians and Gynaecologists,, 2020.
• 5. Jan M, Bhat WM, Rashid M, Ahad B. ElectiveCesareanSec-tion in Obstetric COVID-19 PatientsunderSpinalAnesthesia: A ProspectiveStudy. AnesthEssaysRes. 2020;14(4):611-614.
• 6. Canet J., Gallart L., Gomar C., Paluzie G., Vallès J., Castillo J., Sabaté S., Mazo V., Briones Z., Sanchis J., et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113:1338–1350. doi: 10.1097/ALN.0b013e3181fc6e0a.
• 7. Zaigham M., Andersson O. Maternal and perinatal out-comes with COVID-19: A systematic review of 108 pregnan-cies. Acta Obstet. Gynecol. Scand. 2020;99:823–829. doi: 10.1111/aogs.13867.
• 8. Tran K., Cimon K., Severn M., Pessoa-Silva C.L., Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: A sys-tematic review. PLoS ONE. 2012;7:e35797. doi: 10.1371/journal.pone.0035797.
• 9. Bampoe S., Odor P.M., Lucas D.N. Novel coronavirus SARS-CoV-2 and COVID-19. Practice recommendations for ob-stetric anaesthesia: What we have learned thus far. Int. J. Obstet. Anesth. 2020;43:1–8.
• 10. Plaat F., Campbell J.P. Is spinal anaesthesia an aerosol-generating procedure? Transmission of SARS-CoV-2 from patient to anaesthetist. Br. J. Anaesth. 2020;125:e315. doi: 10.1016/j.bja.2020.06.015.
• 11. Chen R, Zhang Y, Huang L, Cheng BH, Xia ZY, Meng QT. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing cesarean delivery: a case series of 17 patients. Can J Anaesth. 2020;67:655-63.
• 12. vonUngern-Sternberg BS, Boda K, Chambers NA, et al. Risk assessment for respiratory complications in paediatric an-aesthesia: a prospective cohort study. Lancet. 2010;376:773-83.
• 13. Warren J, Sundaram K, Anis H, et al. Spinal anesthesia is associated with decreased complications after total knee and hip arthroplasty. J Am Acad Orthop Surg. 2020;28:213-21.
• 14. Uppal V, Sondekoppam RV, Landau R, El-Boghdadly K, Narouze S, Kalagara HKP. Neuraxial anaesthesia and pe-ripheral nevre blocks during the COVID-19 pandemic: a lit-erature review and practice recommendations. Anaesthe-sia. 2020;75:1350-63. https://doi.org/10.1111/anae.15105
• 15. Yue L, Han L, Li Q, et al. Anesthesia and infection control in cesarean section of pregnant women with COVID-19 infec-tion: A descriptive study. J Clin Anesth. 2020;66:109908.
• 16. Kinsella SM, Carvalho B, Dyer RA, et al. International con-sensus statement on the management of hypotension with vasopressors during caesarean section under spinal anaesthesia. Anaesthesia. 2018;73:71-92. https://doi.org/10.1111/anae.14080
• 17. Zhong Q, Liu YY, Luo Q, et al. Spinal anaesthesia for patients with coronavirus disease 2019 and possible transmission rates in anaesthetists: retrospective, single-centre, obser-vational cohort study. Br J Anaesth. 2020;124:670-5.
• 18. Aydin Güzey N, Uyar Türkyilmaz E. Evaluation of 254 cesar-ean sections with COVID-19 in terms of anesthesia and clin-ical course: 1-year experience. J Anesth. 2022 Aug;36(4):514-523.
• 19. Karasu D, Kilicarslan N, Ozgunay SE, Gurbuz H. Our anesthe-sia experiences in COVID-19 positive patients delivering by cesarean section: A retrospective single-center cohort study. J Obstet Gynaecol Res. 2021 Aug;47(8):2659-2665.
• 20. Jain K, Alen J, Kumar S, Mitra S. Protocolized approach to a COVID-19 parturient undergoing a cesarean section- A ca-sereport. J Anaesthesiol Clin Pharmacol. 2020;36:407-10.
• 21. Türken M, Köse Ş. COVID-19 Bulaş Yolları ve Önleme. Tepecik Eğit. ve Araşt. Hast. Dergisi. 2020;30:36-42. https://doi.org/10.5222/terh.2020.02693
• 22. Schwartz DA. An analysis of 38 pregnant women with covıd‐19, their newborn infants, and maternal‐ fetal transmission of SARS‐CoV‐2: maternal coronavirus ınfections and preg-nancy outcomes. Arch Pathol Lab Med. 2020;144:799–805.
• 23. Juan J, Gil MM, Rong Z, Zhang Y, Yang H, Poon LC. Effect of coronavirus disease 2019 (COVID‐19) on maternal, perinatal and neonatal outcome: systematic re-view. UltrasoundObstetGynecol. 2020;56:15–27.