Investigating the effects of the COVID-19 pandemic on obstetric anesthesia and perioperative outcomes in cesarean section surgery

Year 2023, , 120 - 124, 27.03.2023

Leyla Kutlucan , Ömer Faruk Altaş , Nimet Şenoğlu

https://doi.org/10.38053/acmj.1232318

Cited By: 1

Abstract

Aim: In the literature, studies comparing the preferred anesthesia methods and related parameters in obstetric anesthesia during the pandemic period with the pre-pandemic period are limited. I n this study, primarily in patients who gave birth by cesarean section before and during the COVID-19 (Coronavirus disease 19) pandemic; It was aimed to evaluate the anesthesia method, postoperative complications, length of hospital stay, clinical urgency of the patients and ASA (American Society of Anesthesiologists) scores. In addition, in patients who underwent cesarean section with positive and negative PCR (Polymerase Chain Reaction) tests during the COVID-19 pandemic; It was aimed to evaluate the anesthesia method, postoperative complications, hospital stay, clinical urgency of the cases and ASA scores.
Material and Method: In this retrospective, single-center study, we noted down and compared types of cesarean section (elective or emergency), anesthesia techniques (spinal, spinal+epidural, or general anesthesia), and patients’ ages, ASA scores, PCR test results, postoperative complications (e.g., pneumonia, excessive postpartum bleeding), and lengths of hospital stay.
Results: We carried out this study with the data of 2,406 women, 1,458 of whom gave birth before the pandemic. The findings revealed that the rate of developing complications, the length of hospital stay, the number of patients with an ASA score of 3 and above, and the use of spinal anesthesia significantly increased during the pandemic. Moreover, 182 women were COVID-19-positive among a total of 948 applicants during the pandemic. Although the ASA scores and complication rates were significantly higher among those with a positive PCR test result, the length of hospital stay was similar between the patients by their PCR test results.
Conclusion: Our findings revealed a significant decrease in spinal + epidural anesthesia, which was frequently adopted before, in cases with cesarean section during the pandemic. Spinal anesthesia was mostly used alone. Despite increased complication rates in PCR-positive patients with higher ASA scores undergoing cesarean section, we concluded no significant change in the length of hospital stay. In cases of increased risk of infection and transmission (e.g., pandemic), neuraxial blocks may be preferred as an anesthesia technique to minimize the risk of infection in emergency obstetric operations. It should also be noted that the risk of developing postoperative complications always be high during pandemics.

Keywords

COVID-19, cesarean section, regional anesthesia, American Society of Anesthesiologists scores, postoperative complications

References

• Bampoe S, Odor PM, Lucas DN. Novel coronavirus SARS-CoV-2 and COVID-19. Practice recommendations for obstetric anaesthesia: what we have learned thus far. International Journal of Obstetric Anesthesia 2020; 43: 1–8.
• Uppal V, Sondekoppam RV, Lobo C, Kolli S, Kalagara H, Edra F. Practice recommendations on neuraxialanesthesia and peripheral nerve blocks during the COVID-19 pandemic. In ASRA/ESRA COVID-19 Guidance for Regional Anesthesia; ASRA Society: Gujarat, India, 2020; Volume 31.
• Uppal V, Sondekoppam R, Landau R, El-Boghdadly K, Narouze S, Kalagara HKP. Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations. Anaesthesia 2020; 75: 1350–63.
• Bauer ME, Chiware R, Pancaro C. Neuraxial procedures in COVID-19–positive parturients: a review of current reports. Anesthesia and Analgesia 2020; 131: e22–e24.
• Herman JA, Urits I, Kaye AD, Urman RD, Viswanath O. COVID-19: obstetric anesthesia care considerations. J ClinAnesth. 2020; 65: 109885.
• Guasch E, Brogly N, Gilsanz F: COVID in obstetrics: labor analgesia and cesarean section. Curr Opin Anaesthesiol 2021; 34: 62–8.
• Velly L, Gayat E, Quintard H, et al. Guidelines: anaesthesia in the context of COVID-19 pandemic. Anaesth Crit Care Pain Med 2020; 39: 395-415.
• Macfarlane AJR, Harrop-Griffiths W, Pawa A. Regional anaesthesia and COVID-19: first choice at last? British J Anaesthesia 2020; 125: 243–7.
• Peng PWH, Ho P-L, Hota SS. Outbreak of a new coronavirus: what anaesthetists should know. Br J Anaesth 2020; 124: 497–501.
• Lewis D. Is the coronavirus airborne? Experts can’t agree. Nature 2020; 580: 175.
• Zhong Q, Liu YY, Luo Q, et al. Spinal anaesthesia in patients with coronavirus disease 2019 and possible transmission rates in anaesthetists: retrospective, single centre, observational cohort study. Br J Anaesth 2020; 124: 670-5.
• Cook T, Harrop-Griffiths W. Kicking on while it’s still kicking off - getting surgery and anaesthesia restarted after COVID-19. Anaesthesia 2020; 75: 1273-7.
• Lockhart SL, Duggan LV, Wax RS, Saad S, Grocott HP. Personal protective equipment (PPE) for both anesthesiologists and other airway managers: principles and practice during the COVID-19 pandemic. Can J Anesth 2020; 67: 1005-15.
• Smiley R. Spinal anaesthesia and COVID-19 transmission to anaesthetists. Comment on Br J Anaesth 2020; 124: 670-5. Br J Anaesth 2020; 125: e247-e248.
• Dixon T, Bhatia K, Columb M. The SARS-CoV2 effect. An opportunity to decrease general anaesthesia rate for caesarean section? British Journal of Anaesthesia 2020; 125: e324–e326.
• Bhatia K, Columb M, Bewlay A, et al. The effect of COVID-19 on general anaesthesia rates for caesarean section. A cross-sectional analysis of six hospitals in the north-west of England. Anaesthesia 2021; 76: 312- 9.
• Binyamin Y, Heesen P, Gruzman I, et al.. A retrospective investigation of neuraxialanesthesia rates for elective cesarean delivery before and during the SARS-CoV-2 pandemic. Isr Med Assoc J 2021; 23: 408-11.
• Korkusuz M, Et T. Did the COVID-19 pandemic change the anaesthesia preferences of pregnant women for caesarean section? Turk J Anaesthesiol Reanim 2022; 50: 416-23.
• Ay N, Akyol D, Koyan Karadeniz GN, Çelik M, Gümüş Özcan F. Anesthesia management in cesarian section in pregnant patients with COVID-19 diagnoses. Med Bull Haseki 2022; 60: 447-52.
• Keita H, James A, Bouvet L, et al. Clinical, obstetrical and anaesthesia outcomes in pregnant women during the first COVID-19 surge in France: a prospective multicentre observational cohort study. Anaesth Crit Care Pain Med 2021; 40: 100937.