Assessment of failed spinal anesthesia for cesarean section during COVID-19 pandemic

Abstract

Objective: 1490 pregnant women with confirmed COVID 19 were admitted to the hospital between April 2020 and February 2021. In Ankara City Hospital, Ankara, Turkey, 416 pregnant women gave birth spontaneously and 251 underwent cesarian section. We attempted spinal anesthesia for cesarian sections because all regional anesthesia organizations advised regional anesthesia for obstetric surgery. However, spinal anesthesia for cesarean delivery is not a foolproof method. Material and Method: We used a retrospective analysis of 251 COVID 19 cesarean section anesthesia to determine the incidence of failed spinal anesthesia, management strategies, and risk variables that contribute to failure. Results: The total number of failed spinal anesthesia instances was 14 (5.58%), with 1% of complete failures and 4% of partial failures. One patient was given spinal anesthesia for the 2nd attempt (0.4%), while the other two were given general anesthesia (0.79%). In failed spinal cases, sedation was utilized. Patients received varied dosages of midazolam, fentanyl, ketamine, and propofol. Conclusion: The rate of failed spinal anesthesia among COVID 19 pregnant women was similar to, even lower than, the rate of failed spinal anesthesia in the general population. Despite all the negative consequences, such as wearing PPE and moving around, vision and hearing problems due to PPE, anesthesiologist fear about being infected by the patient or patient anxiety about infection, the future and babies’ health is the reason for this result.

Keywords

• SARS-CoV-2 (COVID-19)
• spinal anesthesia
• obstetrical anesthesia

References

1. 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: e213-e221.
2. Neuman MD, Silber JH, Elkassabany NM, Ludwig JM, Fleisher LA. Comparative effectiveness of regional versus general anesthesia for hip fracture surgery in adults. Anesthesiology 2012; 117: 72-92.
3. Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000; 321: 1493.
4. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: A systematic review. PLoS One 2012; 7: e35797.
5. Uppal V, Sondekoppam RV, Lobo CA, Kolli S, Kalagara HKP. Practice recommendations on neuraxial anesthesia and peripheral nerve blocks during the COVID-19 pandemic. https://www.asra.com/page/2905/practicerecommendations-on-neuraxial-anesthesia-andperip heral-nerve-blocks-dur. [Accessed 10 May 2020]
6. Sng BL, Lim Y, Sia ATH. An observational prospective cohort study of incidence and characteristics of failed spinal anaesthesia for caesarean section. Int J Obstet Anesth 2009; 18: 237e41.
7. Shrestha AB, Shrestha CK, Sharma KR, Neupane B. Failure of subarachnoid block in caesarean section. Anesth Analg 2009; 11: 50e1.
8. Jairo J, Paez L, Ricardo J. Revista Colombiana de Anestesiología Regional versus general anesthesia for cesarean section delivery. Colomb J Anesthesiol 2012; 40: 203e6

9. Agrawal J, Rajput A, Mittal R. Failed spinal anaesthesia- a review. Anaesth Critic Care Med J 2019; 4: 000145.
10. Purva M, Russell IF, Kinsella M. Caesarean section anaesthesia: technique and failure rate. In: Colvin JR, Peden CJ, eds. Raising the Standard: A Compendium of Audit Recipes for Continuous Quality Improvement in Anaesthesia. 3rd ed. London, UK: The Royal College of Anaesthetists, 2012: 221-222.
11. Levy JH, Islas JA, Ghia JN, Turnbull CA. Retrospective study of the incidence and caues of failed spinal anesthetics in a university hospital. Anesth Analg 1985; 64: 705-10.
12. Fuzier R, Bataille B, Fuzier V, et al. Spinal anesthesia failure after local anesthetic injection into cerebrospinal fluid: a multicenter prospective analysis of its incidence and related risk factors in 1214 patients. Reg Anesth Pain Med 2011; 36: 322-6.
13. Van Dillen J, Diesch M, Schutte J, Zwart J, Wolterbeek R, van Roosmalen J. Comparing grades of urgency for classification of cesarean delivery. Int J Gynaecol Obstet 2009; 107: 16-8.
14. Yentis SM, Richards NA. Classification of urgency of caesarean section. Obstet Gynaecol Reprod Med 2008; 18:139-40.
15. Lucas DN, Yentis SM, Kinsella SM, et al. Urgency of caesarean section: A new classification. J R Soc Med 2000; 93: 346-50
16. Kinsella M. Royal College of Anaesthetists / Raising the Standard: a compendium of audit recipes, 3rd Edition, Year 2012.
17. Rukewe A, Adebayo OK, Fatiregun AA. Failed Obstetric Spinal Anesthesia in a Nigerian Teaching Hospital: Incidence and Risk Factors. Anesth Analg 2015; 121: 1301-5.
18. Kinsella SM. A prospective audit of regional anaesthesia failure in 5080 Caesarean sections. Anaesthesia 2008; 63: 822-32.
19. Partani S, Yogendra S, Gupta S A prospective, observational audit of failed regional anaesthesia in 4085 caesarean sections at a tertiary care hospital. Indian J Clin Anaesthesia, 2018; 5: 50-5.
20. Sng BL, Lim Y, Sia AT. An observational prospective cohort study of incidence and characteristics of failed spinal anaesthesia for caesarean section. Int J Obstet Anesth 2009; 18: 237-41.
21. Garry M, Davies S. Failure of regional blockade for caesarean section. Int J Obstet Anesth 2002; 11: 9-12
22. Wu J, Chen X, Yao S, Liu R. Anxiety persists after recovery from acquired COVID-19 in anaesthesiologists. J Clin Anesth 2020; 67: 109984.
23. Agarwal A, Agarwal S, Motiani P. Difficulties encountered while using PPE kits and how to overcome them: an Indian perspective. Cureus 2020; 12: e11652.
24. Henos EA, Seid AA, Debas YM. The incidence and factors associated with failed spinal anesthesia among parturients underwent cesarean section, 2019: A prospective observational study, International Journal of Surgery Open, Volume 24, 2020, 47-51.
25. Adesope OA, Einhorn LM, Olufolabi AJ, Cooter M, Habib AS. The impact of gestational age and fetal weight on the risk of failure of spinal anesthesia for cesarean delivery. Int J Obstet Anesth 2016; 26: 8e14.
26. Sharma SK, Gambling DR, Joshi GP, Sidawi JE, Herrera ER. Comparison of 26-gauge Atraucan and 25-gauge Whitacre needles: insertion characteristics and complications. Can J Anaesth 1995; 42: 706-10.
27. Arevalo-Rodriguez I, Muñoz L, Godoy-Casasbuenas N, et al. Needle gauge and tip designs for preventing post-dural puncture headache (PDPH). Cochrane Database Syst Rev 2017; 4: CD010807.
28. Drasner K, Ringler ML. Repeat injection after a failed spinal: at times, a potentially unsafe practice. Anaesthesiology 1991; 75: 713-4.
29. Steiner LA, Hauenstein L. Ruppen W, Hampl KF, Seeberger MD. Bupivacaine concentrations in lumbar cerebrospinal fluid in patients with failed spinal anaesthesia. Br. J. Anaesth 2009; 102: 839-44.