Obstetrik hastalarda, SARS-CoV-2 spinal sonrası hipotansiyon için risk faktörü müdür?

Abstract

Amaç: COVID-19 pandemisinin başından itibaren, sezaryen operasyonlarında genel anestezide entübasyon ve ekstübasyon sırasında olası virüs yayılımını önlemek için Nöroaksiyel anestezi uygulanması önerilmektedir. Ancak yapılan bazı çalışmalarda aktif COVID-19 varlığında spinal anestezi güvenliğinin, hipotansiyon nedeniyle tartışmalı olduğu belirtilmektedir. Bu çalışmamızda amacımız COVID-19’lu gebe hastalardaki spinal sonrası hipotansiyon oranını literatürde ki COVID 19 olmayan hastalarla karşılaştırarak, Nöroaksiyel anestezinin güvenirliliğini tespit etmektir. Gereç ve Yöntem: Pandeminin başından, Aralık 2020 yılına kadar olan COVID-19’lu gebelerin medikal kayıtları retrospektif olarak çalışmaya dahil edilmiştir. Demografik- vital, özellikle sistolik ve diastolik kan basınçları, kullanılan efedrin-atropin dozları, infüzyon volümleri ve bulantı- kusma sıklığı analiz edilmiştir. Bulgular: Spinal anestezinin neden olduğu hipotansiyon hastaların 54’ünde görülmüştür. (%21,69). Vazopressor (efedrin) tüm hipotansif hastalarda kullanılmıştır. Demografik veriler, kullanılan bupivakain ve spinal anestezi öncesi kullanılan kristaloid volüm miktarı hipotansif olan ve olmayan hastalar arasında farklılık göstermemiştir. Sonuç: Literatürde ilk defa çalışmamızda tek merkezli 249 COVID 19 (+) hastanın spinal anestezi sonrası hipotansiyon oranları ile literatürde ki spinal anestezi sonrası hipotansiyon oranları arasında istatiksel olarak fark olmadığı gösterilmiştir. COVID-19 hastalarında rejyonel anestezinin güvenle uygulanabileceğini önermekteyiz.

Keywords

• hipotansiyon
• SARS-CoV-2
• obstetrik anestezi
• rejyonel anestezi,
• spinal anestezi

Is SARS-CoV-2 a risk factor for hypotension during spinal anesthesia for obstetric patients?

Abstract

Background: Since the onset of COVID-19, recommendations suggest the use of neuraxial anesthesia, over general anesthesia for cesarian section to avoid the risks of aerosolization associated with intubation and extubation. But the safety of performing spinal anesthesia is unclear especially for post spinal hypotension, during the presence of active COVID-19. According to a few studies there was a controversial discussion about the safety of regional anesthesia. In this study we aimed to compare the incidence of hypotension in COVID-19 pregnant patients between non-COVID 19 pregnant patients in the literature to see if the spinal anesthesia is safe or if it poses an additional risk. Materials and Methods: Medical records of COVID-19 pregnant women for cesarean section from the beginning of the pandemic up to December 2020 were retrospectively retrieved. All the demographic-vital data, including systolic and diastolic blood pressure (SBP-DBP), ephedrine-atropine doses, infusion volumes, and nausea and vomiting were retrospectively analyzed. Results: Spinal anesthesia induced hypotension was seen 54 of the patients (21,69%). And vasopressors (Ephedrine) were used to all hypotensive patients. Demographic data’s, the amount of bupivacaine and crystalloid volume which used before the spinal anesthesia showed no differences between hypotensive and non-hypotensive patients. Conclusion: This is the first retrospective study which shows 249 COVID 19 patients’ data in one center that no significant difference was seen in the incidence of hypotension associated with spinal anesthesia for COVID-19 cesarean section compared to non-COVID group in literature. We recommend using of regional anesthesia safely for patients and anesthesiologists during active COVID-19 patients.

Keywords

• hypotension,
• SARS-C0V-2
• spinal anesthesia
• regional anesthesia
• obstetrical anesthesia

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