COVID-19 Hastalarında Rejyonel Anestezi ve Genel Anestezinin Yoğun Bakım Başvurusu, Mortalite Oranları ve Pulmoner Komplikasyonlar Üzerine Etkisi

Abstract

Amaç Yeni tip koronavirüs hastalığı (COVID-19) olan ve cerrahi tedavi gerektiren hastalarda hangi anestezi yönteminin uygulanacağı belirsizliğini korumaktadır. Bu çalışmada COVID-19 enfeksiyonu olan hastalarda rejyonel anestezi (RA) ve genel anestezi (GA)’nın yoğun bakım ünitesine (YBÜ) kabul, pulmoner komplikasyon oranı ve mortalite açısından karşılaştırması amaçladı. Gereç ve Yöntem Mart 2020 ile Aralık 2021 arasında tıbbi kayıtlar incelendi ve çalışmaya RA veya GA altında ameliyat edilen COVID-19 hastaları dahil edildi. Hastalar iki gruba ayrıldı: 1. Grup RA ile ameliyat edilen hastalar ve 2. grup GA ile ameliyat edilen hastalar. Birincil sonuçlarımız yoğun bakım ünitesine kabul oranları, akut pulmoner, renal ve hepatik komplikasyonlar ve perioperatif mortalite oranlarıydı. Bulgular 123 hastayı çalışmaya dahil ettik. Rejyonel anestezi uygulanan hasta sayısı anlamlı olarak daha yüksekti. 97 (%78.9) hasta RA, 26 (%21.1) hasta GA altında opere edildi. YBÜ'ye kabul oranı RA grubunda %8.2 ve GA grubunda %11,5 idi. Fark anlamlı değildi (p=0.422). RA grubunda 6 (%6.2) hastada ve GA grubunda 2 (%7.7) hastada pulmoner komplikasyonlar görüldü ve anlamlı bir fark yoktu (p=0.535). Perioperatif mortalite oranları gruplar arasında anlamlı fark yoktu (RA grubunda %5,2, GA grubunda %7,7) (p=0,535). Sonuç Rejyonel anestezi ile ameliyat edilen COVID-19 hastalarında pulmoner komplikasyonlar, yoğun bakıma yatışı ve perioperatif mortalite oranları daha düşüktü fakat anlamlı bir fark yoktu.

Keywords

• Rejyonel anestezi
• Genel anestezi
• COVİD-19
• YBÜ kabulü
• Pulmoner komplikasyonlar

Regional Anesthesia Vs General Anesthesia In Patients With Covid-19: The Effect On Critical Care Admission, Mortality Rates And Pulmonary Complications

Abstract

Objectives The appropriate anesthesia method in patients requiring surgical treatment with confirmed or suspected new coronavirus disease (COVID-19) is unclear. This study aimed to compare regional anesthesia (RA) with general anesthesia (GA) in patients with COVID-19 infection in terms of admission to intensive care unit (ICU), rate of pulmonary complications, and mortality. Materials and Methods We reviewed medical records between March 2020 and December 2021 added patients with COVID-19 that operated under RA or GA in the study. The patients were assigned into two groups: 1. patients operated under RA and 2. patients operated under GA. Primary outcomes were admission rates to the ICU, acute pulmonary, renal, and hepatic complications, and perioperative mortality rates. Results We included 123 patients in the study. Regional anesthesia was significantly higher in the cohort. 97 (78.9 %) patients were operated under RA and 26 (21.1 %) patients under GA. The admission rate to ICU was 8.2 %in the RA group and 11.5 %in the GA group. The difference was not significant (p=0.422). Pulmonary complications were seen in 6 (6.2 %) patients in the RA group and 2 (7.7 %) patients in the GA group without a significant difference (p=0.535). Perioperative mortality rates were comparable between groups (5.2 %in the RA group vs. 7.7 %in the GA group) (p=0.535). Conclusion Pulmonary complications, ICU admission, and perioperative mortality rates were lower in COVID-19 patients operated under regional anesthesia; however, the differences were not significant.

Keywords

• Regional anesthesia
• General anesthesia
• COVID-19
• ICU admission
• Pulmonary complications

References

1. 1- Besnier E, Tuech JJ, Schwarz L. We asked the experts: Covid-19 outbreak: is there still a place for scheduled surgery? “Reflection from pathophysiological data”. World J Surg 2020; 44: 1695-98. doi: 10.1007/s00268-020-05501-6
2. 2- Warren J, Sundaram K, Anis H, Kamath AF, Mont MA, Higuera CA, et al. Spinal anesthesia is associated with decreased complications after total knee and hip arthroplasty. J Am Acad Orthop Surg 2020; 28: e213-e221221. doi: 10.5435/JAAOS-D-19-00156.
3. 3- COVIDSurg Collaborative. Global guidance for surgical care during the COVID-19 pandemic. Br J Surg 2020; 107(9): 1097-103. doi: 10.1002/bjs.11646.
4. 4- Sondekoppam RV, Lobo CA, Kolli S, Kalagara HK. Practice recommendations on neuraxial anesthesia and peripheral nerve blocks during the COVID-19 pandemic. A joint statement by the American Society of Regional Anesthesia and Pain Medicine (ASRA) and European Society of Regional Anesthesia and Pain Therapy (ESRA) Available at https://www.asra.com/page/2905/practice-recommendations-on- neuraxial-anesthesia-and-peripheral-nerve-blocks-dur.
5. 5- Zhong Q, Liu YY, Luo Q, Zou YF, Jiang HX, Li H, et al. Spinal anaesthesia for patients with coronavirus disease 2019 and possible transmission rates in anaesthetists: retrospective, singlecentre, observational cohort study. Br J Anaesth 2020; 124: 670-5. doi: 10.1016/j.bja.2020.03.007.
6. 6- Wang K, Wu C, Xu J, Zhang B, Zhang X, Gao Z, et al. Factors affecting the mortality of patients with COVID-19 undergoing surgery and the safety of medical staff: A systematic review and meta-analysis. EClinicalMedicine. 2020; 29: 100612. doi:10.1016/j.eclinm.2020.100612
7. 7- Practice Guidelines for Obstetric Anesthesia: An Updated Report by the American Society of Anesthesiologists Task Force on Obstetric Anesthesia and the Society for Obstetric Anesthesia and Perinatology. Anesthesiology 2016; 124: 270-300. doi:10.1097/ALN.0000000000000935.
8. 8- Zheng H, Hebert HL, Chatziperi A, Meng W, Smith BH, Yan J, et al. perioperative management of patients with suspected or confirmed COVID-19: review and recommendations for perioperative management from a retrospective cohort study. Br J Anaesth 2020; 125: 895–911. doi: 10.1016/j.bja.2020.08.049.

9. 9- Nepogodiev D, Bhangu A, Glasbey JC, Li E, Omar OM, Simoes JF, et al. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet 2020; 396(10243): 27-38. doi: 10.1016/S0140-6736(20)31182-X
10. 10- 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;67:655e63. doi: 10.1007/s12630-020-01630-7.
11. 11- Mi B, Chen L, Panayi AC, Xiong Y, Liu G. Surgery in the COVID-19 pandemic: clinical characteristics and outcomes. Br J Surg 2020; 107(9): e297. doi: 10.1002/bjs.11733.
12. 12- Lawrence VA, Hilsenbeck SG, Noveck H, Poses RM, Carson JL. Medical complications and outcomes after hip fracture repair. Arch Intern Med 2002; 162: 2053-7. doi: 10.1001/archinte.162.18.2053
13. 13- Mills GH. Respiratory complications of anaesthesia. Anaesthesia 2018;73 Suppl 1: 25-33. doi: 10.1111/anae.14137
14. 14- Mao R, Qiu Y, He JS, Tan JY, Li XH, Liang J. Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol 2020; 5: 667-78. doi: 10.1016/S2468-1253(20)30126-6.
15. 15- Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth 2020; 67: 568-76. doi: 10.1007/s12630-020-01591-x.