Anesthesiologic management of pregnant women with SARS-COV-2 infection undergoing cesarean delivery

Abstract

Anesthesiologic management of pregnant women with SARS-COV-2 infection undergoing cesarean delivery Antonio Coviello1 , Concetta Posillipo1 , Ludovica Golino1 , Carlo De Angelis2, *, Elisabetta Gragnano1 , Gabriele Saccone1 , Marilena Ianniello1 , Gaetano Castellano3 , Annachiara Marra1 , Alfredo Maresca1 , Maria Vargas1 , Giuseppe Servillo1 1Department of Anesthesiology and Intensive Care Medicine, Policlinico, Federico II University Hospital, 80131 Naples, Italy 2Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, 00155 Rome, Italy 3Department of Anesthesiology and Intensive Care Medicine, Policlinico, Gemelli Molise Spa, 1 86100 Campobasso, Italy *Correspondence: carlo.deangelis@uniroma1.it (Carlo De Angelis) DOI:10.31083/j.ceog.2021.03.2446 This is an open access article under the CC BY 4.0 license (https://creativecommons.org/licenses/by/4.0/). Submitted: 2 January 2021 Revised: 11 February 2021 Accepted: 23 March 2021 Published: 15 June 2021 Background: Pregnant women are usually more susceptible to infection due to typical physiological and mechanical changes, such as increased heart rate, stroke volume and pulmonary residual capacity. The aim of this study was to evaluate an innovative anesthesiologic opioid-free management protocol in symptomatic pregnant women, with COVID-19 and with oxygen therapy, undergoing cesarean delivery with spinal anesthesia. Methods: With the patient in the sitting position, spinal anesthesia was performed at the L1–L2 level. Vertebral level has been identified starting from the sacrum, we counted the laminae in the caudal-to-cephalad direction, which was then marked with a surgical pen. The technique was performed in asepsis, in the subarachnoid space aȻter vision of clear CephaloSpinal Fluid (CSF) in the spinal needle 27 Gauge, without letting out the CSF, bupivacaine 0.5% 10 mg, dexmedetomidine 10 µg and dexamethasone 4 mg was injected. Results: During the study period, 40 pregnant women with one or more symptoms and supplemental oxygen (FiO2 35–40%) who underwent cesarean delivery were included in the study. All pregnant women had pain visual analog scale (VAS) ≤3, and no pregnant women required rescue dose. Adverse eȞfects, such as nausea, vomiting, shivering, or pruritus were not recorded in any case. AȻter a mean of 2.5 hours from the spinal anesthesia, all the included women had a complete motility of the lower limbs and were able to mobilize independently within 12 hours aȻter delivery. Mean time to first Ƞlatus was about 8 hours aȻter delivery. Conclusions: Pregnant women in COVID-19 can safely receive intrathecal dexamethasone and dexmedetomidine during planned cesarean delivery. Keywords Pregnancy; Anesthesia; Delivery; COVID-19; SARS-COV-2; 2019-nCOV; Cesarean delivery; Spinal anesthesia; Neuraxial anesthesia; Labour; Fetus; Pneumonia