Safe obstetric anesthesia practice-COVID-19

Authors

  • Sunil Thakur Dr. RK Govt Medical College, Hamirpur, Himachal Pradesh
  • Sushruti Kaushal All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh
  • Harpreet Kaur Department of Anesthesiology, Dr. RK Govt Medical College, Hamirpur, Himachal Pradesh, India
  • Asmita Kaundal Department of Obstetrics and Gynaaecology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20214675

Keywords:

Obstetric, Anesthesia, Cesarean, Fetus, COVID-19

Abstract

COVID-19 or Corona virus disease 2019 was declared a pandemic by the WHO on 11th March 2020. Cesarean delivery is a commonly performed major surgery around the world. Important considerations while performing a cesarean section on a confirmed or suspected case of COVID19 are safety of the woman and the fetus; and prevention of transmission of SARS-CoV2 infection to the fetus as well as the healthcare providers. Woman and her birthing partner should be screened for the symptoms of COVID-19 before scheduled admission. Cesarean section in a woman suffering from COVID-19 should be managed by a multidisciplinary team consisting of anesthetists, obstetricians, labor and delivery nurses, neonatologist, critical care experts and infectious disease specialists, all members working in tandem with each other. General changes in workflow, reorganization of obstetric anesthesia services and proper use of personal protective equipment (PPE) are required for safe delivery of obstetric anesthesia during the COVID pandemic. Regional anesthesia is the preferred method of anesthesia for cesarean delivery. Using regional anesthesia reduces the need of aerosol generating procedures and avoids the use of mechanical ventilation. It also decreases the possibility of exacerbating the respiratory complications due to intubation. General anesthesia is recommended when a COVID-19 parturient presents with desaturation (oxygen saturation≤ 93%) for emergency cesarean delivery. Use of mechanical barriers around patient’s head during intubation and extubation might reduce exposure. The patient should be allowed to remain in the operating room itself till sufficiently recovered to be shifted directly to the isolation room.

Author Biographies

Sunil Thakur, Dr. RK Govt Medical College, Hamirpur, Himachal Pradesh

Assistant Professor, Department of Anesthesia

Sushruti Kaushal, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh

Assistant Professor, Department of Obstetrics and Gynaecology

Harpreet Kaur, Department of Anesthesiology, Dr. RK Govt Medical College, Hamirpur, Himachal Pradesh, India

Associate Professor, Department of Obstetrics and Gynaecology

Asmita Kaundal, Department of Obstetrics and Gynaaecology, All India Institute of Medical Sciences, Bilaspur, Himachal Pradesh, India

Assistant Professor, Department of Obstetrics and Gynaecology

References

CDC. COVID-19 and Your Health. Centers for Disease Control and Prevention. 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnant-people.html. Accessed on 2021 Jun 2.

Zambrano LD, Ellington SR, Strid P, Galang RR, Oduyebo T, Tong VT et al. Characteristics of women of reproductive age with laboratory-confirmed SARS-CoV-2 infection by pregnancy status-United States, January 22-October 3, 2020. MMWR Morb Mortal Wkly Rep. 2020;1641-7.

Breslin N, Baptiste C, Gyamfi-Bannerman C. Coronavirus disease 2019, infection among asymptomatic and symptomatic pregnant women: two weeks of confirmed presentations to an affiliated pair of New York City hospitals. Am J Obstet Gynecol MFM. 2020;(2):100-18.

Royal College of Obstetricians and Gynaecologists. Coronavirus (COVID-19) infection in pregnancy. London: RCOG. 2020.

Boelig RC. Tracy Manuck, Oliver EA, Mascio DD, Saccone G, Bellussi F, Berghella V. Labor and delivery guidance for COVID-19. AJOG MFM. 2020;1-9.

Ganesh V, Bhatia R, Trikha A. COVID‐19: Considerations for Obstetric Anesthesia and Analgesia. J Obstet Anaesth Crit Care. 2020;10:2.

Davenport G, Eddleston J, Grocott M. Clinical Guide for the management of Critical care adults with COVID‐19 during Corona virus Pandemic. 2020.

Harenberg J, Church R, Tubug T. Anesthesia Considerations of a Pregnant Woman With COVID-19 Undergoing Cesarean Delivery: A Case Report. AANA. 2020;47-53.

Lucas N, Bamber J, Donald F, Platt F. clinical guidelines-PPE for COVID-19. 2020; Available at: https://www.oaa-anaes.ac.uk/assets/_managed/cms/files/Clinical%20Guidelines/OAA-PPE-infographic_11.04.20.pdf. Accessed on 2021 Jun 2.

Centers for Disease Control and Prevention. Interim infection prevention and control recom- mendations for patients with suspected or confirmed coronavirus disease 2019 (COVID- 19) in healthcare settings. Available at: https:// www.cdc.gov/coronavirus/2019-ncov/infection- control/control-recommendations.html. Accessed March 23, 2021.

An Update on the Perioperative Considerations for COVID-19 Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). Anesthesia Patient Safety Foundation. Available at: https://www.apsf.org/article/an-update-on-the-perioperative-considerations-for-covid-19-severe-acute-respiratory-syndrome-coronavirus-2-sars-cov-2/. Accessed on 2021 Jun 16.

Miller E, Leffert L, Landau R. Society for Obsteric Anestesia and Perinatology. Interim Con‐siderations for Obstetric Anaesthesia Care related to COVID19. Available at: http://soap.org. Accessed on 2021 Jun 2.

COVID-19 and Anesthesia FAQ. Anesthesia Patient Safety Foundation. Available at: https://www.apsf.org/covid-19-and-anesthesia-faq/. Accessed on 2021 Jun 16.

Ashokka B, Loh MH, Tan CH. Care of the pregnant woman with coronavirus disease 2019 in labor and delivery: anesthesia, emergency cesarean delivery, differential diagnosis in the acutely ill parturient, care of the newborn, and protection of the healthcare personnel. AJOG. 2019;66-74:e3.

Guascha E, Broglya N, Manriqueb S. Recomendaciones prácticas en la paciente obstétrica con infección por COVID-19. Rev Esp Anestesiol Reanim. 2020;67(8):438-45.

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Published

2021-11-25

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Section

Review Articles