ABSTRACT
BACKGROUND: Neuraxial blocks is the recommended mode of analgesia and anesthesia in parturients with Coronavirus 19 (COVID-19). There is limited data on the hemodynamic responses to neuraxial blocks in COVID-19 patients. We aim to compare the hemodynamic responses to neuraxial blocks in COVID-19 positive and propensity-matched COVID-19 negative parturients. METHODS: We conducted retrospective, cross-sectional case-control study of hemodynamic changes associated with neuraxial blocks in COVID-19 positive parturients in a Tertiary care academic medical center. Fifty-one COVID-19 positive women confirmed by nasopharyngeal reverse transcription-polymerase chain reaction (RT-PCR), were compared with propensity-matched COVID negative controls (n = 51). Hemodynamic changes after neuraxial block were recorded by electronic medical recording system and analyzed using paired and unpaired T- test and Wilcoxon-Mann-Whitney Rank Sum tests. The primary outcome was ≥ 20% change in MAP and HR after neuraxial block placement. RESULTS: In the epidural group, 7% COVID-19 positive parturients had > 20% decrease in mean arterial pressure (MAP) from baseline compared to 15% COVID-19 negative parturients (P = 0.66). In the spinal group, 83% of COVID-19 positive parturients had a decrease in MAP more than 20% from baseline compared to 71% in control (P = 0.49). MAP drop of more than 40% occurred in 29% COVID positive parturients in the spinal group versus 17% in COVID-19 negative parturients (P = 0.5465). In COVID-19 positive spinal group, 54% required vasopressors whereas 38% in COVID-19 negative spinal group required vasopressors (P = 0.387). We found a significant correlation between body mass index (BMI) > 30 and hypotension in COVID ( +) parturient with odds ratio (8.63; 95% CI-1.93 - 37.21) (P = 0.007). CONCLUSION: Incidence and severity of hypotension after neuraxial blocks were similar between COVID-19 positive and COVID-19 negative parturients. BMI > 30 was a significant risk factor for hypotension as described in preexisting literature, this correlation was seen in COVID-19 positive parturients. The likely reason for parturients with BMI > 30 in COVID negative patients not showing similar correlation, is that the sample size was small.
Subject(s)
Anesthesia, Obstetrical , Anesthesia, Spinal , COVID-19 , Hypotension , Case-Control Studies , Cross-Sectional Studies , Female , Hemodynamics , Humans , Hypotension/epidemiology , Pregnancy , Pregnant Women , Retrospective StudiesABSTRACT
Objective: The objective of this study was to evaluate mortality patterns among patients with history of stroke/TIA who were enrolled in a retrospective study of patients hospitalized with COVID-19 at eight different hospitals in the city of Louisville, Kentucky. Background: The global coronavirus disease (COVID-19) pandemic has been associated with increased Mortality. It is essential to identify comorbidities associated with this increased risk. Design/Methods: Records from the Louisville COVID-19 Study database met inclusion if they were hospitalized between the dates March 15 to June 20, 2020. Groups with and without past history of stroke were compared for significant events in the clinical course (e.g., Myocardial Infarction, Deep Vein Thrombosis, Pulmonary Embolism, acute stroke, cardiac arrest and mortality) using chi-square test. The mortality between these groups were compared stratified by age groups 86 yrs. Results: 692 COVID-19 positive patients were admitted during this period, 93 (13%) had a past history of stroke. The mortality among patients with past history of stroke, 26 (28%) was higher than patients without past history of stroke, 85 (14%);p=0.001. Clinic Patients 35 years of age had mean mortality of 25%. Among middle aged patients (36-65 years group), the mortality was six times higher (30%) when there was a past history of stroke compared to no past history of stroke (5%). The mortality among older patients (>66 years) was similar With in these groups (~20%).Other significant clinical outcomes like Pulmonary embolism, cardiac arrest were not significantly elevated with past history of stroke. Conclusions: In this cohort of COVID-19 patients in our registry, a history of past stroke confers a high risk of mortality, which is especially high among middle aged patients. These results beckon further analyses to identify underlying pathophysiological mechanisms and biomarkers related to such age-specific mortality.