Recommendations for obstetric anesthesia during coronavirus disease 2019 epidemic

ABSTRACT

Obstetric anesthesia is an important part of clinical anesthesia during the coronavirus disease 2019(COVID-19 )epidemic. Obstetric anesthesia management faces challenges such as difficulty in evaluation, in managing patients with emergent or fluctuating conditions, and in taking care of both the mother and the fetus/newborn.Obstetric anesthesia should focus on the following aspects.First, detailed evaluation of COVID-19 should be carried out.Except for epidemic-related evaluation, the effect of physiologic changes during pregnancy and complex condition of the parturient and critical condition on COVID-19 evaluation should be considered.The possible effects of maternal lung conditions on the fetus should be paid attention to simultaneously to determine the optimal timing for delivery, delivery mode and degree of protection.Second, tight infection control of the environment, staff and devices is necessary.Delivery of the suspected or diagnosed cases of novel coronavirus infection should be performed in an isolation delivery room or in a negative pressure operating room.Anesthetic personnel should be minimized, and skilled anesthetists should be arranged in priority.Medical staff should wear personal protective equipment according to standards.Third, the keypoint of optimizing anesthesia management is to maintain sufficient oxygenation and stable circulation.For neuraxial anesthesia, coughing and hypotension should be minimized.For general anesthesia, protection from infection during airway management is essential.Fourth, humanistic care should be implemented, and psychological health education and psychological crisis intervention should be conducted for parturients.Fifth, though no evidence supported the vertical transmission yet, the newborn of the suspected or diagnosed mother of novel coronavirus infection should be isolated, and breastfeeding is not permitted until the mother recover.To minimize the risk of infection and optimize clinical safety, multi-discipline-based teamwork by the obstetricians, anesthetists, neonatologists, infect-control experts and intensive care unit staff on infection control and maternal-fetal management is important. © 2020 Chinese Medical Association