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Hemodynamic changes associated with neuraxial anesthesia in pregnant women with covid 19 disease: a retrospective case-control study.
Sangroula, D; Maggard, B; Abdelhaleem, A; Furmanek, S; Clemons, V; Marsili, B; Stikes, R; Hill, M; Sigdel, A; Clifford, S P; Huang, J; Akca, O; Logsdon, M C.
  • Sangroula D; Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA. daisy.sangroula@louisville.edu.
  • Maggard B; Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA. daisy.sangroula@louisville.edu.
  • Abdelhaleem A; Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA.
  • Furmanek S; Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.
  • Clemons V; Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.
  • Marsili B; Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.
  • Stikes R; Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.
  • Hill M; Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.
  • Sigdel A; Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.
  • Clifford SP; Department of Anesthesiology & Perioperative Medicine, University of Louisville School of Medicine, 530 S. Jackson Street, Room C2A03, Louisville, KY, 40202, USA.
  • Huang J; Center for Women, and Infants, University of Louisville Hospital, 530 S. Jackson Street, Louisville, KY, 40202, USA.
  • Akca O; Center of Excellence for Research in Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.
  • Logsdon MC; Division of Infectious Diseases, University of Louisville School of Medicine, 501 East Broadway, Suite 100, Louisville, KY, 40202, USA.
BMC Anesthesiol ; 22(1): 179, 2022 06 09.
Article in English | MEDLINE | ID: covidwho-2139145
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hypotension / Anesthesia, Obstetrical / Anesthesia, Spinal Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Pregnancy Language: English Journal: BMC Anesthesiol Year: 2022 Document Type: Article Affiliation country: S12871-022-01719-0

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Hypotension / Anesthesia, Obstetrical / Anesthesia, Spinal Type of study: Observational study / Prognostic study / Randomized controlled trials Limits: Female / Humans / Pregnancy Language: English Journal: BMC Anesthesiol Year: 2022 Document Type: Article Affiliation country: S12871-022-01719-0