PUI = persons under investigation; RANZCOG = xxx; RCOA-OAA = xxx; RCOG = xxx; RNA = ribonucleic acid; RT-PCR = real-time reverse transcriptasepolymerase chain reaction; SMFM-SOAP = xxx; SOAP = xxx; SOGC = xxx; Spo 2 = pulse oximetry; SARS = severe acute respiratory syndrome; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; SPG = sphenopalatine ganglion With increasing numbers of Coronavirus Disease 2019 (COVID 19) cases due to efficient human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States, preparation for the unpredictable setting of labor and delivery is paramount. The priorities are 2-fold in the management of obstetric patients with COVID-19 infection or persons under investigation (PUI): (1) caring for the range of asymptomatic to critically ill pregnant and postpartum women; (2) protecting health care workers and beyond from exposure during the delivery hospitalization (health care providers, personnel, family members). The goal of this review is to provide evidence-based recommendations or, when evidence is limited, expert opinion for anesthesiologists caring for pregnant women during the COVID 19 pandemic with a focus on preparedness and best clinical obstetric anesthesia practice.
(Anesth Analg. 2020;131:7–15)
When caring for obstetric patients infected with coronavirus disease 2019 (COVID-19), there are a number of factors to consider to safeguard the pregnant or postpartum woman and health care workers. The goal of this review was to provide recommendations based on evidence or expert opinion for anesthesiologists caring for pregnant women in the age of COVID-19.
Background
We tested the hypothesis that patients who continued buprenorphine postoperatively experience postoperative respiratory depression less frequently than those who discontinued buprenorphine.
Methods
This is a retrospective cohort study of patients who were on buprenorphine preoperatively. The primary outcome was postoperative respiratory depression as defined by respiratory rate < 10/minute, oxygen saturation (SpO2) < 90%, or requirement of naloxone for 48 h postoperatively. The secondary outcome was the composite of postoperative respiratory complications. The associations between postoperative buprenorphine continuation and respiratory depression and respiratory complications were estimated using separate multivariable logistic regression models, including demographic, intraoperative characteristics, and preoperative buprenorphine dose as covariates.
Results
Postoperative buprenorphine continuation was not associated with postoperative respiratory depression (adjusted odds ratio (OR), 1.11, 95% confidence interval (CI), 0.61 to 1.99, P=0.72). In subanalysis stratified by the preoperative buprenorphine dose, buprenorphine continuation was not associated with postoperative respiratory depression either when preoperative buprenorphine dose was high (≥16 mg daily) or low (<16 mg daily). Postoperative buprenorphine continuation was associated with lower incidence of postoperative respiratory complications (adjusted OR, 0.43, 95% CI, 0.21 to 0.86, P=0.02).
Conclusions
Continuing buprenorphine was not associated with respiratory depression, but it was associated with a lower incidence of respiratory complications.
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