Anesthesia Considerations for Pregnant People With COVID-19 Infection

Abstract

The purpose of this review is to describe updates following initial recommendations on best anesthesia practices for obstetric patients with coronavirus disease 2019. The first surge in the United States prompted anesthesiologists to adapt workflows and reconsider obstetric anesthesia care, with emphasis on avoidance of general anesthesia, the benefit of early neuraxial labor analgesia, and prevention of emergent cesarean delivery whenever possible. While workflows have changed to allow sustained safety for obstetric patients and health care workers, it is notable that obstetric anesthesia protocols for labor and delivery have not significantly evolved since the first coronavirus disease 2019 wave.

COVID-19 Severity Among Non-Vaccinated Pregnant Women During the Delta Wave in Tunisia: A Retrospective Monocentric Study

“…We suggest that spinal anesthesia can be safe for COVID-19 infected pregnant women, even in patients with pneumonia [5,21]. However, general anesthesia remains risky in obstetric patients because of difficult airway management and the risk of contamination of healthcare workers [22,23].…”

Regional Anesthesia Conversion to General Anesthesia during Cesarean Section of a Woman with Antepartum Hemorrhage due to Placenta Previa and Ovarian Cyst with Moderate Confirmed COVID-19: A

“…To prevent hemodynamic instability, we used ephedrine 10 mg as a maintenance agent. The current practice of spinal hypotension prevention with vasopressors helps with hemodynamic instability following neuraxial anesthesia for cesarean delivery [7]. Dosage adjustments are needed since pregnant patients are physiologically more sensitive to intravenous induction agents [3], as in our case, we used intravenous propofol 50 mg, fentanyl 100 mcg, and atracurium 30 mg during intubation.…”

Safety of spinal anesthesia in pregnant vaccinated with one or two doses of the BNT162b2 vaccine: A retrospective observational cohort study

“…At the beginning of the Covid-19 pandemic, some authors recommended the early placement of an epidural catheter (elective cesarean section) or the administration of a single subarachnoid anesthesia (emergency cesarean section) in order to reduce the possibility of aerosol formation and cross-infection in the operating room. 8 , 9 , 10 , 11 , 12 General anesthesia is usually performed in an emergency situation, such as placental abruption >50%, severe ARDS in patients with Covid-19, among others.…”