Considerations and recommendations for obstetric anesthesia care during COVID-19 pandemic - Saudi anesthesia society guidelines

Abstract

Introduction: Severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) emerged in Wuhan, China late 2019 and became a pandemic causing coronavirus disease 2019 (COVID-19). Despite its lower mortality rate compared to the other coronaviruses, it has a higher human-to-human transmission rate. Anesthesiologists may benefit from a review of the current evidence related to the obstetric patient with COVID-19. Methods: We reviewed the literature for relevant articles as well as experts' opinions from related medical societies' websites. Conclusion: There are several anesthetic considerations in the care of pregnant women with COVID-19 due to their unique physiological changes. We provide considerations and recommendations for departmental and institutional leadership as well as the obstetric anesthesia providers. These recommendations may apply and can be edited, for future droplet or airborne based pandemics. The rapidly evolving literature makes it important to get updates directly from the relevant medical societies' websites.

Safety measures for COVID-19: a review of surgical preparedness at four major medical centres in Saudi Arabia

“…If disconnection is needed, the endotracheal tube should be clamped. If extensions are needed, they should be attached before induction [21].…”

“…HCPs are advised not to touch environmental surfaces, like doorknobs and elevator buttons, during transport. These actions should be performed by an accompanying security team [21]. Team debriefing is an essential strategy for detecting system defects and improving team performance.…”

Labour analgesia in COVID-19 positive parturients: Points to ponder!

“…Nevertheless, these patients additionally classify as potential candidates for labour analgesia for safe conduct of normal vaginal delivery. While an epidural registers as the gold-standard of labour analgesia, the circumstantial decision-making on the relative risk-benefit profile of labour epidural in a COVID-19 patient can be precarious in view of the peculiarities such as: Thrombocytopenia , initially reported in almost one-third COVID-19 patients and associated with thrice the risk of a severe underlying infection in accordance with a recent meta-analysis [ 1 , 2 , 3 ]. Despite the limited data on thrombocytopenia in pregnancy, a declining platelet-count poses a certain obstetric anaesthesiologist’s dilemma.…”

“…Amid the range of theoretical-to-practical concerns of varying significances, most of the working obstetric-guidelines propose the safety of neuraxial anaesthesia in COVID-19 positive parturients, particularly at the bet of avoiding higher risk of aerosol generation associated with general anaesthesia in the context of emergency caesarean-sections [ 1 , 2 , 3 ]. Nevertheless, these patients additionally classify as potential candidates for labour analgesia for safe conduct of normal vaginal delivery.…”

“… Coagulopathy, resulting from the prothrombotic sequel of an underlying COVID-19 infection [ 4 , 5 ] can potentially aggravate the pregnancy-associated hypercoagulable state. Anticoagulants being administered in such circumstances, present obvious concerns [ 1 , 2 , 3 ]. Epidural-associated pyrexia , manifests with an elevated incidence of two and a half times with labour epidural analgesia.…”