Obstetric anaesthesia: Overview + SIG resources

Brugada syndrome is an autosomal dominant disorder that affects cardiac sodium channels and predisposes patients to an increased risk of sudden cardiac death. Obstetric anesthesia management in patients with Brugada syndrome poses a challenge due to the prevalence of local anesthetic use for labor analgesia or cesarean section. However, central neuraxial techniques and local anesthetics have been used safely in parturients with this syndrome and may be offered to patients during preadmission counseling. We present the case of a primigravida who opted for further labor analgesia via a combined spinal-epidural technique. To our knowledge, this is the first case report of a lidocaine infusion administered via an epidural catheter to a laboring parturient with Brugada syndrome. We further discuss the use of local anesthetics, other medications, and central neuraxial techniques in those with Brugada syndrome to assist anesthesiologists caring for expectant mothers.

Introduction: Fanconi-Bickel syndrome (FBS) is a rare genetic condition characterized by extremely short stature, renal tubular dysfunction, osteoporosis, and rickets. The literature is scant regarding the successful reproduction of women with FBS. Cesarean delivery is indicated due to the risk of pelvic fracture from vaginal delivery in a patient with FBS and rickets, yet no case describing the anesthetic has been reported. Clinical Findings. We present a 39-inch-tall, 46.47 kg/m2 BMI woman with FBS who was scheduled for cesarean delivery and requesting neuraxial anesthesia. A low-dose, combined spinal-epidural technique (CSE) was employed to account for her extreme short stature yet allow for additional dosing if needed. The cesarean delivery, hospital course, and follow-up were all uneventful.

Conclusion: A single case of an FBS patient's successful pregnancy was previously reported in the literature without describing the anesthetic technique. Our case is unique in that it is the first case in the literature that we are aware of describing the anesthetic technique. This case may provide a template for clinicians treating FBS patients and patients with extremely short stature.

Abstract
Purpose: The study aims to compare anesthesia methods, clinical course, and maternal and fetal outcomes of symptomatic and asymptomatic pregnant women undergoing cesarean operation with confirmed COVID-19.

Methods: 254 pregnant women with COVID-19 who had a cesarean section in our hospital between March 2020 and March 2021 were included in the study. Demographic information, laboratory test results, radiological data, treatments, anesthesia methods, and prognoses of the patients were evaluated retrospectively.

Results: On admission, 160 (63%) patients were asymptomatic (Group A), and 94 (37%) patients were symptomatic (Group S). The ratio of patients who needed oxygen therapy in the obstetric ward (p < 0.001) and intraoperative period (p < 0.001) and ICU admission (p = 0.005) was higher in Group S. Neutrophil-to-lymphocyte ratio (NLR), ferritin, procalcitonin, aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were higher in Group S. In both groups, spinal anesthesia was performed predominantly. The rate of general anesthesia was significantly higher in Group S (16.0% vs. 4.4%, p = 0.003). No difference was found in the amount of sedatives during the spinal anesthesia.

Conclusion: Close follow-up of the laboratory values and comorbidities (especially asthma) of pregnant will provide information about the clinical course as in other patient groups. Spinal anesthesia is a safe and sufficient anesthesia method in both symptomatic and asymptomatic COVID-19 pregnant women when performed by experienced hands.

The above guidance was commissioned from the Obstetric Anaesthetists’ Association (OAA) by the Faculty of Intensive Care Medicine, the Intensive Care Society, the Association of Anaesthetists and the Royal College of Anaesthetists.

Abstract.
Purpose: To assess the management and safety of epidural or general anesthesia for Cesarean delivery in parturients with coronavirus disease (COVID-19) and their newborns, and to evaluate the standardized procedures for protecting medical staff.

Methods: We retrospectively reviewed the cases of parturients diagnosed with severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection disease (COVID-19). Their epidemiologic history, chest computed tomography scans, laboratory measurements, and SARS-CoV-2 nucleic acid positivity were evaluated. We also recorded the patients' demographic and clinical characteristics, anesthesia and surgery-related data, maternal and neonatal complications, as well as the health status of the involved medical staff.

Results: The clinical characteristics of 17 pregnant women infected with SARS-CoV-2 were similar to those previously reported in non-pregnant adult patients. All of the 17 patients underwent Cesarean delivery with anesthesia performed according to standardized anesthesia/surgery procedures. Fourteen of the patients underwent continuous epidural anesthesia with 12 experiencing significant intraoperative hypotension. Three patients received general anesthesia with tracheal intubation because emergency surgery was needed. Three of the parturients are still recovering from their Cesarean delivery and are receiving in-hospital treatment for COVID-19. Three neonates were born prematurely. There were no deaths or serious neonatal asphyxia events. All neonatal SARS-CoV-2 nucleic acid tests were negative. No medical staff were infected throughout the patient care period.

Conclusions: Both epidural and general anesthesia were safely used for Cesarean delivery in the parturients with COVID-19. Nevertheless, the incidence of hypotension during epidural anesthesia appeared excessive. Proper patient transfer, medical staff access procedures, and effective biosafety precautions are important to protect medical staff from COVID-19.

Editor—Wuhan, the core city of central China, has reported an outbreak of atypical pneumonia caused by a 2019 novel coronavirus in late 2019. This coronavirus is officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).1,2 There are many pregnant women presenting with coronavirus disease 2019 (COVID-19), which undoubtedly threatens the lives of both mother and baby. Currently, there are no statistics regarding pregnant women infected with COVID-19. A retrospective review has indicated the clinical characteristics of nine pregnant women with COVID-19.3 However, how anaesthesia was undertaken during delivery is unknown. Here, we report a case of successful spinal anaesthesia in a woman with confirmed COVID-19 who required emergency Caesarean section. Of note, there were 35 cases with confirmed COVID-19 undergoing emergency Caesarean delivery in Wuhan Union Hospital from 23 January, 2020 to 20 February, 2020, with further clinical investigation in progress.