IMR Press / CEOG / Volume 48 / Issue 3 / DOI: 10.31083/j.ceog.2021.03.2446
Open Access Original Research
Anesthesiologic management of pregnant women with SARS-COV-2 infection undergoing cesarean delivery
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1 Department of Anesthesiology and Intensive Care Medicine, Policlinico, Federico II University Hospital, 80131 Naples, Italy
2 Department of Maternal and Child Health and Urological Sciences, Sapienza University of Rome, 00155 Rome, Italy
3 Department of Anesthesiology and Intensive Care Medicine, Policlinico, Gemelli Molise Spa, 1 86100 Campobasso, Italy
Clin. Exp. Obstet. Gynecol. 2021 , 48(3), 628–630;
Submitted: 2 January 2021 | Revised: 11 February 2021 | Accepted: 23 March 2021 | Published: 15 June 2021
(This article belongs to the Special Issue CoVID-19 in OB/GYN)

Background: Pregnant women are usually more susceptible to infection due to typical physiological and mechanical changes, such as increased heart rate, stroke volume and pulmonary residual capacity. The aim of this study was to evaluate an innovative anesthesiologic opioid-free management protocol in symptomatic pregnant women, with COVID-19 and with oxygen therapy, undergoing cesarean delivery with spinal anesthesia. Methods: With the patient in the sitting position, spinal anesthesia was performed at the L1–L2 level. Vertebral level has been identified starting from the sacrum, we counted the laminae in the caudal-to-cephalad direction, which was then marked with a surgical pen. The technique was performed in asepsis, in the subarachnoid space after vision of clear Cephalo-Spinal Fluid (CSF) in the spinal needle 27 Gauge, without letting out the CSF, bupivacaine 0.5% 10 mg, dexmedetomidine 10 μg and dexamethasone 4 mg was injected. Results: During the study period, 40 pregnant women with one or more symptoms and supplemental oxygen (FiO2 35–40%) who underwent cesarean delivery were included in the study. All pregnant women had pain visual analog scale (VAS) 3, and no pregnant women required rescue dose. Adverse effects, such as nausea, vomiting, shivering, or pruritus were not recorded in any case. After a mean of 2.5 hours from the spinal anesthesia, all the included women had a complete motility of the lower limbs and were able to mobilize independently within 12 hours after delivery. Mean time to first flatus was about 8 hours after delivery. Conclusions: Pregnant women in COVID-19 can safely receive intrathecal dexamethasone and dexmedetomidine during planned cesarean delivery.

Cesarean delivery
Spinal anesthesia
Neuraxial anesthesia
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