Neuroaxial anesthesia for COVID-19 parturient

World Congress on SURGERY, SURGEONS AND ANESTHESIA

November 29-30, 2021 Webinar

Vakhtang Shoshiashvili Levan Ratiani Ketevan Machavariani Eka Khuchua

TSMU First University Clinic. Tbilisi, Georgia

Keynote: J Surgery

Abstract :

Statement of the problem: COVID-19 pandemic presents unique challenges for anesthesiologists, especially those, which are caring for patients during labor and delivery. It is well established, that in case of COVID-19, for the reasons of safety of patients and healthcare personnel, elective surgical and anesthesia procedures must be postponed but it is not possible for parturient. Therefore, the anesthesiologist must solve specific problems relating to pregnancy, childbirth and COVID-19. In the TSMU first university clinic, 42 parturients were COVID-19 positive according to PCR- test and they were treated using institutive COVID-19 protocol. Due to radiation safety, chest X-ray or CT study was not performed for these patients. Prior to neuroaxial interventions coagulation study had been anticipated. For providing of the neuroaxial procedures nasal canula oxygenation under surgical mask had been used for each parturient and health-care personnel equipped with PPE and N-95 mask. For labor analgesia epidural anesthesia was the preferred method. Initially, 0.2% ropivacaine 10.0 was injected with consequent infusion of maintenance dose - 0.1% naropine 5-7 ml/h and bolus doses of 0.2% ropivacaine added as needed. In case of cesarean section, 10 ml of 0.75% ropivacaine was injected through the epidural catheter with subsequent continuous infusion of 4-5 ml/h 0.5% ropivacaine. For patients without initial epidural catheter placement or epidural catheter malfunction, spinal anesthesia was used for cesarean section with subarachnoid injection of 9-12 mg. bupivacaine and 4 mg dexamethasone. Hypotension was treated with phenylephrine bolus injections. In cases of resistant hypoxemia, general anesthesia was used for cesarean delivery. Neuroaxial anesthesia provided without significant complications and was safe for physiologic childbirths and cesarean sections for COVID-19 parturient. Conclusion: Neuroaxial anesthesia is safe for childbirth analgesia and cesarean for COVID-19 parturient. No other special methods are needed for this reason, except the measures which are defined according to institutive protocol for the prevention of infection spread. Biography Vakhtang Shoshiashvili is an anesthesiologist in Tbilisi State Medical University (TSMU) First University Clinic. He is also assistant professor of TSMU, faculty of medicine, department of anesthesiology and intensive care, associate professor, faculty of medicine, European University, associate professor, faculty of medicine, Kutaisi University.
Recent Publications
1. Vakhtang Shoshiashvili, Inga Shoshiashvili, Tamari Rukhadze. Headache after Intrathecal Catheter - Subcutaneous Access Port Insertion for Cancer Pain Treatment – Case Report. J Med - Clin Res & Rev. 2019; 3(5): 1-3.
2. Vakhtang Shoshiashvili. Transnasal Sphenopalatine Ganglion Block for Postdural Puncture Headache Treatment after Spinal Anesthesia – Case Report. Anesth Pain Res. 2019; 3(1): 1-4.
3. Vakhtang Shoshiashvili. “Drug Addiction Among Anesthesia Providers". Acta Scientific Medical Sciences 4.2 (2020): 01-03.
4. Shoshiashvili V, El-Molla A, Fetouh FA et al. (2020.) Safety and efficacy of lidocaine perioperative infusion – A prospective, controlled study. J Anesth Clin Res. 11:950. DOI:10.35248/2155- 6148.20.11
5. Shoshiashvili V, Davitashvili D, Kachibaia N, Ratiani L, Machavariani K. (2020). Operating Room and Personnel During COVID-19 Pandemic, When Clinic is Not Yet on Front-Line. . J Anesth Clin Res. 11:951. DOI:10.35248/2155-6148.20.11:951
6. Ratiani L., Machavariani K., Shoshiashvili V. Sepsis:importance of ethnic properties and phenotype. GMN VOL. 302 No. 5 May 2020 p 92-96