Clinical Trials Logo

Clinical Trial Summary

In this study the investigators used a retrospective analysis to 251 SARS-CoV-2 patients' cesarean section anesthesia to determine the incidence of failed spinal anesthesia, management strategies, and risk variables that contribute to failure.


Clinical Trial Description

All anesthesiologists face a challenge when it comes to the anesthesia of patients with coronavirus disease who are going to have a cesarian section. Patients' and healthcare personnel' safety should be prioritized. Non-emergent procedures in patients with respiratory infections, such as COVID-19, should be postponed and rescheduled once the infection has been treated. However, some emergency treatments, such as cesarian section, cannot be postponed. So, for COVID 19 patients, which method should be used? According to past studies, the risk of maternal death is 16,7 times higher with general anesthesia than with regional anesthesia (1). Furthermore, general anesthesia, which requires aerosol-generating procedures such as ventilating and intubating patients, has a higher risk of respiratory problems during or after surgery than regional anesthesia. Earlier data on pregnant patients during the COVID 19 pandemic showed no difference in COVID 19-related mortality between pregnant and non-pregnant patients, but a recent study found that pregnancy is associated with a 70% greater risk of death. Another important point is that, when compared to those who are not exposed to tracheal intubation, the transfer of acute respiratory infection to a health care professional during tracheal intubation is 6.6 times higher. For such reasons, the European and American Societies of Regional Anesthesia jointly issued COVID 19 recommendations stating that regional anesthesia should be preferred over general anesthesia whenever possible, and practice recommendations for regional anesthesia during the pandemic have already been published. In addition, the American Society of Anesthesiologists and the Society for Obstetric Anesthesiology and Perinatology advise doctors to "consider using neuraxial methods rather than general anesthesia for most cesarian deliveries." In many facilities, single-shot spinal anesthesia is the preferred method for cesarian section. It delivers great anesthesia because of its ease of use, rapid onset of sensory and motor blockage, reliability, ease of mastering, and capacity to provide optimal surgical circumstances; it also minimizes the hazards of general anesthetic while enhancing partition satisfaction. In addition, when compared to general anesthesia, the risk of complications such intraoperative bleeding, surgical site infection, and postoperative pain is lower with spinal anesthesia. In 1899, August Bier proclaimed spinal anesthesia to be a failure, stating, "Experienced professional, correct technique, single puncture, adequate CSF backflow, effective anesthetic agent!" So, why did it fail? -Capriciousness!!" Single shot spinal anesthesia failure may occur when the subarachnoid space is not reached, or analgesia is not sufficient for surgery after injection. The issue is that if anesthesia fails during COVID 19 procedures, we'll need to develop a new approach for supplementing anesthesia and analgesia cautiously, quickly, and meticulously. Failed spinal anesthesia can be partial or complete. If anesthesia and analgesia are not achieved within ten minutes after successful intrathecal injection, the bupivacaine spinal anesthetic is regarded to have failed. Partial failure was defined as insufficient extent, quality, or duration of pharmacological action for that procedure, while complete failure was described as no sensory or motor blockage. Failure of spinal anesthesia necessitates extreme caution, judgment, and technique. If surgery has not yet begun, a partial or total failure can be managed by increasing the Trendelenburg position or administering a second spinal anesthetic. However, if the surgery has already begun, it can be managed by changing positions, injecting local anaesthetic in the operation area by the surgeon, administering sedation with oxygen, opioids, benzodiazepines, or ketamine, and then converting the anesthesia to general anesthesia. The failure rate of spinal anesthesia is widely distributed, according to researches, ranging from 1 to 17 percent. During spinal anesthesia, the Royal College of Anesthetics proposes a failure rate of 3% in emergencies and 1% for elective procedures. The goal of this study was to determine failure rate and solutions for spinal anesthesia in the context of a COVID 19 pandemic. ;


Study Design


Related Conditions & MeSH terms


NCT number NCT05067985
Study type Observational
Source Ankara City Hospital Bilkent
Contact
Status Completed
Phase
Start date April 1, 2020
Completion date March 12, 2021

See also
  Status Clinical Trial Phase
Recruiting NCT04979858 - Reducing Spread of COVID-19 in a University Community Setting: Role of a Low-Cost Reusable Form-Fitting Fabric Mask N/A
Not yet recruiting NCT04999098 - Clinical Study to Assess the Antiviral Properties of Echinaforce Reducing Oropharyngeal Concentration and Infectivity of SARS-CoV2 Phase 4
Not yet recruiting NCT04978038 - Third Dose of COVID-19 Vaccine in LTCF Residents Phase 4
Active, not recruiting NCT05055505 - The School SPIT Study - Elementary Schools in Low COVID-19 Incidence Regions N/A
Active, not recruiting NCT05055492 - The School SPIT Study - Elementary Schools in High COVID-19 Incidence Regions N/A
Active, not recruiting NCT05060510 - The School SPIT Study - COVID-19 Testing in Secondary Schools N/A
Recruiting NCT05054218 - COVID-19 Immunogenicity of a Third Dose of mRNA-1273 Vaccine Among Cancer Patients
Recruiting NCT05076253 - Efficacy of Ivermectin in COVID-19 Phase 1/Phase 2
Not yet recruiting NCT05030974 - RECOVAC Booster Vaccination Study Phase 4
Not yet recruiting NCT05077969 - Leidos-Enabled Adaptive Protocol (LEAP-CT) for Evaluation of Post-exposure Prophylaxis for Newly-infected COVID-19 Patients (Addendum 2) Phase 2
Not yet recruiting NCT05067946 - Evaluation of Efficacy, Safety and Immunogenicity of GX-19N in Healthy Individuals Who Have Received COVID-19 Vaccines Phase 2/Phase 3
Not yet recruiting NCT05013034 - Exploratory Regimen of Basiliximab for Treatment of Pulmonary Cytokine Storm in SARS-CoV-2 Hospitalized Adult Patients Phase 2
Not yet recruiting NCT05073718 - Acetylsalicylic Acid in COVID-19 (ASA-SARS) Phase 3
Not yet recruiting NCT05047783 - Masitinib in Patients With Symptomatic Mild to Moderate COVID-19 Phase 2
Not yet recruiting NCT04590222 - Impact of a Monoamine Oxidase Inhibitor on the Phenotype of Blood Mononucleated Cells in Patients With COVID-19
Active, not recruiting NCT04953039 - Use of Saliva for COVID-19 Diagnosis
Not yet recruiting NCT05074121 - NAC for Attenuation of COVID-19 Symptomatology Phase 2
Not yet recruiting NCT05089565 - Immune Response to SARS-CoV-2/COVID-19 Vaccination in Sarcoidosis
Not yet recruiting NCT05083130 - Awake Prone Positioning in Moderate to Severe COVID-19 N/A
Recruiting NCT04918797 - COVAXIN in a Pediatric Cohort Phase 2/Phase 3