Hemodynamic changes in patients with SARS-CoV-2 infection presenting for cesarean delivery under spinal anesthesia: a retrospective case-control study

Hemodynamic changes in patients with SARS-CoV-2 infection presenting for cesarean delivery under spinal anesthesia: a retrospective case-control study

•Hemodynamic response to spinal anesthesia is altered in SARS-CoV-2 infection.•SARS-CoV-2 positive patients exhibit less post-spinal hypotension.•The relationship remains after adjusting for covariates.•These results point to important cardiovascular effects of the virus. Coronavirus disease 2019 (C...

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Bibliographic Details
Published in:International journal of obstetric anesthesia Vol. 53; p. 103624
Main Authors: Scoon, L.E.G., Gray, K.J., Zhou, G., Cohen, R.Y., Armero, W., Chen, Y.K., Ray, A.M., Diouf, K., Goldfarb, I.T., Boatin, A.A., Kovacheva, V.P.
Format: Journal Article
Language:English
Published: Netherlands Elsevier Ltd 01-02-2023
Subjects:
Anesthesia, spinal
Anesthesia, Spinal - adverse effects
Blood pressure
Case-Control Studies
COVID-19
Female
Hemodynamics
Humans
Hypotension - etiology
Hypotension, pregnancy
Infant, Newborn
Original
Pregnancy
Pregnancy Complications, Infectious - diagnosis
Retrospective Studies
SARS-CoV-2
COVID-19
SARS-CoV-2
Blood pressure
Anesthesia, spinal
Hypotension, pregnancy
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Summary:•Hemodynamic response to spinal anesthesia is altered in SARS-CoV-2 infection.•SARS-CoV-2 positive patients exhibit less post-spinal hypotension.•The relationship remains after adjusting for covariates.•These results point to important cardiovascular effects of the virus. Coronavirus disease 2019 (COVID-19) is associated with adverse maternal and neonatal outcomes. Early studies suggested that COVID-19 was associated with a higher incidence of hypotension following neuraxial anesthesia in parturients. We explored the hemodynamic response to spinal anesthesia for cesarean delivery in pregnant severe respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) positive patients, using a retrospective case-control design. We searched our electronic medical records for patients who received spinal anesthesia for cesarean delivery, and were SARS-CoV-2 positive or recovered at delivery, and used historical and SARS-CoV-2 negative controls from two tertiary care hospitals. We compared the demographic, clinical, and hemodynamic variables between patients who were SARS-CoV-2 positive at delivery, those who were positive during pregnancy and recovered before delivery, and controls. Analyses were stratified by normotensive versus hypertensive status of the patients at delivery. We identified 22 SARS-CoV-2 positive, 73 SARS-CoV-2 recovered, and 1517 controls. The SARS-CoV-2 positive, and recovered pregnant patients, had on average 5.6 and 2.2 mmHg, respectively, higher post-spinal mean arterial pressures (MAPs) than control patients, adjusting for covariates. Additionally, the lowest post-spinal MAP was negatively correlated with the number of daysbetween the onset of COVID-19 symptoms and delivery in patients with hypertension (correlation −0.55, 95% CI −0.81 to −0.09). Patients with SARS-CoV-2 infection during pregnancy exhibit less spinal hypotension than non-infected patients. While the clinical significance of this finding is unknown, it points to important cardiovascular effects of the virus.
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ISSN:0959-289X
1532-3374
DOI:10.1016/j.ijoa.2022.103624