SARS-CoV-2 PANDEMIC AND FAILED SPINAL ANESTHESIA
Condition: Regional Anesthesia; SARS-CoV2 Infection
MeSH terms: COVID-19
Study type: Observational

Summary: 
      The investigators used a retrospective review of 251 SARS-CoV-2 (severe acute respiratory
      syndrome coronavirus 2) positive patients' cesarean section anesthesia to determine the rate
      of failed spinal anesthesia, management techniques for failed block, and risk factors that
      contribute to failure in this study.
    

Detailed 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 (Coronavirus disease 2019), 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.
    

Intervention name(s): covid 19 spinal anesthesia
Intervention type(s): Procedure
Intervention description(s): this group description covers that all the covid 19 pregnant women which we gave spinal anesthesia for cesarean section procedures. The investigators analyzed them retrospectively.
Intervention MeSH terms: Anesthetics
Observational model: Cohort
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        we included records of spinal anesthesia performed on confirmed COVID 19 patients in the
        Ankara City Hospital between April 2020 and February 2021
      
Keywords: regional anesthesia failure; regional anesthesia for SARS-CoV-2