Safety of spinal anesthesia and analysis of cerebrospinal fluid in SARS-CoV-2 pregnant women undergoing cesarean section: an observational prospective study
Abstract Background Systemic infection has always been considered a relative contraindication to neuraxial anesthesia, despite the fact that infectious complications are relatively uncommon. Pregnancy-related physiological changes and coronavirus disease (COVID-19) neurotropic features may facilitat...
| Main Authors: | , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-11-01
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| Series: | Journal of Anesthesia, Analgesia and Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s44158-023-00135-1 |
| _version_ | 1797413630138908672 |
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| author | Giulia Fierro Barbara Milan Silvia Bettinelli Elisa Bottari Dario Bugada Ilaria Roncagliolo Marco Arosio Claudio Farina Ferdinando Luca Lorini |
| author_facet | Giulia Fierro Barbara Milan Silvia Bettinelli Elisa Bottari Dario Bugada Ilaria Roncagliolo Marco Arosio Claudio Farina Ferdinando Luca Lorini |
| author_sort | Giulia Fierro |
| collection | DOAJ |
| description | Abstract Background Systemic infection has always been considered a relative contraindication to neuraxial anesthesia, despite the fact that infectious complications are relatively uncommon. Pregnancy-related physiological changes and coronavirus disease (COVID-19) neurotropic features may facilitate the virus’ entry into the central nervous system. The principal aim of this study was to test the safety of spinal anesthesia in “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2)-positive pregnant women and to examine cerebrospinal fluid (CSF) characteristics. Methods We conducted a prospective observational single-center study in asymptomatic or paucisymptomatic consecutive pregnant SARS-CoV-2 patients who underwent spinal anesthesia for cesarean section. Women with severe infection were excluded because they underwent general anesthesia. At the time of spinal anesthesia, we collected CSF samples, and then we performed a chemical-physical analysis to look for signs of inflammation and for SARS-CoV-2 genome. Results We included 26 women. No spinal anesthesia complications were reported in the perioperative period and after 2 months. All CSF samples were crystal clear, and all physical-chemical values were within physiological ranges: the median concentration of CSF/plasma glucose ratio was 0.66, IQR 0.5500 (0.6000–0.7100), and the average CSF protein concentration value was 23.2 mg/dl (SD 4.87). In all samples, genomes of SARS-CoV-2 and other neurotropic viruses were not detected. Conclusions Spinal anesthesia was safe in SARS-CoV-2 pregnant women with mild disease; no clinical maternal complications were detected, and no CSF changes indicative of inflammatory or infectious diseases that would compromise the safety of the procedure were found. |
| first_indexed | 2024-03-09T05:21:48Z |
| format | Article |
| id | doaj.art-047815d9342e44419d047dc5b4caff48 |
| institution | Directory Open Access Journal |
| issn | 2731-3786 |
| language | English |
| last_indexed | 2024-03-09T05:21:48Z |
| publishDate | 2023-11-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Anesthesia, Analgesia and Critical Care |
| spelling | doaj.art-047815d9342e44419d047dc5b4caff482023-12-03T12:40:04ZengBMCJournal of Anesthesia, Analgesia and Critical Care2731-37862023-11-01311810.1186/s44158-023-00135-1Safety of spinal anesthesia and analysis of cerebrospinal fluid in SARS-CoV-2 pregnant women undergoing cesarean section: an observational prospective studyGiulia Fierro0Barbara Milan1Silvia Bettinelli2Elisa Bottari3Dario Bugada4Ilaria Roncagliolo5Marco Arosio6Claudio Farina7Ferdinando Luca Lorini8Department of Emergency and Intensive Care, ASST Papa Giovanni XXIIIDepartment of Emergency and Intensive Care, ASST Papa Giovanni XXIIIDepartment of Emergency and Intensive Care, ASST Papa Giovanni XXIIIDepartment of Intensive Care Unit, Royal Brompton HospitalDepartment of Emergency and Intensive Care, ASST Papa Giovanni XXIIIDepartment of Anesthesia and Intensive Care, University of MilanMicrobiology and Virology Laboratory, ASST Papa Giovanni XXIIIMicrobiology and Virology Laboratory, ASST Papa Giovanni XXIIIDepartment of Emergency and Intensive Care, ASST Papa Giovanni XXIIIAbstract Background Systemic infection has always been considered a relative contraindication to neuraxial anesthesia, despite the fact that infectious complications are relatively uncommon. Pregnancy-related physiological changes and coronavirus disease (COVID-19) neurotropic features may facilitate the virus’ entry into the central nervous system. The principal aim of this study was to test the safety of spinal anesthesia in “severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2)-positive pregnant women and to examine cerebrospinal fluid (CSF) characteristics. Methods We conducted a prospective observational single-center study in asymptomatic or paucisymptomatic consecutive pregnant SARS-CoV-2 patients who underwent spinal anesthesia for cesarean section. Women with severe infection were excluded because they underwent general anesthesia. At the time of spinal anesthesia, we collected CSF samples, and then we performed a chemical-physical analysis to look for signs of inflammation and for SARS-CoV-2 genome. Results We included 26 women. No spinal anesthesia complications were reported in the perioperative period and after 2 months. All CSF samples were crystal clear, and all physical-chemical values were within physiological ranges: the median concentration of CSF/plasma glucose ratio was 0.66, IQR 0.5500 (0.6000–0.7100), and the average CSF protein concentration value was 23.2 mg/dl (SD 4.87). In all samples, genomes of SARS-CoV-2 and other neurotropic viruses were not detected. Conclusions Spinal anesthesia was safe in SARS-CoV-2 pregnant women with mild disease; no clinical maternal complications were detected, and no CSF changes indicative of inflammatory or infectious diseases that would compromise the safety of the procedure were found.https://doi.org/10.1186/s44158-023-00135-1PregnancySARS-CoV-2Spinal anesthesiaCerebrospinal fluidChemical-physical analysis |
| spellingShingle | Giulia Fierro Barbara Milan Silvia Bettinelli Elisa Bottari Dario Bugada Ilaria Roncagliolo Marco Arosio Claudio Farina Ferdinando Luca Lorini Safety of spinal anesthesia and analysis of cerebrospinal fluid in SARS-CoV-2 pregnant women undergoing cesarean section: an observational prospective study Journal of Anesthesia, Analgesia and Critical Care Pregnancy SARS-CoV-2 Spinal anesthesia Cerebrospinal fluid Chemical-physical analysis |
| title | Safety of spinal anesthesia and analysis of cerebrospinal fluid in SARS-CoV-2 pregnant women undergoing cesarean section: an observational prospective study |
| title_full | Safety of spinal anesthesia and analysis of cerebrospinal fluid in SARS-CoV-2 pregnant women undergoing cesarean section: an observational prospective study |
| title_fullStr | Safety of spinal anesthesia and analysis of cerebrospinal fluid in SARS-CoV-2 pregnant women undergoing cesarean section: an observational prospective study |
| title_full_unstemmed | Safety of spinal anesthesia and analysis of cerebrospinal fluid in SARS-CoV-2 pregnant women undergoing cesarean section: an observational prospective study |
| title_short | Safety of spinal anesthesia and analysis of cerebrospinal fluid in SARS-CoV-2 pregnant women undergoing cesarean section: an observational prospective study |
| title_sort | safety of spinal anesthesia and analysis of cerebrospinal fluid in sars cov 2 pregnant women undergoing cesarean section an observational prospective study |
| topic | Pregnancy SARS-CoV-2 Spinal anesthesia Cerebrospinal fluid Chemical-physical analysis |
| url | https://doi.org/10.1186/s44158-023-00135-1 |
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