AUTHOR=Zhang Yuan , Chen Rong , Cao Chen , Gong Yuan , Zhou Qin , Wei Min , Xia ZhongYuan , Chen XiangDong , Meng QingTao 

TITLE=The Risk of Neuraxial Anesthesia-Related Hypotension in COVID-19 Parturients Undergoing Cesarean Delivery: A Multicenter, Retrospective, Propensity Score Matched Cohort Study

JOURNAL=Frontiers in Medicine

VOLUME=Volume 8 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2021.713733

DOI=10.3389/fmed.2021.713733

ISSN=2296-858X

ABSTRACT=BACKGROUND: SARS-CoV-2 infection was referred to sympathetic hyperactivity, which might increase the susceptibility of neuraxial anaesthesia-related hypotension resulted from sympathetic inhibition. We conducted a multicenter, retrospective, propensity score matched (PSM) cohort study to determine whether COVID-19 parturients have an increased risk of hypotension after neuraxial anaesthesia for caesarean delivery.
METHODS: Clinical data of COVID-19 parturients were collected from the electronic medical records from 1th January to 31th May, 2020 in three hospitals of Hubei Province, China. Information of Control parturients (without COVID-19) were obtained at the same institutions over a similar period in 2019. All American Society of Anaesthesiologists (ASA) Physical Status II full termed pregnant women who received caesarean delivery under neuraxial anaesthesia were included. The primary objective was to obtain and compare the incidence of neuraxial anaesthesia-related hypotension. Secondary objectives were the analysis of anaesthetic implementation and administration, intraoperative maternal vital signs and adverse reactions, and neonatal Apgar scores at 1 and 5 minutes after delivery. The clinical characteristics of COVID-19 parturients were also analysed. PSM was derived to balance the predictors for neuraxial anaesthesia-related hypotension based on previous studies.
RESULTS: In present study, 101 COVID-19 parturients and 186 Control parturients were derived from 1,403 cases referenced to propensity score matching. The incidence of neuraxial anaesthesia-related hypotension was 57.4% in COVID-19 parturients and 41.9% in Control parturients with an incidence risk ratio (IRR) of 1.37 (95% CI 1.08 to 1.74; P=0.012; post-hoc Cramér's V=0.15) in the PSM cohort. The incidences of nausea, vomiting, dizziness and shaking were significantly higher in the COVID-19 group than Control group (48.5% vs 17.2%, P<0.001; 10.9% vs 4.3%, P=0.03; 18.8% vs 3.2%, P<0.001; 51.5% vs 18.3%, P<0.001; respectively). The Apgar scores at 1 minute was significantly lower in newborns from COVID-19 parturients than that in Control babies (P=0.04). 
CONCLUSIONS: An increased risk of neuraxial anaesthesia-related hypotension in COVID-19 parturients undergoing caesarean delivery should be stressed.