Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1016/j.bjane.2020.06.002
Brazilian Journal of Anesthesiology
Narrative Review

Recommendations for local-regional anesthesia during the COVID-19 pandemic

Recomendações para realização de anestesia loco-regional durante a pandemia de COVID-19

Rodrigo Moreira e Lima, Leonardo de Andrade Reis, Felipe Souza Thyrso de Lara, Lino Correa Dias, Márcio Matsumoto, Glenio Bitencourt Mizubuti, Adilson Hamaji, Lucas Wynne Cabral, Lígia Andrade da Silva Telles Mathias, Lais Helena Navarro e Lima

Downloads: 3
Views: 70

Abstract

Since the beginning of the COVID-19 pandemic, many questions have come up regarding safe anesthesia management of patients with the disease. Regional anesthesia, whether peripheral nerve or neuraxial, is a safe alternative for managing patients with COVID-19, by choosing modalities that mitigate pulmonary function involvement. Adopting regional anesthesia mitigates adverse effects in the post-operative period and provides safety to patients and teams, as long as there is compliance with individual protection and interpersonal transmission care measures. Respecting contra-indications and judicial use of safety techniques and norms are essential. The present manuscript aims to review the evidence available on regional anesthesia for patients with COVID-19 and offer practical recommendations for safe and efficient performance.

Keywords

COVID-19,  Regional anesthesia,  Epidural anesthesia,  Spinal anesthesia

Resumo

Desde o início da pandemia de COVID-19, muitas questões surgiram referentes à segurança do manejo anestésico de pacientes acometidos pela doença. A anestesia regional, seja esta periférica ou neuroaxial, é alternativa segura no manejo do paciente COVID-19, desde que o emprego de modalidades que minimizam o comprometimento da função pulmonar seja escolhido. A adoção desta técnica anestésica minimiza os efeitos adversos no pós-operatório e oferece segurança para o paciente e equipe, desde que sejam respeitados os cuidados com proteção individual e de contágio interpessoal. Respeito às contraindicações e emprego criterioso das técnicas e normas de segurança são fundamentais. Este manuscrito tem por objetivo revisar as evidências disponíveis sobre anestesia regional em pacientes com COVID-19 e oferecer recomendações práticas para sua realização segura e eficiente.

Palavras-chave

COVID-19,  Anestesia regional,  Anestesia peridural,  Raquianestesia

References

1. Practice Recommendations on Neuraxial Anesthesia and Peripheral Nerve Blocks during the COVID-19 Pandemic. Disponível em: https://www.asra.com/page/2905/practice-recommendations-on-neuraxialanesthesia-and-peripheral-nerve-blocks-dur. Acesso em 21/04/2020.

2. COVID-19 Guidance for Regional Anesthesia Neuraxial Anesthesia and Peripheral Nerve Blocks. Disponível em https://esraeurope.org/wpcontent/uploads/2020/04/ESRAASRA-COVID-19-Guidelines-.pdf. Acesso em 21/04/2020.

3. Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anesth 2020; 67: 568–576. https://doi.org/10.1007/s12630-020-01591-x.

4. World Health Organization. Infection prevention and control of epidemic-and pandemic-prone acute respiratory diseases in health care. Geneva: WHO; 2014.

5. Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: A systematic review. PLoS One. 2012;7:e35797.

6. Orser BA. Recommendations for Endotracheal Intubation of COVID-19 Patients.Anesth Analg. 2020 May;130(5):1109-1110.

7. Zhong Q, Lui YY, Zou YF, Li JH, Zhang JJ, Li Z, Yang X, Ma M, Tang LJ, Chen YY, Zheng F, Ke JJ, Zhang ZZ. Spinal anaesthesia for patients with coronavirus disease 2019 and possible transmission rates in anaesthetists: retrospective, single center, observational cohort study. Brit J Anaesthesia, 2020;124(6):670-675. doi: 10.1016/j.bja.2020.03.007

8. Yue L, Han L, Li Q, Zhong M, Wang J, Wan Z, Chu C, Zeng Y, Peng M, Yang L, Li N. Anaesthesia and infection control in cesarean section of pregnant women with coronavirus disease 2019 (COVID-19). medRxiv 2020.03.23.20040394; doi: https://doi.org/10.1101/2020.03.23.20040394.

9. Chen R, Zhang Y, Huang L, Cheng BH, Xia ZY, Meng QT. Safety and efficacy of different anesthetic regimens for parturients with covid-19 undergoing cesarean delivery: a case series of 17 patients. Can J Anaesth. 2020; 2020 Mar 16. doi: 10.1007/s12630-020-01630-7.

10. Warren J, Sundaram K, Anis H et al. Spinal anesthesia is associated with decreased complications after total knee and hip arthroplasty. J Am Acad Orthop Surg. 2020;28:e213-e221. doi: 10.5435/JAAOS-D-19-00156.

11. von Ungern-Sternberg BS, Boda K, Chambers NA et al. Risk assessment for respiratory complications in paediatric anaesthesia: A prospective cohort study. Lancet. 2010;376:773-83. doi: 10.1016/S0140-6736(10)61193-2.

12. Lie SA, Wong SW, Wong LT, Wong TGL, Chong SY. Practical considerations for performing regional anesthesia: Lessons learned from COVID-19 pandemic. Can J Anesth 2020 ; Mar 24.

13. Wong J, Goh QY, Tan Z et al. Preparing for a covid-19 pandemic: A review of operating room outbreak response measures in a large tertiary hospital in singapore. Can J Anaesth. 2020;Mar 11.

14. Thomas-Rüddel D, Winning J, Dickmann P, Ouart D, Kortgen A, Janssens U, Bauer M. Coronavirus disease 2019 (COVID-19): update for anesthesiologists and intensivists March 2020. Anaesthesist https://doi.org/10.1007/s00101-020-00760-3.

15. Miller AJ, Arnold AC. The renin-angiotensin system in cardiovascular autonomic control: recent developments and clinical implications. Clin Auton Res 2019; 29:231-43.

16. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (covid-19) infections: A meta-analysis. Clin Chim Acta. 2020;13:145-8. doi: 10.1016/j.cca.2020.03.022.

17. Narouze S, Benzon HT, Provenzano D, Buvanendran A, Andres J, Deer T, Rauck R, Huntoon MA. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications (Second Edition): Guidelines From the American Society of Regional Anesthesia and Pain Medicine, the European Society of Regional Anaesthesia and Pain Therapy, the American Academy of Pain Medicine, the International Neuromodulation Society, the North American Neuromodulation Society, and the World Institute of Pain. Reg Anesth Pain Med 2018; 43(3):225-62.

18. Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol 2020. doi: 10.1001/jamaneurol. 2020.1127. [Epub ahead of print] 1

19. Sun X, Liu Y, Mei W, Safety Considerations for Neuraxial Anaesthesia in Parturients with COVID-19. Br J Anaest 2020. doi.org/10.1016/j.bja.2020.05.005. [Epub ahead of print]

20. Yang S, Gu C, Mandeville ET, et al. Anesthesia and Surgery Impair Blood-Brain Barrier and Cognitive Function in Mice. Front Immunol 2017; 8:902

21. Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, Zhan LY, Jia Y, Zhang L, Liu D, Xia ZY, Xia Z. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020;000: 100331. doi:10.1016/j.eclinm.2020.100331

22. Uppal V, Sondekoppam RV, Lobo CA, Kolli S, Kalagara HKP. Practice Recommendations on Neuraxial Anesthesia and Peripheral Nerve Blocks during the COVID-19 Pandemic. ASRA/ESRA COVID-19 Guidance for Regional Anesthesia. 31/03/2020.

23. Ferioli M, Cisternino C, Leo V, Pisani L, Palange P, Nava S. Protecting healthcare workers from SARS-CoV-2 infection: practical indications. Eur Respir Rev 2020; 29: 200068; DOI: 10.1183/16000617.0068-2020.

24. Horlocker TT, Vandermeuelen E, Kopp SL, Gogarten W, Leffert LR, Benzon HT. Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy American Society of Regional Anesthesia and Pain Medicine Evidence-Based Guidelines (Fourth Edition). Reg Anesth Pain Med 2018; 43: 263-309.

25. Gogarten W Vandermeulen E, Aken HV, Kozek S, Samama JVLC. Regional anaesthesia and antithrombotic agents: recommendations of the European Society of Anaesthesiology. Eur J Anaesthesiol 2010; 27: 999-1015.

26. Anvisa, Procedimento operacional padronizado – Equipamento de proteção individual e segurança no trabalho para profissionais de saúde da APS no atendimento às pessoas com suspeita ou infecção pelo novo coronavírus(COVID-19) https://portalarquivos.saude.gov.br/images/pdf/2020/marco/30/20200330-POPEPI-ver002-Final.pdf “acesso em Abril 2020”.

27. World Health Organization. Rational use of personal protective equipment for coronavirus disease 2019 (covid-19). 2020; Feb 27. Available at: https://apps.who.int/iris/bitstream/handle/10665/331215/WHO-2019-nCovIPCPPE_use-2020.1-eng.pdf. Acesso 10 de abril de 2020.

28. Boelig RC, Manuck T, Oliver EA, Di Mascio D, Saccone G, Bellussi F, Berghella V. Labor and Delivery Guidance for COVID-19. American Journal of Obstetrics & Gynecology MFM (2020), doi: https://doi.org/10.1016/j.ajogmf.2020.100110.

29. Simonds AK, Hanak A, Chatwin M, et al. Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections. Health Technol Assess. 2010;14:131-72.

30. Hui DS, Hall SD, Tang JW, et al. Exhaled air dispersion during oxygen delivery via simple oxygen mask. Chest 2007; 132:540-6.

31. Filatov A, Sharma P, Hindi F, Espinosa PS. Neurological complications of coronavirus disease (covid- 19): encephalopathy. Cureus. 2020;12(3): e7352. doi:10.7759/cureus.7352.

32. Uppal V, McKeen DM. Strategies for prevention of spinal-associated hypotension during cesarean delivery: Are we paying attention? Can J Anaesth. 2017;64:991-6. doi: 10.1007/s12630-017-0930-0.

33. Neal JM, Bernards CM, Hadzic A, Hebl JR, Hogan QH, Horlocker TT, Lee LA, Rathmell JP, Sorenson EJ, Suresh S, Wedel DJ. ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med 2008; 33(5): 404-15.

34. Updated advice regarding PPE to be worn when managing pregnant women with known or suspected COVID-19. 11/04/2020.

35. Webb CA, Weyker PD, Zhang L, et al. Unintentional dural puncture with a Tuohy needle increases risk of chronic headache. Anesth Analg 2012;115: 124-32.

36. Zamora JE, Murdoch J, Simchison B, Day AG Contamination: a comparison of 2 personal protective systems. CMAJ. 2006 Aug 1;175(3):249-54.

5ee3ba890e882529603195f5 rba Articles
Links & Downloads

Rev. Bras. Anestesiol.

Share this page
Page Sections