{
    "abstract": "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.\nWe 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.\nWe 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\u202fmmHg, 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).\nPatients 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.",
    "authors": [
        {
            "affiliation": "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Georgetown University School of Medicine, Washington, DC, USA.",
            "firstname": "L E G",
            "initials": "LEG",
            "lastname": "Scoon"
        },
        {
            "affiliation": "Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.",
            "firstname": "K J",
            "initials": "KJ",
            "lastname": "Gray"
        },
        {
            "affiliation": "Center for Clinical Investigation, Brigham and Women's Hospital, Boston, MA, USA.",
            "firstname": "G",
            "initials": "G",
            "lastname": "Zhou"
        },
        {
            "affiliation": "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.",
            "firstname": "R Y",
            "initials": "RY",
            "lastname": "Cohen"
        },
        {
            "affiliation": "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.",
            "firstname": "W",
            "initials": "W",
            "lastname": "Armero"
        },
        {
            "affiliation": "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.",
            "firstname": "Y K",
            "initials": "YK",
            "lastname": "Chen"
        },
        {
            "affiliation": "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.",
            "firstname": "A M",
            "initials": "AM",
            "lastname": "Ray"
        },
        {
            "affiliation": "Division of General OBGYN Specialists, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.",
            "firstname": "K",
            "initials": "K",
            "lastname": "Diouf"
        },
        {
            "affiliation": "Massachusetts General Hospital, Department of Obstetrics and Gynecology, Boston, MA, USA, Harvard Medical School, Boston, MA, USA.",
            "firstname": "I T",
            "initials": "IT",
            "lastname": "Goldfarb"
        },
        {
            "affiliation": "Massachusetts General Hospital, Department of Obstetrics and Gynecology, Boston, MA, USA, Harvard Medical School, Boston, MA, USA.",
            "firstname": "A A",
            "initials": "AA",
            "lastname": "Boatin"
        },
        {
            "affiliation": "Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA. Electronic address: vkovacheva@bwh.harvard.edu.",
            "firstname": "V P",
            "initials": "VP",
            "lastname": "Kovacheva"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2022 Elsevier Ltd. All rights reserved.",
    "doi": "10.1016/j.ijoa.2022.103624\n10.5114/ait.2021.105120\n10.7189/jogh.11.05018\n10.3390/v13050853\n10.1016/j.jiph.2021.03.013\n10.1097/AOG.0000000000004339\n10.1001/jamapediatrics.2021.1050\n10.1016/j.ijoa.2020.04.006\n10.1007/s12630-020-01630-7\n10.3389/fmed.2021.713733\n10.1111/j.1399-6576.2010.02239.x\n10.1016/j.bja.2020.03.007\n10.1213/01.ANE.0000175229.98493.2B\n10.1213/ane.0b013e31818065bc\n10.1016/j.jstrokecerebrovasdis.2020.105357\n10.1093/bja/aes313\n10.5222/MMJ.2021.08364\n10.3390/ijerph18147221\n10.1111/1471-0528.16339\n10.1186/s12884-020-03275-2\n10.1113/EP089820\n10.1161/CIRCRESAHA.120.317015\n10.1016/S0140-6736(20)30251-8\n10.1016/j.bbadis.2020.165999\n10.3390/jcm9092924\n10.1038/s41598-021-92045-x",
    "journal": "International journal of obstetric anesthesia",
    "keywords": [
        "Anesthesia, spinal",
        "Blood pressure",
        "COVID-19",
        "Hypotension, pregnancy",
        "SARS-CoV-2"
    ],
    "methods": null,
    "publication_date": "2023-01-13",
    "pubmed_id": "36634448\n34006045\n34221361\n34067086\n34020209\n33560778\n33885740\n32437912\n32283073\n32180175\n34490304\n20455872\n32234250\n30575675\n16116006\n18806043\n33039765\n22964265\n34239759\n34299673\n32479682\n33023500\n34311498\n33909683\n32264791\n32007145\n32142651\n33137411\n32927798\n34162913",
    "results": "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\u202fmmHg, 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).",
    "title": "Hemodynamic changes in patients with SARS-CoV-2 infection presenting for cesarean delivery under spinal anesthesia: a retrospective case-control study.",
    "xml": "<Element 'PubmedArticle' at 0x788503b81800>"
}