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J Zhejiang Univ (Med Sci)  2020, Vol. 49 Issue (2): 249-252    DOI: 10.3785/j.issn.1008-9292.2020.03.04
    
Anesthesia management in cesarean section for patient with COVID-19: a case report
KANG Xianhui(),ZHANG Rong,HE Huiliang,YAO Yongxing,ZHENG Yueying,WEN Xiaohong*(),ZHU Shengmei*()
Department of Anesthesiology, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China
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Abstract  

Since the coronavirus disease 2019 (COVID-19) affects the cardio-pulmonary function of pregnant women, the anesthetic management and protection of medical staff in the cesarean section is significantly different from that in ordinary surgical operation. This paper reports a case of cesarean section for a woman with COVID-19, which was successfully performed in the First Affiliated Hospital of Zhejiang University School of Medicine on February 8, 2020. Anesthetic management, protection of medical staff and psychological intervention for the pregnant woman during the operation were discussed. Importance has been attached to the preoperative evaluation of pregnant women with COVID-19 and the implementation of anesthesia plan. For moderate patients, intraspinal anesthesia is preferred in cesarean section, and try to reduce its influence in respiration and circulation in both maternal and infant; general anesthesia with endotracheal intubation should be adopted for severe or critically ill patients. Ensure the safety of medical environment, and anesthetists should carry out level-Ⅲ standard protection. Special attention and support should be paid to maternal psychology: fully explanation before operation to reduce anxiety; relieve the discomfort during operation, so as to reduce tension; avoid the bad mood due to pain after operation.



Key wordsCoronavirus disease 2019      Severe acute respiratory syndrome coronavirus 2      Novel coronavirus pneumonia      Cesarean section      Anesthesia, epidural      Case reports     
Received: 29 February 2020      Published: 11 March 2020
CLC:  R614  
Corresponding Authors: WEN Xiaohong,ZHU Shengmei     E-mail: kxhui66@zju.edu.cn;0087420@zju.edu.cn;smzhu20088@zju.edu.cn
Cite this article:

KANG Xianhui,ZHANG Rong,HE Huiliang,YAO Yongxing,ZHENG Yueying,WEN Xiaohong,ZHU Shengmei. Anesthesia management in cesarean section for patient with COVID-19: a case report. J Zhejiang Univ (Med Sci), 2020, 49(2): 249-252.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2020.03.04     OR     http://www.zjujournals.com/med/Y2020/V49/I2/249


一例妊娠合并2019冠状病毒病(COVID-19)患者的剖宫产麻醉管理

2019冠状病毒病(COVID-19)会影响妊娠妇女的心肺功能,其剖宫产术的麻醉管理和医护人员防护与普通手术显著不同。2020年2月8日浙江大学医学院附属第一医院成功实施一例妊娠合并COVID-19患者剖宫产手术,本文介绍围术期麻醉管理、医护人员防护和产妇心理干预等经验。应重视妊娠合并COVID-19患者术前评估和麻醉计划实施,COVID-19普通型患者剖宫产首选椎管内麻醉,注意减少对母婴呼吸循环的影响;重型和危重型患者应选择气管插管全身麻醉。加强医疗环境安全,麻醉医生应尽量采取三级标准防护。对于产妇心理应予特殊关注:术前加强解释说明减轻产妇焦虑;术中减轻产妇不适,缓解紧张情绪;术后避免产妇因疼痛而产生不良的情绪。


关键词: 2019冠状病毒病,  严重急性呼吸综合征冠状病毒2,  新型冠状病毒肺炎,  剖宫产术,  麻醉, 硬膜外,  病例报告 
[1]   CHEN H J , GUO J J , WANG C et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records[J]. Lancet, 2020,
doi: 10.1016/S0140-6736(20)30360-3
[2]   周志强, 孙星星, 李世勇 et al. 新型冠状病毒肺炎流行期间剖宫产术的麻醉管理[J]. 中华麻醉学杂志, 2020, 40
ZHOU Zhiqiang , SUN Xingxing , LI Shiyong et al. Anesthesia management for cesarean section during novel coronavirous epidemic[J]. Chinese Journal of Anesthesiology, 2020, 40
doi: 10.3760/cma.j.issn.0254-1416.2020.0006
[3]   WU Z , MCGOOGAN J M . Characteristics of and important lessons from the coronavirus disease 2019(COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention[J]. JAMA, 2020,
doi: 10.1001/jama.2020.2648
[4]   薄禄龙, 万小健, 卞金俊 . 新型冠状病毒肺炎患者实施气管插管术的感控建议:基于SARS患者气道管理的文献回顾[J]. 中华麻醉学杂志, 2020, 40
BO Lulong , WAN Xiaojian , BIAN Jinjun . Suggestions on infection control for performing endotracheal intubation in patients with novel coronavirus pneumonia: based on literature review of airway management in patients with SARS[J]. Chinese Journal of Anesthesiology, 2020, 40
doi: 10.3760/cma.j.issn.0254-1416.2020.0002
[5]   中华医学会麻醉学分会气道管理学组 . 新型冠状病毒肺炎危重型患者气管插管术的专家建议(1.0版)[J]. 中华麻醉学杂志, 2020, 40
Chinese Society of Anesthesiology Task Force on Airway Management . Expert recommendations for tracheal intubation in critically ill patients with novel coronavirus pneumonia (version 1.0)[J]. Chinese Journal of Anesthesiology, 2020, 40
doi: 10.3760/cma.j.issn.0254-1416.2020.02.003
[6]   KAMMING D , GARDAM M , CHUNG F . Anaesthesia and SARS[J]. Br J Anaesth, 2003, 90 (6): 715- 718
doi: 10.1093/bja/aeg173
[7]   熊利泽 . 抗击新型冠状病毒肺炎疫情:给麻醉科医护工作者的几点建议[J]. 中华麻醉学杂志, 2020, 40 (2): 129
XIONG Lize . Fight against novel coronavirus pneumonia: suggestions for medical staff in anesthesiology department[J]. Chinese Journal of Anesthesiology, 2020, 40 (2): 129
doi: 10.3760/cma.j.issn.0254-1416.2020.0001
[8]   中国医师协会新生儿科医师分会, 中国富有保健协会新生儿保健专业委员会, 《中华围产医学杂志》编辑委员会 et al. 新生儿科2019新型冠状病毒感染防控专家建议[J]. 中华围产医学杂志, 2020, 23 (2): 80- 84
Chinese Neonatologist Association , Chinese Medical Doctor Association , Neonatal Health Association et al. Proposed prevention and control of 2019 novel coronavirus infection in neonates[J]. Chinese Journal of Perinatal Medicine, 2020, 23 (2): 80- 84
doi: 10.3760/cma.j.issn.1007-9408.2020.02.002
[9]   马宁, 马弘, 李凌江 . 《新型冠状病毒肺炎疫情紧急心理危机干预指导原则》专家解析[J]. 中华精神科杂志, 2020, 53
MA Ning , MA Hong , LI Lingjiang . Reading and analysis of the guiding principles of emergent psychological crisis intervention in the novel coronavirusd pneumonia[J]. Chinese Journal of Psychiatry, 2020, 53
doi: 10.3760/cma.j.issn.1006-7884.2020.0001
[10]   中国医师协会妇产科医师分会母胎医师专业委员会, 中华医学会妇产科分会产科学组, 中华医学会围产医学分会 et al. 妊娠期与产褥期新型冠状病毒感染专家建议[J]. 中华围产医学杂志, 2020, 23 (2): 73- 79
Maternal and Fetal Experts Committee , Chinese Physician Society of Obstetrics and Gynecology , Chinese Medical Doctor Association et al. Proposed management of 2019-novel coronavirus infection during pregnancy and puerperium[J]. Chinese Journal of Perinatal Medicine, 2020, 23 (2): 73- 79
doi: 10.3760/cma.j.issn.1007-9408.2020.02.001
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