Regional anesthesia in the time of COVID-19: a minireview
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SPECIAL FEATURE: SPECIAL ARTICLE Anesthesia in the Time of COVID-19
Regional anesthesia in the time of COVID‑19: a minireview Kunihisa Hotta1 Received: 6 July 2020 / Accepted: 18 July 2020 © Japanese Society of Anesthesiologists 2020
Abstract The treatment of surgical patients who are confirmed or suspected of coronavirus disease 2019 (COVID-19) is a challenge for all anesthesiologists. The safety of both patients and healthcare workers should be taken into consideration when performing anesthesia management for patients with COVID-19. General anesthesia requiring airway intervention may exacerbate COVID-19 pneumonia, and aerosol generation during airway intervention risks COVID-19 transmission to medical staff. However, regional anesthesia is not an aerosol-generating procedure. The neuraxial anesthesia may have little adverse influence on clinical outcomes in patients with COVID-19 after reviewing previous case reports. Regional anesthesia may have some advantages over general anesthesia for this group of patients, but unplanned conversion to general anesthesia during surgery is not preferred. Thus, careful consideration should be given to ensure that the surgery is performed entirely under regional anesthesia. The use of ultrasound guidance and the performance by an experienced physician may reduce the incidence of failed block and complications. The use of long-acting local anesthetic prolongs the anesthetic effect of regional anesthesia. Besides, a safe and sufficient dose of local anesthetic should be used. Keywords COVID-19 · Regional anesthesia · Neuraxial anesthesia · Peripheral nerve block
Introduction Severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) caused the coronavirus disease 2019 (COVID-19) epidemic worldwide, which results in great concern and confusion to our society. Although most patients with COVID19 experience a mild to moderate clinical course, some of the patients develop severe, sometimes fatal, pneumonia. There have been no drugs approved for the treatment of COVID-19 yet. The treatment of surgical patients who are confirmed or suspected of this disease is a challenge for all anesthesiologists. General anesthesia requiring airway intervention may exacerbate COVID-19 pneumonia. Aerosol generation during airway intervention risks COVID-19 transmission to medical staff. However, regional anesthesia may have some advantages over general anesthesia for this group of patients. This minireview focuses on regional * Kunihisa Hotta [email protected] 1
Department of Anesthesiology and Critical Care Medicine, Jichi Medical University School of Medicine, 3311‑1 Yakushiji, Shimotsuke‑shi, Tochigi 329‑0498, Japan
anesthesia in patients with COVID-19 and discusses the practical consideration for performing regional anesthesia.
Anesthesia method: general or regional? The safety of both patients and healthcare workers should be taken into consideration when performing anesthesia management for patients who are confirmed or suspected to have COVID-19. Patients with acute and recent re
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