The effect of the COVID-19 pandemic on anesthesia management and clinical outcomes in caesarean section

Objective: With this study, we aimed to retrospectively evaluate the effects of the pandemic period on obstetric anesthesia management and outcomes for mother and baby. Material and Method: In our study, the patient files and anesthesia registration forms of the patients who were taken to cesarean section by the Obstetrics and Gynecology Department in two separate periods, September 2019 - March 2020 (six months before the pandemic) and March 2020 - September 2020 (the first six months of the pandemic period), were retrospectively analyzed. carried out by scrutiny. Data were obtained by scanning backwards from Çukurova University Medical Faculty Hospital Information Management System (HIMS) and printed patient files. Demographic and clinical data of the patients, operation and anesthesia management, and postoperative data were recorded and the results were compared in terms of pre-pandemic and pandemic period. Results: A total of 1241 female patients who underwent cesarean section were included in our study, including 621 patients in the pre-pandemic period and 620 patients in the post-pandemic period. It was observed that there was no significant difference between the two periods in terms of maternal age (mean maternal age before and after the pandemic, respectively 30.86±5.91, 30.71±6.21, p=0.780). It was observed that there was a significant decrease in the number of pregnant women with additional diseases during the pandemic period (p=0.001). There was no significant difference between the two periods in terms of pregnancy-related comorbidity and gestational week (p>0.05). Although there was no difference in mean pre-operative hemoglobin values between the two periods, it was found that hemoglobin values below 11 g/dL were observed less frequently during the pandemic period (p=0.353 and p=0.001, respectively). Pre-operative hematocrit values were found to be higher in the pandemic period than before the pandemic (p=0.001). It was observed that the mean white blood cell, platelet and neutrophil values obtained pre-operatively did not differ between the two periods (p>0.05). While post-operative hemoglobin values were higher than the other group during the pandemic period, this difference was not statistically significant, but the increase in mean post-operative hematocrit values was observed to be significant (p=0.100 and p=0.001, respectively). Post-operative mean white blood cell, platelet and neutrophil values were not statistically different in the pre-pandemic period and during the pandemic period (p>0.05). It was observed that the APGAR scores measured in the first and fifth minutes of the patients were higher in the pre-pandemic period, but at the tenth minute. It was observed that there was no difference between the pre-pandemic period and the pandemic period in terms of APGAR scores measured (p=0.002, p=0.004 and p=0.468, respectively). While the rate of regional anesthesia application was 57% in the pre-pandemic period, this rate was 64.8% during the pandemic period. (p=0.005). It was determined that there was no significant difference between the two periods in terms of patients' need for vasopressors (p=0.249). It was observed that the difference observed between the two periods in postpartum pain management was due to the increase in the proportion of patients who used paracetamol alone (11.9% vs. 18.1%; p=0.049). When the complications observed in the post-operative period were examined, complications were not observed in 84.2% of the patients in the pre pandemic period, while this rate was 86.3% during the pandemic period (p=0.001). It was determined that the duration of hospitalization of the patients during the pandemic period was significantly shorter (p=0.001). Conclusion: The pandemic period has led to many changes in clinical practices. It is possible to see these effects of the pandemic in cesarean section operations. In our study, we revealed the effects of the pandemic on anesthesia applications, especially in cesarean section operations. Key Words: Cesarean section, COVID-19, Obstetric Anesthesia, Pandemic