More information needed for patients with COVID-19 receiving spinal anaesthesia

Editor—Zhong and colleagues¹ reported on the safety of administering spinal anaesthesia to patients with coronavirus disease 2019 (COVID-19) and the subsequent transmission rates to the anaesthetists providing their care. We congratulate the authors on the rapidity of their publication on a topic that lacks published data and directly pertains to the safety of patients and physicians. However, there are several points that could benefit from further clarification.

First, we question why different criteria were used to identify COVID-19 in patients vs anaesthetists. Patients in the study were diagnosed with COVID-19 not by laboratory testing, but rather by clinical criteria established by the National Health Commission of China (NHCC).² Only 13 of the 49 patients considered positive in this manner had confirmatory reverse transcription–polymerase chain reaction (RT–PCR) tests, which is significantly lower than described elsewhere.³ This raises the question of how many patients in the study were truly infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at the time of surgery. Comparing differences in outcomes between patients with only a clinical diagnosis vs those with positive RT–PCR testing would be informative. The criteria used to diagnose patients in the study contrast with the criteria used for anaesthetists, who were required to have a positive RT–PCR test. Only five of the 44 anaesthetists were positive in this manner, but a significant number of them had symptoms consistent with infection as described in Table 4. It would be instructive to know how many of the anaesthetists would have been positive using the NHCC clinical criteria.

Secondly, the primary objective of the study was to describe the safety of neuraxial anaesthesia in COVID-19 patients. Although the authors report some important clinical outcomes, other data specific for COVID-19 including baseline oxygen saturations, indications for supplemental oxygen, and blood pressure trends greater than 5 min after surgery were not reported. Similarly, more data on the clinical characteristics of the anaesthetists would be beneficial. Of the five who contracted COVID-19, only one had symptoms but two required hospitalisation for supplementary oxygen. Patients with COVID-19 may have significant hypoxaemia without dyspnoea, but additional data regarding hospitalisation in this asymptomatic patient are not provided.⁴

A number of other discrepancies are present in the paper. The description of Table 4 suggests that a significant portion of anaesthetists had symptoms consistent with COVID-19 infection at the time they were delivering spinal anaesthesia. Did they really have these symptoms while caring for patients? This would be concerning in a location actively experiencing widespread transmission of SARS-CoV-2, especially considering that four of the five anaesthetists with confirmed infection had no symptoms at all. More specific data on the use of umifenovir would be helpful. For instance, the paper does not make it clear what percentage of the anaesthetists taking umifenovir subsequently became infected. Lack of these data weakens any conclusions that can be drawn regarding the protective effects of different levels of personal protective equipment. Finally, 42 of the 49 patients are reported as being female, whereas 45 of the 49 patients underwent Caesarean sections, implying that some men underwent this procedure.

This study is a valuable contribution to the field of anaesthesia, and obstetric anaesthesia in particular, at a time when limited information exists on COVID-19 in parturients. However, we feel that additional clarification on several points in the paper would further strengthen its utility.

Declarations of interest

The authors declare that they have no conflicts of interest.