BACKGROUND The safety of performing spinal anaesthesia for both patients and anaesthetists alike in the presence of active infection with the novel coronavirus disease 2019 (COVID-19) is unclear. Here, we report the clinical characteristics and outcomes for both patients with COVID-19 and the anaesthetists who provided their spinal anaesthesia. METHODS Forty-nine patients with radiologically confirmed COVID-19 for Caesarean section or lower-limb surgery undergoing spinal anaesthesia in Zhongnan Hospital, Wuhan, China participated in this retrospective study. Clinical characteristics and perioperative outcomes were recorded. For anaesthesiologists exposed to patients with COVID-19 by providing spinal anaesthesia, the level of personal protective equipment (PPE) used, clinical outcomes (pulmonary CT scans), and confirmed COVID-19 transmission rates (polymerase chain reaction [PCR]) were reviewed. RESULTS Forty-nine patients with COVID-19 requiring supplementary oxygen before surgery had spinal anaesthesia (ropivacaine 0.75%), chiefly for Caesarean section (45/49 [91%]). Spinal anaesthesia was not associated with cardiorespiratory compromise intraoperatively. No patients subsequently developed severe pneumonia. Of 44 anaesthetists, 37 (84.1%) provided spinal anaesthesia using Level 3 PPE. Coronavirus disease 2019 infection was subsequently confirmed by PCR in 5/44 (11.4%) anaesthetists. One (2.7%) of 37 anaesthetists who wore Level 3 PPE developed PCR-confirmed COVID-19 compared with 4/7 (57.1%) anaesthetists who had Level 1 protection in the operating theatre (relative risk reduction: 95.3% [95% confidence intervals: 63.7-99.4]; P<0.01). CONCLUSIONS Spinal anaesthesia was delivered safely in patients with active COVID-19 infection, the majority of whom had Caesarean sections. Level 3 PPE appears to reduce the risk of transmission to anaesthetists who are exposed to mildly symptomatic surgical patients.

中文翻译：

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冠状病毒病患者的脊髓麻醉2019和麻醉师的可能传播率：回顾性，单中心，观察性队列研究。

背景技术尚不清楚在存在新型冠状病毒病2019（COVID-19）主动感染的情况下，对患者和麻醉师进行脊柱麻醉的安全性。在这里，我们报告了COVID-19病人和提供脊柱麻醉的麻醉师的临床特征和结局。方法回顾性研究了49例经放射学确诊为剖腹产或下肢手术的COVID-19的患者，在武汉市中南医院接受了脊柱麻醉。记录临床特征和围手术期结果。对于通过脊髓麻醉暴露于COVID-19的麻醉师，使用的个人防护设备（PPE）的水平，临床结果（肺部CT扫描），并确认COVID-19的传输速率（聚合酶链反应[PCR]）。结果49例COVID-19患者在手术前需要补充氧气进行了脊髓麻醉（罗哌卡因0.75％），主要用于剖宫产（45/49 [91％]）。术中脊髓麻醉与心肺功能损害无关。随后没有患者出现严重的肺炎。在44位麻醉师中，有37位（84.1％）使用3级PPE进行了脊柱麻醉。随后在5/44（11.4％）的麻醉师中通过PCR确认了冠状病毒病2019感染。佩戴3级PPE的37名麻醉师中有1名（2.7％）制定了PCR确认的COVID-19，而在手术室中采用1级防护的麻醉师为4/7名（57.1％）（相对危险度降低：95.3％[95％置信度时间间隔：63.7-99.4]； P <0.01）。结论活动性COVID-19感染的患者安全地进行了脊髓麻醉，其中大多数患者进行了剖腹产。3级PPE似乎可以减少传播给轻度对症手术患者的麻醉师的风险。