The time to perform spinal or general anaesthesia in COVID-19 positive parturients requiring emergency caesarean delivery: a prospective crossover simulation study

Background: Spinal anaesthesia is the commonest performed technique for caesarean deliveries except in the emergency setting where general anaesthesia is preferred due to its rapid onset and predictability. There are several modifications to performing general anaesthesia for COVID-19 patients in Australia. We hypothesised that the performance time of these techniques amongst specialist anaesthetists would be similar for COVID-19 parturients undergoing emergency caesarean delivery. Methods: We designed a simulation cross-over study. The primary outcome was the time taken to perform general anaesthesia or spinal anaesthesia in this setting. We also examined the decision-making process time, the decision to incision time and the level of stress associated with both scenarios. Results: Nine specialist anaesthetists participated in the research. There was no difference in the time taken to perform spinal or general anaesthesia (mean difference (GA-SA scenario) -1.2 (-5.3-2.8) minutes, p = 0.5). Irrespective of group allocation the mean time to complete the spinal anaesthesia scenario was 27.4 (standard deviation = 7.8) minutes, while for the general anaesthesia scenario was 24.0 (7.2) minutes. There was no difference between these times (mean difference (GA-SA scenario) = -3.5 minutes, 95th percent confidence interval -9.7-2.8 minutes, p = 0.24). There was no evidence of a carryover effect for the two scenarios based on the group allocation (p = 0.69) and no significant difference between stress levels (p = 0.44). Conclusions: The time to perform spinal anaesthesia was similar to the time to perform general anaesthesia for a confirmed COVID-19 parturient in a simulation environment.