COVID-19：症例報告のレビュー

COVID-19: review of case reports.

• Yutaka Oda

抄録

最近発表されたコロナウイルス疾患（COVID-19）患者の麻酔に関連する症例報告をレビューした。COVID-19の診断は重症急性呼吸器症候群コロナウイルス2（SARS-CoV-2）の逆転写酵素ポリメラーゼ連鎖反応検査で陽性であった。緊急帝王切開分娩に対応した報告が多数あった。COVID-19を発症した妊婦の初発症状や検査値は非妊婦と同様であった。COVID-19患者では手術後の死亡率が高いことが報告されているが、ほとんどの症例で局所麻酔下での帝王切開分娩は成功しており、術後の経過は両親、新生児ともに良好であった。SARS-CoV-2の母子垂直感染の直接の証拠はないが，COVID-19妊婦から分娩2時間後の新生児に免疫グロブリン値の上昇と肝機能の異常からCOVID-19と診断され，その可能性を完全に排除できないことが示唆された。COVID-19を有する生後8ヶ月の男児に緊急脳シャント再建術を繰り返し施行した。気管チューブは術後手術室で抜去され、術後の経過は問題なかった。すべての手術は、患者と医療従事者の安全を確保するために、レベル3の個人保護を備えた医療スタッフが隔離された手術室で行うべきである。

Recently published case reports relating to anesthesia in patients with coronavirus disease (COVID-19) were reviewed. The diagnosis of COVID-19 was confirmed by positive results of reverse transcriptase polymerase chain reaction test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Numerous reports handled emergency cesarean delivery. Primary symptoms and laboratory data of pregnant women with COVID-19 were similar to those of non-pregnant patients. Although the mortality rate is reported to be high after surgery in patients with COVID-19, cesarean delivery was successfully performed under regional anesthesia in most cases and postoperative course was favorable both in the parents and newborns. There is no direct evidence of vertical mother-to-child transmission of SARS-CoV-2; however, a diagnosis of COVID-19 was made in a newborn two hours after delivery from a pregnant woman with COVID-19, based on the increased immunoglobulin levels and deranged liver function, suggesting that its possibility cannot be completely eliminated. Emergency cerebral shunt reconstruction was performed repeatedly in an eight-month-old boy with COVID-19. The tracheal tube was removed in the operating room after surgery and postoperative course was uneventful. All the procedures should be performed in isolated operating rooms with medical staff with level-3 personal protection to ensure the safety of patients and health care providers.