Background

According to 2017 McDonald criteria, CSF analysis is useful for the diagnosis of multiple sclerosis. Incidence of vasovagal response after spinal anesthesia, a similar procedure to spinal tap, is estimated around 4-5 % in the published literature[i].

Since the implementation of new sanitary measures for COVID-19 pandemic (mask for patient and medical staff, face shield for the staff), the author suspected an increase in vasovagal response occurring in patients during spinal tap procedure.

[i] Vahabi S, Slavash B, Badiozaman R. The incidence of vasovagal response in spinal anesthesia during surgery. J Anest & Inten Care Med. 2018; 5(1).

Objectives

Under an unchanged practice setting of the author, the objective is to compare the occurrence of vasovagal response in association with CSF sampling since the beginning of the COVID-19 pandemic in March 2020 in comparison with the previous year.

Methods

The author is working in an out-of-hospital private neurology clinic. CSF sampling are done within the clinic by the author using the same technical procedure for the last 3 years, using the sitting position for the vast majority. The patients' reactions to the procedure have been systematically documented in their chart. In a retrospective analysis, the author's patients undergoing a CSF examination since the beginning of the pandemic (2020-03-16) were compared to the ones from the previous year, specifically examining the occurrence of vasovagal response.

Results

From 2020-03-23 to 2020-07-16, 15 patients (18-72 years, mean 46.4y) were sampled for CSF, 60% for multiple sclerosis suspicion. In the previous year, from 2019-03-01 to 2020-02-12, 26 patients (26-82 years, mean 50.2y) were sampled, 46.2% for multiple sclerosis suspicion.

9 (46.7%) patients experienced a vasovagal response during the COVID-19 pandemic compared to 2 (7.7%) patients in the previous year (p = 0.003). One patient having recurrent vasovagal response during the procedure had to be referred for fluoroscopy, a situation that rarely occurs in the author's practice. As for confounding factors, there were more cardiovascular issues identified in the pre-pandemic cohort.

Conclusions

A marked increase of vasovagal response after CSF sampling is observed since the beginning of the pandemic, in comparison to expected occurrence from previous year. Anxiety related to COVID-19 & the mask use (doctor or patient) are suspected factors in this increase. A study supports these findings; 47% of medical students that experienced syncope in operating theatre reported that wearing a surgical mask was a contributory factor[i].

Favoring a lateral decubitus position and particular COVID-19 reassurance have been implemented in the author's practice in order to decrease the occurrence of this unpleasant reaction. Follow-up is ongoing.

[i] Jamjoom A, Nikkar-Esfahani A, Fitzgerald J. Operating theatre related syncope in medical students : a cross sectional study. BMC Med Educ. 2009; 9 : 14.

Background

According to 2017 McDonald criteria, CSF analysis is useful for the diagnosis of multiple sclerosis. Incidence of vasovagal response after spinal anesthesia, a similar procedure to spinal tap, is estimated around 4-5 % in the published literature[i].

Since the implementation of new sanitary measures for COVID-19 pandemic (mask for patient and medical staff, face shield for the staff), the author suspected an increase in vasovagal response occurring in patients during spinal tap procedure.

[i] Vahabi S, Slavash B, Badiozaman R. The incidence of vasovagal response in spinal anesthesia during surgery. J Anest & Inten Care Med. 2018; 5(1).

Objectives

Under an unchanged practice setting of the author, the objective is to compare the occurrence of vasovagal response in association with CSF sampling since the beginning of the COVID-19 pandemic in March 2020 in comparison with the previous year.

Methods

The author is working in an out-of-hospital private neurology clinic. CSF sampling are done within the clinic by the author using the same technical procedure for the last 3 years, using the sitting position for the vast majority. The patients' reactions to the procedure have been systematically documented in their chart. In a retrospective analysis, the author's patients undergoing a CSF examination since the beginning of the pandemic (2020-03-16) were compared to the ones from the previous year, specifically examining the occurrence of vasovagal response.

Results

From 2020-03-23 to 2020-07-16, 15 patients (18-72 years, mean 46.4y) were sampled for CSF, 60% for multiple sclerosis suspicion. In the previous year, from 2019-03-01 to 2020-02-12, 26 patients (26-82 years, mean 50.2y) were sampled, 46.2% for multiple sclerosis suspicion.

9 (46.7%) patients experienced a vasovagal response during the COVID-19 pandemic compared to 2 (7.7%) patients in the previous year (p = 0.003). One patient having recurrent vasovagal response during the procedure had to be referred for fluoroscopy, a situation that rarely occurs in the author's practice. As for confounding factors, there were more cardiovascular issues identified in the pre-pandemic cohort.

Conclusions

A marked increase of vasovagal response after CSF sampling is observed since the beginning of the pandemic, in comparison to expected occurrence from previous year. Anxiety related to COVID-19 & the mask use (doctor or patient) are suspected factors in this increase. A study supports these findings; 47% of medical students that experienced syncope in operating theatre reported that wearing a surgical mask was a contributory factor[i].

Favoring a lateral decubitus position and particular COVID-19 reassurance have been implemented in the author's practice in order to decrease the occurrence of this unpleasant reaction. Follow-up is ongoing.

[i] Jamjoom A, Nikkar-Esfahani A, Fitzgerald J. Operating theatre related syncope in medical students : a cross sectional study. BMC Med Educ. 2009; 9 : 14.