Background and Aims Spinal anesthesia (SA) is the main type of anesthesia for caesarean section (SC). COVID-19 pneumonia which complicates the course of pregnancy, requires a rational choice of sedation and respiratory support to ensure SA.

Methods The safe conduct of SA was ensured by the temporary discontinuation of the use of heparinoids in the perioperative period. SA was performed exclusively in the sitting position, then the patient was transferred to the horizontal position with the head end elevated by 30–45 degrees (depending on the needs). Respiratory support was used at all stages of preparation, performance, and administration of anesthesia: high-flow oxygenation (HFO) through nasal cannula or face mask, and noninvasive mechanical lung ventilation through the face mask. Maintenance of normotension was provided by intravenous boluses phenylephrine. Sedation was provided by intravenous bolus small doses of propofol or ketamine.

Results The above-described features of SA were used by us during CS in 30 women in labor with severe coronavirus pneumonia. Compliance with the characteristics of SA for CS by coronavirus pneumonia was expressed in the following:

1) sitting position - half sitting at all stages of the perioperative period;

2) constant respiratory support, mainly HFO;

3) early transfer to the pron-position in the postoperative period;

4) predominant use 50–75 mg ketamine (not propofol) for sedation during CS

This approach ensured that there was no need to use general anesthesia with tracheal intubation for CS.

Conclusions Supplemented with HFO, ketamine sedation, half-sitting SA is the method of choice for providing CS in labor with severe coronavirus pneumonia.