Comparison of Perioperative Characteristics and Clinical Outcomes of COVID-19 and non-COVID-19 Patients Undergoing Neurosurgery-A Retrospective Analysis

Background Patients with coronavirus disease 2019 (COVID-19) presenting for neurosurgery are not rare. Considering the lack of literature informing the outcomes in this subset, present study was conducted to compare perioperative management and postoperative outcomes between COVID-19 and non-COVID-19 neurosurgical patients. Methods After ethics committee approval, data of all patients with COVID-19 along with an equal number of age and diagnosis matched non-COVID-19 patients undergoing neurosurgery between April 2020 and January 2021 was analyzed retrospectively. Predictors of poor outcome were identified using multivariate logistic regression analysis. Results During the study period, 50 COVID-19 patients (28 laboratory confirmed (group-C) and 22 clinicoradiological diagnosed [group-CR]) underwent neurosurgery and were compared with 50 matched non-COVID-19 patients. Preoperatively, clinicoradiological diagnosed COVID-19 patients had higher American Society of Anesthesiologists (ASA) grade ( p = 0.01), lower Glasgow Coma Scale (GCS) score ( p < 0.001), and more pulmonary involvement ( p = 0.004). The duration of intensive care unit stay was significantly longer in laboratory confirmed patients ( p = 0.03). Poor clinical outcome (in-hospital mortality or discharge motor-GCS <= 5) did not differ significantly between the groups ( p = 0.28). On univariate analysis, younger age, higher ASA grade, lower preoperative GCS, and motor-GCS, higher intraoperative blood and fluid administration and traumatic brain injury diagnosis were associated with poor outcome. On multivariable logistic regression. only lower preoperative motor-GCS remained the predictor of poor outcome. Conclusions The concomitant presence of COVID-19 infection did not translate into poor outcome in patients undergoing neurosurgery. Preoperative motor-GCS predicted neurological outcome in both COVID-19 and non-COVID-19 neurosurgical patients.

Effect of Heat and Moisture Exchange Filter on the Dead Space Ventilation in a Pediatric Patient

The use of heat and moisture exchange filter (HMEF) has become a routine standard of care in general anesthesia (GA), more so, during the current COVID-19 pandemic times. However its routine use, especially in pediatric patients, has several issues. We report a case of increased dead space ventilation in a pediatric patient due to the presence of HMEF. Hypercapnia and its cause was instantly diagnosed with two capnography sampling lines placed at two ends of the HMEF.