Korábban SARS-CoV-2-fertozésen átesett betegek mutéti érzéstelenítése és perioperatív ellátása.

Összefoglaló. A korábban SARS-CoV-2-vírusfertozésen átesett betegeknél különösen fontos az elektív mutét idopontjának megválasztása. Egy több, mint százezer beteget felölelo tanulmány szerint átlagosan 7 hét szükséges az elektív mutétre bocsátáshoz. Sürgos mutétek esetében a beteg általános állapota és a mutéttol várt javulás alapján mérlegelendo a mutét idopontja. A vitális indikációjú mutétek képezik a legnagyobb rizikót, hiszen ezen esetekben igen csekély ido és lehetoség van a preoperatív betegelokészítésre. A SARS-CoV-2-vírusfertozés nem minden esetben múlik el nyomtalanul. Szövodményeként felléphetnek cardiopulmonalis, véralvadási, központi idegrendszeri, mozgásszervi problémák, akut veseelégtelenség, ion- és vércukorháztartás felborulása, valamint gastrointestinalis eltérések is, melyek lehetnek rövid vagy hosszú távúak, illetve egyes esetekben maradandó károsodások is. A preoperatív kivizsgálási stratégiát, a mutéti érzéstelenítés módszerét (általános vagy regionális), valamint az intraoperatív monitorozást ezen szövodmények súlyosságának, valamint a mutét típusához megfeleloen kell megválasztani. A posztoperatív idoszakban a SARS-CoV-2-vírusfertozésen átesett betegek körében gyakrabban lehet szükség emelt szintu monitorozásra vagy intenzív osztályos megfigyelésre. Orv Hetil. 2022; 163(18): 695-701. Summary. The timing of elective surgery is very important in patients, who suffered SARS-CoV-2 virus infection. According to a study of more than 100,000 patients, it takes approximately seven weeks to be safely admitted to elective surgery. In the case of emergency surgeries, the date of the surgery should be considered based on the patient's general condition and the expected improvement from the surgery. Surgery with a vital indication takes the greatest risk, as there is very little time and opportunity for preoperative examination in these cases. SARS-CoV-2 virus infection does not go away without a trace. Complications may include cardiopulmonary, coagulation, central nervous system, locomotor problems, acute renal failure, ionic and diabetic disorders, and gastrointestinal abnormalities, which may be short-term or long-term, and in some cases permanent. The preoperative examination strategy, the method of anesthesia (general or regional) and the intraoperative monitoring should be chosen according to the severity of these complications and the type of surgery. In the postoperative period, patients suffered with SARS-CoV-2 virus infection may require more frequent monitoring or intensive ward monitoring. Orv Hetil. 2022; 163(18): 695-701.

Thoracic Anesthesia during the COVID-19 Pandemic: 2021 Updated Recommendations by the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) Thoracic Subspecialty Committee.

The novel coronavirus pandemic has radically changed the landscape of normal surgical practice. Lifesaving cancer surgery, however, remains a clinical priority, and there is an increasing need to fully define the optimal oncologic management of patients with varying stages of lung cancer, allowing prioritization of which thoracic procedures should be performed in the current era. Healthcare providers and managers should not ignore the risk of a bimodal peak of mortality in patients with lung cancer; an imminent spike due to mortality from acute coronavirus disease 2019 (COVID-19) infection, and a secondary peak reflecting an excess of cancer-related mortality among patients whose treatments were deemed less urgent, delayed, or cancelled. The European Association of Cardiothoracic Anaesthesiology and Intensive Care Thoracic Anesthesia Subspecialty group has considered these challenges and developed an updated set of expert recommendations concerning the infectious period, timing of surgery, vaccination, preoperative screening and evaluation, airway management, and ventilation of thoracic surgical patients during the COVID-19 pandemic.

Pharmacological options in treating SASR-CoV-2 infection/COVID-19 / [Farmakoterápiás lehetoségek SARS-CoV-2-fertozés/COVID­19-betegség esetén]

There is currently no proven effective therapy for COVID-19. Here we discuss the drugs most investigated for the treatment of the disease. All the listed therapies are experimental at this stage. However, due to the severe healthcare effects of the pandemic and the potentially fatal outcome of COVID-19 patients treated in the intensive care units, their off-label use should none-the-less be considered. Orv Hetil. 2020; 161(17): 685­688.

Organ replacement therapy and life-supporting treatment modalities in critically ill COVID-19 patients / [Emelt szintu szervtámogató és életfenntartó kezelések kritikus állapotú COVID­19-fertozött betegeken]

In critically ill COVID-19 patients, the failure of the cardiorespiratory system can be due to one of the following: (1) cytokine storm, haemophagocytosis ­ septic shock, (2) unmanageable hypoxemia, (3) isolated organ failure or as part of multi-organ failure. Herein we give an overview of the therapeutic options for treating or preventing these disease states. In recent years, CytoSorb-haemoperfusion to remove cytokines has shown promising results in the treatment of septic shock. Inhalational nitric oxide (iNO), inhalational epoprostenol and veno-venous extracorporeal membrane oxygenation (ECMO) are options in severe hypoxemia that is unresponsive to conventional mechanical ventilation. Renal failure is a frequent component of the multi-organ failure usually seen with disease progression and necessitates starting one of the available continuous renal replacement modalities. Orv Hetil. 2020; 161(17): 704­709.

Intrahospital resuscitation of COVID-19 patients / [A COVID­19-betegek kórházon belüli újraélesztésének speciális szempontjai]

The coronavirus pandemic is a serious challenge for healthcare workers worldwide. The virus is spread through the air by droplets of moisture when people cough or sneeze and it has a very high virulence. Procedures generating airway aerosols are dangerous for every participant of patient care. Mortality of COVID-19 is above 10%, thus cardiopulmonary resuscitation is an often needed intervention in this patient group. Resuscitation is an aerosol-generating process and thus carries the risk of contamination. The goal of this article is to give a practice-based overview of the specialities of cardiopulmonary resuscitation in coronavirus-infected patients. Orv Hetil. 2020. 161(17): 710­712.

Airway management of coronavirus-infected patients / [Légútbiztosítás koronavírus-fertozött betegekben]

The coronavirus pandemic is a serious challenge for healthcare workers worldwide. The virus is spread through the air by droplets of moisture when people cough or sneeze and it has a very high virulence. Procedures generating airway aerosols are dangerous for every participant of patient care. The serious form of coronavirus infection can cause progressive respiratory failure. The best treatment is early endotracheal intubation and invasive mechanical ventilation. Intubation is an aerosol-generating process and thus carries the risk of contamination. Additionally the airway management of this patient population is usually difficult. The goal of this article is to give a practice-based overview of the peculiarities of airway management in coronavirus-infected patients with special regard to infection control and patient safety considerations. Orv Hetil. 2020; 161(17): 696­703.

Practical aspects of anesthetic and perioperative care for COVID-19 patients / [A COVID­19-fertozött betegek anesztéziájának és perioperatív ellátásának gyakorlati szempontjai]

Caring for those affected by the coronavirus outbreak of December 2019 imposed a heavy burden on healthcare systems. Not only because some patients require intensive care, but because patients with any form of the disease may need surgical intervention. Managing these cases is a major challenge for anesthesiologists. The purpose of this summary is to present the practical aspects of anesthetic and perioperative care for patients requiring surgical treatment. Orv Hetil. 2020; 161(17): 692­695.

Practical aspects of intensive care for critically ill COVID-19 patients requiring respiratory support / [Kritikus állapotú, légzéstámogatást igénylo COVID­19-fertozött beteg ellátásának gyakorlati szempontjai]

In December 2019, a novel outbreak of pneumonia was reported in Wuhan city, China. Initially, the zoonitic infection spread from human to human, causing a pandemic. This viral disease (COVID-19) can appear in a variety of forms, from asymptomatic through the spectrum of mild symptoms to severe respiratory failure, requiring intensive care. Caring for this latter group of patients puts a significant burden on health care. The purpose of this summary is to present the practical aspects of intensive care for patients requiring respiratory support and mechanical ventilation. Orv Hetil. 2020; 161(17): 678­684.

Thoracic Anesthesia of Patients with Suspected or Confirmed 2019 Novel Coronavirus Infection: Preliminary Recommendations for Airway Management by the EACTA Thoracic Subspecialty Committee

The novel coronavirus has caused a pandemic around the world. Management of patients with suspected or confirmed coronavirus infection who have to undergo thoracic surgery will be a challenge for the anesthesiologists. infection who have to undergo thoracic surgery will be a challenge for the anesthesiologists. The thoracic subspecialty committee of European Association of Cardiothoracic Anaesthesiology (EACTA) has conducted a survey of opinion in order to create recommendations for the anesthetic approach to these challenging patients. It should be emphasized that both the management of the infected patient with COVID-19 and the self-protection of the anesthesia team constitute a complicated challenge. The text focuses therefore on both important topics.