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2.
Crit Care Med ; 49(10): 1684-1693, 2021 10 01.
Article in English | MEDLINE | ID: covidwho-1452742

ABSTRACT

OBJECTIVES: Clinical trials evaluating the safety and effectiveness of sedative medication use in critically ill adults undergoing mechanical ventilation differ considerably in their methodological approach. This heterogeneity impedes the ability to compare results across studies. The Sedation Consortium on Endpoints and Procedures for Treatment, Education, and Research Recommendations convened a meeting of multidisciplinary experts to develop recommendations for key methodologic elements of sedation trials in the ICU to help guide academic and industry clinical investigators. DESIGN: A 2-day in-person meeting was held in Washington, DC, on March 28-29, 2019, followed by a three-round, online modified Delphi consensus process. PARTICIPANTS: Thirty-six participants from academia, industry, and the Food and Drug Administration with expertise in relevant content areas, including two former ICU patients attended the in-person meeting, and the majority completed an online follow-up survey and participated in the modified Delphi process. MEASUREMENTS AND MAIN RESULTS: The final recommendations were iteratively refined based on the survey results, participants' reactions to those results, summaries written by panel moderators, and a review of the meeting transcripts made from audio recordings. Fifteen recommendations were developed for study design and conduct, subject enrollment, outcomes, and measurement instruments. Consensus recommendations included obtaining input from ICU survivors and/or their families, ensuring adequate training for personnel using validated instruments for assessments of sedation, pain, and delirium in the ICU environment, and the need for methodological standardization. CONCLUSIONS: These recommendations are intended to assist researchers in the design, conduct, selection of endpoints, and reporting of clinical trials involving sedative medications and/or sedation protocols for adult ICU patients who require mechanical ventilation. These recommendations should be viewed as a starting point to improve clinical trials and help reduce methodological heterogeneity in future clinical trials.


Subject(s)
Hypnotics and Sedatives/pharmacokinetics , Hypnotics and Sedatives/therapeutic use , Congresses as Topic , Consensus , Delphi Technique , District of Columbia , Humans , Hypnotics and Sedatives/pharmacology , Respiration, Artificial/instrumentation , Respiration, Artificial/methods , Time Factors
3.
Best Pract Res Clin Anaesthesiol ; 35(3): 267-268, 2021 10.
Article in English | MEDLINE | ID: covidwho-1433002
4.
Best Pract Res Clin Anaesthesiol ; 35(3): 269-292, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1401261

ABSTRACT

Coronaviruses belong to the family Coronaviridae order Nidovirales and are known causes of respiratory and intestinal disease in various mammalian and avian species. Species of coronaviruses known to infect humans are referred to as human coronaviruses (HCoVs). While traditionally, HCoVs have been a significant cause of the common cold, more recently, emergent viruses, including severe acute respiratory syndrome coronavirus (SARS-CoV-2) has caused a global pandemic. Here, we discuss coronavirus disease (COVID-19) biology, pathology, epidemiology, signs and symptoms, diagnosis, treatment, and recent clinical trials involving promising treatments.


Subject(s)
Antiviral Agents/administration & dosage , COVID-19/epidemiology , COVID-19/therapy , SARS-CoV-2 , Adenosine Monophosphate/administration & dosage , Adenosine Monophosphate/analogs & derivatives , Adrenal Cortex Hormones/administration & dosage , Alanine/administration & dosage , Alanine/analogs & derivatives , Animals , COVID-19/diagnosis , COVID-19/immunology , Coronavirus/drug effects , Coronavirus/immunology , Cough/epidemiology , Cough/therapy , Diabetes Mellitus/epidemiology , Diabetes Mellitus/therapy , Fatigue/epidemiology , Fatigue/therapy , Fever , Heart Diseases/epidemiology , Heart Diseases/therapy , Humans , Positive-Pressure Respiration/methods , Prognosis , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy , SARS-CoV-2/drug effects , SARS-CoV-2/immunology , Treatment Outcome
5.
Curr Opin Anaesthesiol ; 34(4): 464-469, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1313887

ABSTRACT

PURPOSE OF REVIEW: Nonoperating room anesthesia (NORA) continues to increase in popularity and scope. This article reviews current and new trends in NORA, trends in anesthesia management in nonoperating room settings, and the evolving debates surrounding these trends. RECENT FINDINGS: National data suggests that NORA cases will continue to rise relative to operating room (OR) anesthesia and there will continue to be a shift towards performing more interventional procedures outside of the OR. These trends have important implications for the safety of interventional procedures as they become increasingly more complex and patients continue to be older and more frail. In order for anesthesia providers and proceduralists to be prepared for this future, rigorous standards must be set for safe anesthetic care outside of the OR.Although the overall association between NORA and patient morbidity and mortality remains unclear, focused studies point toward trends specific to each non-OR procedure type. Given increasing patient and procedure complexity, anesthesiology teams may see a larger role in the interventional suite. However, the ideal setting and placement of anesthesia staff for interventional procedures remain controversial. Also, the impact of COVID-19 on the growth and utilization of non-OR anesthesia remains unclear, and it remains to be seen how the pandemic will influence the delivery of NORA procedures in postpandemic settings. SUMMARY: NORA is a rapidly growing field of anesthesia. Continuing discussions of complication rates and mortality in different subspecialty areas will determine the need for anesthesia care and quality improvement efforts in each setting. As new noninvasive procedures are developed, new data will continue to shape debates surrounding anesthesia care outside of the operating room.


Subject(s)
Anesthesia , Anesthesiology , Anesthetics , COVID-19 , Anesthesia/adverse effects , Humans , SARS-CoV-2
6.
Curr Opin Anaesthesiol ; 34(4): 464-469, 2021 Aug 01.
Article in English | MEDLINE | ID: covidwho-1254866

ABSTRACT

PURPOSE OF REVIEW: Nonoperating room anesthesia (NORA) continues to increase in popularity and scope. This article reviews current and new trends in NORA, trends in anesthesia management in nonoperating room settings, and the evolving debates surrounding these trends. RECENT FINDINGS: National data suggests that NORA cases will continue to rise relative to operating room (OR) anesthesia and there will continue to be a shift towards performing more interventional procedures outside of the OR. These trends have important implications for the safety of interventional procedures as they become increasingly more complex and patients continue to be older and more frail. In order for anesthesia providers and proceduralists to be prepared for this future, rigorous standards must be set for safe anesthetic care outside of the OR.Although the overall association between NORA and patient morbidity and mortality remains unclear, focused studies point toward trends specific to each non-OR procedure type. Given increasing patient and procedure complexity, anesthesiology teams may see a larger role in the interventional suite. However, the ideal setting and placement of anesthesia staff for interventional procedures remain controversial. Also, the impact of COVID-19 on the growth and utilization of non-OR anesthesia remains unclear, and it remains to be seen how the pandemic will influence the delivery of NORA procedures in postpandemic settings. SUMMARY: NORA is a rapidly growing field of anesthesia. Continuing discussions of complication rates and mortality in different subspecialty areas will determine the need for anesthesia care and quality improvement efforts in each setting. As new noninvasive procedures are developed, new data will continue to shape debates surrounding anesthesia care outside of the operating room.


Subject(s)
Anesthesia , Anesthesiology , Anesthetics , COVID-19 , Anesthesia/adverse effects , Humans , SARS-CoV-2
7.
BMC Anesthesiol ; 21(1): 155, 2021 05 20.
Article in English | MEDLINE | ID: covidwho-1238704

ABSTRACT

BACKGROUND: The surge of critically ill patients due to the coronavirus disease-2019 (COVID-19) overwhelmed critical care capacity in areas of northern Italy. Anesthesia machines have been used as alternatives to traditional ICU mechanical ventilators. However, the outcomes for patients with COVID-19 respiratory failure cared for with Anesthesia Machines is currently unknow. We hypothesized that COVID-19 patients receiving care with Anesthesia Machines would have worse outcomes compared to standard practice. METHODS: We designed a retrospective study of patients admitted with a confirmed COVID-19 diagnosis at a large tertiary urban hospital in northern Italy. Two care units were included: a 27-bed standard ICU and a 15-bed temporary unit emergently opened in an operating room setting. Intubated patients assigned to Anesthesia Machines (AM group) were compared to a control cohort treated with standard mechanical ventilators (ICU-VENT group). Outcomes were assessed at 60-day follow-up. A multivariable Cox regression analysis of risk factors between survivors and non-survivors was conducted to determine the adjusted risk of death for patients assigned to AM group. RESULTS: Complete daily data from 89 mechanically ventilated patients consecutively admitted to the two units were analyzed. Seventeen patients were included in the AM group, whereas 72 were in the ICU-VENT group. Disease severity and intensity of treatment were comparable between the two groups. The 60-day mortality was significantly higher in the AM group compared to the ICU-vent group (12/17 vs. 27/72, 70.6% vs. 37.5%, respectively, p = 0.016). Allocation to AM group was associated with a significantly increased risk of death after adjusting for covariates (HR 4.05, 95% CI: 1.75-9.33, p = 0.001). Several incidents and complications were reported with Anesthesia Machine care, raising safety concerns. CONCLUSIONS: Our results support the hypothesis that care associated with the use of Anesthesia Machines is inadequate to provide long-term critical care to patients with COVID-19. Added safety risks must be considered if no other option is available to treat severely ill patients during the ongoing pandemic. CLINICAL TRIAL NUMBER: Not applicable.


Subject(s)
Anesthesiology/instrumentation , COVID-19/epidemiology , COVID-19/therapy , Critical Illness/epidemiology , Critical Illness/therapy , Respiration, Artificial/instrumentation , Aged , Female , Humans , Italy/epidemiology , Male , Middle Aged , Respiration, Artificial/methods , Retrospective Studies
9.
Best Pract Res Clin Anaesthesiol ; 35(3): 437-448, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1116288

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, emerged in late 2019 in Wuhan, China. The World Health Organization declared the virus a pandemic on March 11, 2020. Disease progression from COVID-19 infection has shown significant symptom manifestations within organ systems beyond the respiratory system. The literature has shown increasing evidence of cardiovascular involvement during disease course and an associated increase in mortality among infected patients. Although the understanding of this novel virus is continually evolving, it is currently proposed that the mechanism by which the SARS-CoV-2 virus contributes to cardiovascular manifestations involves the ACE2 transmembrane protein. The protein ACE2 is highly expressed in blood vessel pericytes, and infection can result in microvascular dysfunction and subsequent acute coronary syndromes. Complications involving the cardiovascular system include myocardial infarction, arrhythmias, shock, and heart failure. In this evidence-based review, we discuss risk factors of cardiovascular involvement in COVID-19 infection, pathophysiology of COVID-19-related cardiovascular infection, and injury, COVID-19 effects on the cardiovascular system and corresponding treatments, and hematologic effects of COVID-19 and COVID-19 in heart transplant patients. Clinicians managing COVID-19 patients should appreciate the potential cardiovascular effects related to the disease process.


Subject(s)
COVID-19/epidemiology , Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/virology , Cardiovascular System/virology , Evidence-Based Practice/methods , COVID-19/therapy , Cardiovascular Diseases/therapy , Delivery of Health Care/methods , Delivery of Health Care/standards , Evidence-Based Practice/standards , Humans , Risk Factors
10.
Best Pract Res Clin Anaesthesiol ; 35(3): 449-459, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1116287

ABSTRACT

Coronavirus disease (COVID-19) causes many deleterious effects throughout the body. Prior studies show that the incidence of acute kidney injury in COVID-19 patients could be as high as 25%. There are also autopsy reports showing evidence of viral tropism to the renal system. In this regard, COVID-19 can damage the kidneys and increase a patient's risk of requiring dialysis. Available evidence suggests that renal involvement in COVID-19 infection is not uncommon, and there has been an increased incidence of chronic kidney disease related to the pandemic. In this literature analysis, we address COVID-19 and its effects on the renal system, including the pathophysiologic mechanisms. We also address current studies on the causes of injury to the renal system, the cause of kidney failure, its effect on mortality, the impact on dialysis patients, and the impact on renal transplant patients. COVID-19 disease may have unique features in individuals on chronic dialysis and kidney transplant recipients, requiring increased vigilance in limiting viral transmission in perioperative, in-patient, and dialysis center settings.


Subject(s)
COVID-19/physiopathology , Kidney Diseases/physiopathology , Kidney/physiopathology , COVID-19/epidemiology , COVID-19/therapy , Humans , Kidney/virology , Kidney Diseases/epidemiology , Kidney Diseases/therapy , Kidney Diseases/virology , Renal Dialysis/methods , Renal Dialysis/trends , Treatment Outcome
11.
Best Pract Res Clin Anaesthesiol ; 35(3): 351-368, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1049749

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces coronavirus-19 disease (COVID-19) and is a major health concern. Following two SARS-CoV-2 pandemic "waves," intensive care unit (ICU) specialists are treating a large number of COVID19-associated acute respiratory distress syndrome (ARDS) patients. From a pathophysiological perspective, prominent mechanisms of COVID19-associated ARDS (CARDS) include severe pulmonary infiltration/edema and inflammation leading to impaired alveolar homeostasis, alteration of pulmonary physiology resulting in pulmonary fibrosis, endothelial inflammation (endotheliitis), vascular thrombosis, and immune cell activation. Although the syndrome ARDS serves as an umbrella term, distinct, i.e., CARDS-specific pathomechanisms and comorbidities can be noted (e.g., virus-induced endotheliitis associated with thromboembolism) and some aspects of CARDS can be considered ARDS "atypical." Importantly, specific evidence-based medical interventions for CARDS (with the potential exception of corticosteroid use) are currently unavailable, limiting treatment efforts to mostly supportive ICU care. In this article, we will discuss the underlying pulmonary pathophysiology and the clinical management of CARDS. In addition, we will outline current and potential future treatment approaches.


Subject(s)
COVID-19/therapy , Critical Care/standards , Health Knowledge, Attitudes, Practice , Intensive Care Units/standards , Respiratory Distress Syndrome/therapy , Adrenal Cortex Hormones/administration & dosage , Anticoagulants/administration & dosage , COVID-19/diagnosis , COVID-19/physiopathology , Critical Care/trends , Humans , Immunologic Factors/administration & dosage , Intensive Care Units/trends , Respiration, Artificial/standards , Respiration, Artificial/trends , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/physiopathology
12.
Best Pract Res Clin Anaesthesiol ; 35(3): 293-306, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-987182

ABSTRACT

International hospitals and healthcare facilities are facing catastrophic financial challenges related to the COVID-19 pandemic. The American Hospital Association estimates a financial impact of $202.6 billion in lost revenue for America's hospitals and healthcare systems, or an average of $50.7 billion per month. Furthermore, it could cost low- and middle-income countries ~ US$52 billion (equivalent to US$8.60 per person) each four weeks to provide an effective healthcare response to COVID-19. In the setting of the largest daily COVID-19 new cases in the US, this burden will influence patient care, surgeries, and surgical outcomes. From a global economic standpoint, The World Bank projects that global growth is projected to shrink by almost 8% with poorer countries feeling most of the impact, and the United Nations projects that it will cost the global economy around 2 trillion dollars this year. Overall, a lack of preparedness was a major contributor to the struggles experienced by healthcare facilities around the world. Items such as personal protective equipment (PPE) for healthcare workers, hospital equipment, sanitizing supplies, toilet paper, and water were in short supply. These deficiencies were exposed by COVID-19 and have prompted healthcare organizations around the world to invent new essential plans for pandemic preparedness. In this paper, we will discuss the economic impact of COVID-19 on US and international hospitals, healthcare facilities, surgery, and surgical outcomes. In the future, the US and countries around the world will benefit from preparing a plan of action to use as a guide in the event of a disaster or pandemic.


Subject(s)
COVID-19/economics , COVID-19/epidemiology , Cost of Illness , Delivery of Health Care/economics , Global Health/economics , COVID-19/therapy , Delivery of Health Care/trends , Global Health/trends , Health Personnel/economics , Health Personnel/trends , Humans , Pandemics , Personal Protective Equipment/economics , Personal Protective Equipment/trends , United States/epidemiology
13.
Best Pract Res Clin Anaesthesiol ; 35(3): 333-349, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-966663

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can lead to severe pneumonia and multiorgan failure. While most of the infected patients develop no or only mild symptoms, some need respiratory support or even invasive ventilation. The exact route of transmission is currently under investigation. While droplet exposure and direct contact seem to be the most significant ways of transmitting the disease, aerosol transmission appears to be possible under circumstances favored by high viral load. Despite the use of personal protective equipment (PPE), this situation potentially puts healthcare workers at risk of infection, especially if they are involved in airway management. Various recommendations and international guidelines aim to protect healthcare workers, although evidence-based research confirming the benefits of these approaches is still scarce. In this article, we summarize the current literature and recommendations for airway management of COVID-19 patients.


Subject(s)
Airway Management/standards , COVID-19/prevention & control , Health Personnel/standards , Hospitalization , Personal Protective Equipment/standards , Practice Guidelines as Topic/standards , Aerosols , Airway Management/trends , COVID-19/epidemiology , Health Personnel/trends , Hospitalization/trends , Humans , Pandemics/prevention & control , Personal Protective Equipment/trends
14.
Best Pract Res Clin Anaesthesiol ; 35(3): 369-376, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-962786

ABSTRACT

Hospitals face catastrophic financial challenges in light of the coronavirus disease 2019 (COVID-19) pandemic. Acute shortages in materials such as masks, ventilators, intensive care unit capacity, and personal protective equipment (PPE) are a significant concern. The future success of supply chain management involves increasing the transparency of where our raw materials are sourced, diversifying of our product resources, and improving our technology that is able to predict potential shortages. It is also important to develop a proactive budgeting strategy to meet supply demands through early designation of dependable roles to support organizations and through the education of healthcare staff. In this paper, we discuss supply chain management, governance and financing, emergency protocols, including emergency procurement and supply chain, supply chain gaps and how to address them, and the importance of communication in the times of crisis.


Subject(s)
COVID-19/therapy , Crew Resource Management, Healthcare/methods , Equipment and Supplies, Hospital/supply & distribution , Personal Protective Equipment/supply & distribution , COVID-19/economics , COVID-19/epidemiology , Civil Defense/economics , Civil Defense/methods , Crew Resource Management, Healthcare/economics , Equipment and Supplies, Hospital/economics , Humans , Personal Protective Equipment/economics
15.
Best Pract Res Clin Anaesthesiol ; 35(3): 377-388, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-962785

ABSTRACT

The Hospital Incident Command System (HICS) is an incident management system specific to hospitals based on the principles of Incident Command System (ICS), and it includes prevention, protection, mitigation, response, and recovery. It plays a crucial role in effective and timely response during the periods of disasters, mass casualties, and public health emergencies. In recent times, hospitals have used a customized HICS structure to coordinate effective responses to public health problems such as the Ebola outbreak in the US and SARS epidemic in Taiwan. The current COVID-19 pandemic has placed unprecedented challenges on the healthcare system, necessitating the creation of HICS that can help in the proper allocation of resources and ineffective utilization of healthcare personnel. The key elements in managing a response to this pandemic include screening and early diagnosis, quarantining affected individuals, monitoring disease progression, delivering appropriate treatment, and ensuring an adequate supply of personal protective equipment (PPE) to healthcare staff.


Subject(s)
COVID-19/epidemiology , Crew Resource Management, Healthcare/methods , Emergency Medical Services/methods , COVID-19/therapy , Emergency Medical Services/trends , Humans , Incidence , Information Centers/trends
16.
Best Pract Res Clin Anaesthesiol ; 35(3): 307-319, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-956948

ABSTRACT

Telemedicine is the medical practice of caring for and treating patients remotely. With the spread of the coronavirus disease-2019 (COVID-19) pandemic, telemedicine has become increasingly prevalent. Although telemedicine was already in practice before the 2020 pandemic, the internet, smartphones, computers, and video-conferencing tools have made telemedicine easily accessible and available to almost everyone. However, there are also new challenges that health care providers may not be prepared for, including treating and diagnosing patients without physical contact. Physician adoption also depends upon reimbursement and education to improve the telemedicine visits. We review current trends involving telemedicine, how pandemics such as COVID-19 affect the remote treatment of patients, and key concepts important to healthcare providers who practice telemedicine.


Subject(s)
COVID-19/prevention & control , Health Personnel/trends , Practice Patterns, Physicians'/trends , Telemedicine/trends , COVID-19/diagnosis , COVID-19/epidemiology , Humans , Pain Management/methods , Pain Management/trends , Pandemics/prevention & control , Substance-Related Disorders/epidemiology , Substance-Related Disorders/therapy , Telemedicine/methods
17.
Best Pract Res Clin Anaesthesiol ; 35(3): 415-424, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-938789

ABSTRACT

The growth of office-based surgery (OBS) has been due to ease of scheduling and convenience for patients; office-based anesthesia safety continues to be well supported in the literature. In 2020, the Coronavirus Disease 19 (COVID-19) has resulted in dramatic shifts in healthcare, especially in the office-based setting. The goal of closing the economy was to flatten the curve, impacting office-based and ambulatory practices. Reopening of the economy and the return to ambulatory surgery and OBS and procedures have created a challenge due to COVID-19 and the infectious disease precautions that must be taken. Patients may be more apt to return to the outpatient setting to avoid the hospital, especially with the resurgence of COVID-19 cases locally, nationally, and worldwide. This review provides algorithms for screening and testing patients, selecting patients for procedures, choosing appropriate procedures, and selecting suitable personal protective equipment in this unprecedented period.


Subject(s)
Ambulatory Surgical Procedures/standards , Anesthesia/standards , COVID-19/prevention & control , Patient Care/standards , Personal Protective Equipment/standards , Practice Guidelines as Topic/standards , Ambulatory Surgical Procedures/trends , Anesthesia/trends , COVID-19/epidemiology , Humans , Patient Care/trends , Personal Protective Equipment/trends
18.
Best Pract Res Clin Anaesthesiol ; 35(3): 405-414, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-927468

ABSTRACT

The current COVID-19 pandemic is testing political leaders and healthcare systems worldwide, exposing deficits in crisis communication, leadership, preparedness and flexibility. Extraordinary situations abound, with global supply chains suddenly failing, media communicating contradictory information, and politics playing an increasingly bigger role in shaping each country's response to the crisis. The pandemic threatens not just our health but also our economy, liberty, and privacy. It challenges the speed at which we work, the quality of our research, and the effectiveness of communication within the scientific community. It can impose ethical dilemmas and emotional stress on healthcare workers. Nevertheless, the pandemic also provides an opportunity for healthcare organizations, leaders, and researchers to learn from their mistakes and to place their countries and institutions in a better position to face future challenges.


Subject(s)
COVID-19/epidemiology , Crew Resource Management, Healthcare/standards , Health Personnel/standards , Leadership , COVID-19/therapy , Communication , Crew Resource Management, Healthcare/methods , Delivery of Health Care/methods , Delivery of Health Care/standards , Humans , Pandemics
19.
Perioper Care Oper Room Manag ; 20: 100122, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-601756
20.
Best Pract Res Clin Anaesthesiol ; 34(2): 345-351, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-325827

ABSTRACT

Limiting the spread of the disease is key to controlling the COVID-19 pandemic. This includes identifying people who have been exposed to COVID-19, minimizing patient contact, and enforcing strict hygiene measures. To prevent healthcare systems from becoming overburdened, elective and non-urgent medical procedures and treatments have been postponed, and primary health care has broadened to include virtual appointments via telemedicine. Although telemedicine precludes the physical examination of a patient, it allows collection of a range of information prior to a patient's admission, and may therefore be used in preoperative assessment. This new tool can be used to evaluate the severity and progression of the main disease, other comorbidities, and the urgency of the surgical treatment as well as preferencing anesthetic procedures. It can also be used for effective screening and triaging of patients with suspected or established COVID-19, thereby protecting other patients, clinicians and communities alike.


Subject(s)
Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Preoperative Care/methods , Telemedicine/methods , Anesthesia , COVID-19 , Humans
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