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.

Implications in Neuroanesthesia during the COVID-19 pandemic

COVID-19, declared a pandemic by the World Health Organization in March 2020, has generated more than 11,000,000 cases and 500,000 deaths worldwide. The risk of operation in aerosol-generating procedures and stay in prolonged procedures has impacted neurosurgical and endovascular care, generating important implications for neuroanesthesiologists and perioperative care in general due to the risk of infection of patients and staff and the association of SARS-CoV-2 with neurosurgical patients. Objective. Present a series of recommendations based on current evidence on the implications for neuroanesthesiologists and the perioperative management of the neurocritical and neurosurgical patient during the COVID-19 pandemic. Material and methods. Bibliographic review through systematic search of keywords related to neuroanesthesiology and perioperative management of the neurosurgical and neurocritical patient during the COVID-19 pandemic. Results. The neurosurgical and neurocritical patient poses important challenges that imply the capacity for rapid response, establishment of management protocols, multidisciplinary stratification, availability of infrastructure, PPE and personnel to ensure their care. Conclusions. The role of the neuroanesthesiologist is fundamental in the organization and management of the pandemic;it must be kept safe, protected and updated in the specific considerations of the neurocritical patient in this "new normal". © 2021 Instituto Nacional de Neurologia y Neurocirurgia. All rights reserved.

COVID-19 and the perioperative neuroscience - A narrative review.

Among the several medical specialties, anesthesiologists are probably the most affected ones from the coronavirus disease (COVID-19) pandemic as they are at the frontline. In the present stage of the pandemic, where we are observing community transmission, more people with elective neurologic and neurosurgical problems are likely to be tested positive for this virulent disease. Neuroanesthesiologists play an important role in the perioperative period and in neuroradiology suite. It is imperative to know the best available ways by which health care providers can manage their patients and also necessary steps to prevent the spread of infection, not only amongst themselves but also between patients. A high index of suspicion in such patients may help avoid delay in diagnosis and catastrophic sequelae. An overall knowledge about the disease will help plan the clinical management of neurologic patients, during the perioperative period.

Battle-Tested Guidelines and Operational Protocols for Neurosurgical Practice in Times of a Pandemic: Lessons Learned from COVID-19.

The COVID-19 outbreak has led to fundamental disruptions of health care and its delivery with sweeping implications for patients and physicians of all specialties, including neurosurgery. In an effort to conserve hospital resources, neurosurgical procedures were classified into tiers to determine which procedures have to be performed in a timely fashion and which ones can be temporarily suspended to aid in the hospital's reallocation of resources when equipment is scarce. These guidelines were created quickly based on little existing evidence, and thus were initially variable and required refinement. As the early wave can now be assessed in retrospect, the authors describe the lessons learned and the protocols established based on published global evidence to continue to practice neurosurgery sensibly and minimize disruptions. These operational protocols can be applied in a surge of COVID-19 or another airborne pandemic.

Emergency neurological procedures during COVID-19 pandemic: Practical issues.

The novel coronavirus disease 2019 (COVID-19) has emerged as a global pandemic. A significant number of these patients would present to hospitals with neurological manifestations and neurosurgical emergencies requiring urgent treatment. The anesthesiologists should be prepared to manage these cases in an efficient and timely manner in the operating room, intensive care units, and interventional neuroradiology suites. The clinical course of the disease is in an evolving stage. As we acquire more knowledge about COVID-19, new recommendations and guidelines are being formulated and regularly updated. This article discusses the anesthetic management of urgent neurosurgical and neurointerventional procedures. In addition, a brief overview of intrahospital transport of neurologically injured patients has been addressed.

Finding the Calm in the Chaos: An Institutional Protocol for Anesthetic Management of a Patient for Neurosurgery during Coronavirus Disease 2019 Pandemic.

"Coronavirus disease 2019" (COVID-19) transmitted by a novel coronavirus via contact or droplet spread is a highly infectious disease, the containment of which requires vigilance and stringent infection control policies. In the backdrop of hospitals becoming hot zones and an increasing number of health care workers contracting the disease, it is crucial to formulate an approach while administering anesthesia during the testing times of COVID-19 pandemic. In this background, this comprehensive article deals with the perioperative management during this pandemic and includes risk stratification based on an innovative simple scoring system, rationale use of personal protective equipments, and infection prevention protocols. The document of updated literature, though not intended to replace any guidelines, is aimed at providing protocol to health care workers to protect themselves while providing the best care in this pandemic.