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Purpose: The aim of this study was to evaluate how prevalent asymptomatic SARS-CoV-2 virus infection (COVID-19) is among patients undergoing ophthalmic surgery at two tertiary referral hospitals. Material(s) and Method(s): This retrospective study included patients without COVID-19 symptoms who underwent preoperative screening using reverse transcription-polymerase chain reaction (RT-PCR) before ophthalmic surgery at the Kocaeli University and Gaziantep University departments of ophthalmology [between September 1, 2020, and December 15, 2020 (group 1);between March 1, 2021, and May 30, 2021 (group 2)]. Patients scheduled for surgery and followed up in the retina, glaucoma, pediatric ophthalmology and strabismus, cataract and refractive surgery, and cornea departments were examined. Result(s): RT-PCR was positive for SARS-CoV-2 in 12 (1.4%) of 840 patients in group 1 and 7 (1.1%) out of 600 patients in group 2. None of the patients were symptomatic of COVID-19. The majority of the patients were scheduled for retina or cataract and refractive surgery in both groups (group 1;retina: 29.2%, cataract and refractive: 57.0%, group-2;retina: 31.3%, cataract and refractive: 54.5%). SARS-CoV-2 RT-PCR testing was positive for seven patients in group 1 (7/245, 2.9%) and five patients in group 2 (5/188, 2.6%) who were scheduled for retinal surgery. Conclusion(s): The necessity, availability, and practicality of COVID-19 RT-PCR testing prior to ophthalmic surgeries varies depending on the protocols of each institution. COVID-19 RT-PCR testing is suggested especially before vitreoretinal surgeries and general anesthesia procedures, because of the difficulty in managing postoperative complications.Copyright © 2023 Gazi Eye Foundation. All rights reserved.
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Postoperative respiratory failure is a significant cause of morbidity and mortality. Early identification of patients at moderate to high risk of postoperative respiratory failure is critical to effective prevention strategies. A multi-disciplinary team developed a robust process for the early identification of at-risk patients and the prevention of respiratory failure in the perioperative setting.
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Background: Renewed interest in regional anaesthesia during the recent COVID-19 pandemic has inspired application of neuraxial anaesthesia for previously unconventional indications, such as awake abdominal surgeries. These patients needed little sedation, since studies demonstrate that neuraxial anaesthesia causes sedation as measured by the bispectral index (BIS). In contrast, no published study has investigated the possible sedative effects of non-neuraxial regional anaesthesia. This pilot randomised controlled trial (RCT) was designed as a template for, and to test the feasibility of, performing a definitive RCT to establish if non-neuraxial regional anaesthesia has any sedative effect. Method(s): Forty participants presenting for forearm surgery were randomly allocated to two treatment groups (supraclavicular block and control). Their level of sedation was monitored with BIS prior to surgery for 60 minutes. Specific feasibility outcomes were planned and data were collected according to CONSORT 2010 recommendations. Result(s): Out of 48 patients screened, 41 (85.42%) were invited to participate. Forty patients (97.56%) consented and 100% of these completed the study. In four participants (10%), BIS electrodes needed replacement, while inadequate contact was shown in three participants (7.50%). Data collection and form completion were deemed "easy" and block success rate was 100%. Differences in mean BIS between groups were < 5 and a difference of 10% between groups in incidence of BIS < 80 (85% block group, 75% control group) was shown. Conclusion(s): We propose that progression to formal RCT is feasible only with specific modifications to the study design. The decrease in BIS value from baseline should be measured per patient and a clinically significant decrease should be estimated;emergency patients should be excluded;the sample size should be 500 patients;and multiple trial sites should be used. Further consideration should be given to whether such a trial would provide clinically useful information, and would justify the risks, patient discomfort and the considerable financial cost.Copyright © 2023, Medpharm Publications. All rights reserved.
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By 2022, publishing has already returned to the standard. This means that the global SARS-CoV-2 pandemic for anaesthesiologists is all but forgotten, and the safety of anesthesia is again the dominant issue. However, in addition to the traditional search for answers to whether we should prefer regional or general anesthesia and for which procedures and what is the best prevention of PONV, there is now another associated topic - postoperative delirium and postoperative cognitive dysfunction. Although both entities are crucial to the overall perioperative course, they still need more attention. This is even though, especially in elderly patients, they have already been shown to significantly affect perioperative morbidity and mortality. Moreover, to the surprise of many, recent data show that their incidence is not so much dependent on the type of anesthesia but on the quality of its administration. This text aims to briefly summarize some key publications in the field of anesthesiology and to highlight papers that should not escape attention.Copyright © 2022, Czech Medical Association J.E. Purkyne. All rights reserved.
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Background: The purpose of this study was to evaluate the impact of COVID-19 pandemic on the training process of anesthesia residents in Cairo University Hospital regarding technical skills, operative, and critical care experience. Method(s): This cross-sectional survey study included two groups of anesthesia residents according to the time of their residency in relation to the pandemic (before-pandemic group [N = 44] and during-pandemic group [N = 42]). The participants were asked to fill out a questionnaire regarding their training. The questionnaire included technical skills experience (regional anesthesia, vascular access, and advanced airway techniques, soft tissue ultrasound), operative and critical care experience, and duration of intensive care unit (ICU) rotation. The quality of training was graded as adequate, moderate, or deficient training according to the number of performed procedure/managed cases. Comparisons of continuous data were done using the Mann-Whitney test, and qualitative categorical was analyzed using the chi-square test. Result(s): All the participants completed the questionnaire. The training in the during-pandemic group was lesser than that in the before-pandemic group for most of the technical skills except for soft tissue ultrasound which was more in the during-pandemic group. The operative experience was less in the during-pandemic group than that in the before-pandemic group. On the other hand, the ICU experience was more in the during-pandemic group than that in the before-pandemic group. Conclusion(s): The COVID-19 pandemic disrupted the training program of anesthesiology residents with regard to elective procedures and produced over-training in critical care subspeciality.Copyright © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.
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Advances in neonatal medicine have progressively increased the survival of premature infants. Increased survival has however come at the cost of increased number of infants with prematurity-related complications. This is represented by high rates of respiratory distress syndrome, bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), sepsis, periventricular leukomalacia (PVL), intraventricular haemorrhage (IVH), cerebral palsy, hypoxic ischaemic encephalopathy (HIE) and visual and hearing problems in survivors. In addition to prolonged hospital stay after birth, readmission to hospital in the first year of life is common if chronic lung disease exists. Around 3% of newborns have a congenital physical anomaly with 60% of congenital anomalies affecting the brain or heart and around 1% having multiple anomalies. Individual congenital conditions requiring surgical intervention in the neonatal period are rare. Neonates have a higher perioperative mortality risk largely due to the degree of prior illness, the complexity of their surgeries, and infant physiology. The maintenance of oxygenation and perfusion in the perioperative phase is critical as both affect cerebral perfusion and neurocognitive outcome but the triggers for intervention and the thresholds of physiological parameters during neonatal anaesthesia are not well described. After even minor surgical procedures, ex-premature infants are at higher risk for postoperative complications than infants born at term.Copyright © 2022
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BACKGROUND: Regional anesthesia is a promising method in patients with post coronavirus disease 2019 (COVID-19) pulmonary sequelae for preserving pulmonary function and preventing postoperative pulmonary complications, compared with general anesthesia. CASE SUMMARY: We provided surgical anesthesia and analgesia suitable for breast surgery by performing pectoral nerve block type II (PECS-II), parasternal, and intercostobrachial nerve blocks with intravenous dexmedetomidine administration in a 61-year-old female patient with severe pulmonary sequelae after COVID-19 infection. CONCLUSION: Sufficient analgesia for 7 h was provided via PECS-II, parasternal, and intercostobrachial blocks perioperatively.
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Urticaria within one hour of lidocaine injection is a sign of type I (immediate) hypersensitivity to lidocaine, yet most patients suspected of having a lidocaine allergy do not exhibit urticaria. Aside from being a sign of a rare lidocaine allergy, urticaria can also be a symptom of COVID-19. COVID-19 patients who experience urticaria after receiving lidocaine require careful evaluation to determine the cause. Here, we present a case of a patient exhibiting urticaria one hour after a lidocaine injection for the Pecto-intercostal nerve block to treat COVID-19-induced costochondritis.
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Regional anaesthesia (RA) has an important and ever-expanding role in ambulatory surgery. Specific practices vary depending on the preferences and resources of the anaesthesia team and hospital setting. It is used for various purposes, including as primary anaesthetic technique for surgery but also as postoperative analgesic modality. The limited duration of action of currently available local anaesthetics limits their application in postoperative pain control and enhanced recovery. The search for the holy grail of regional anaesthetics continues. Current evidence suggests that a peripheral nerve block performed with long-acting local anaesthetics in combination with intravenous or perineural dexamethasone gives the longest and most optimal sensory block. In this review, we outline some possible blocks for ambulatory surgery and additives to perform RA. Moreover, we give an update on local anaesthesia drugs and adjuvants, paediatric RA in ambulatory care and discuss the impact of RA by COVID-19. Copyright © 2022 Elsevier Ltd
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In 2019, the North East Anaesthesia Sustainable Healthcare (NEASH) Network was formed. Its aim is to encourage coordinated sustainability efforts. We comprise over 80 anaesthetists with representatives in every Trust in our region. The NHS accounts for 4% of UK carbon emissions. Two per cent of NHS emissions come solely from anaesthetic gases. In late 2020, we began a region-wide project to raise awareness of the environmental impact of general anaesthesia (GA) with the aim of reducing emissions throughout our geographical area. Methods NEASH performed a snapshot audit of 1 full week's GA data in early 2021. Consumed volatile agent, nitrous oxide (N2O) and total intravenous anaesthesia (TIVA) were converted into kilograms of carbon dioxide equivalents (kg CO2e) [1, 2]. Each Trust's emissions were divided by total GA time giving kg CO2e per hour (kg CO2e.h-1), allowing efficiency comparison between sites. We presented our results and the following messages to each Trust. Firstly, stop using desflurane and use N2O only when essential as these agents have the highest global warming potential (GWP). Secondly, we encouraged sevoflurane use as it has the lowest GWP of volatiles (followed by isoflurane);low fresh gas flows are essential. Thirdly, consider TIVA, as its GWP is lower than volatile GA. Although outside the scope of our audit, we reminded colleagues that local or regional anaesthesia have a lower CO2e than GA. In early 2022, we re-audited to assess the impact of our messages. Results The results of 5340 h of GA data are displayed in the table below. Discussion Due to increased operating post-COVID-19 and the inclusion of a hospital that was unable to participate in round 1, round 2 contained 787 more hours of data. Despite this, emissions of CO2e were 12.83 t lower, demonstrating an average hourly emission reduction of 61.1%. This was mainly driven by reduced desflurane and N2O use. Two hospitals in our region have since decommissioned N2O manifolds and two others are undertaking this process. Region-wide procurement data obtained by NEASH showed that three hospitals have ceased ordering desflurane. TIVA use remained broadly the same, which may be due to a lack of availability of equipment. This region-wide project is easily reproducible nationwide and could make significant contributions towards NHS net zero. (Table Presented).
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INTRODUCTION: Acute respiratory infection (ARI) can significantly reduce postoperative quality of life and impair the recovery of older adult patients with lower-limb fractures, and its relationship with methods of anesthesia remains inconclusive. Using data from the National Health Insurance Research Database (NHIRD) of Taiwan, this study examined the data of patients who received surgical management for lower-limb fractures and compared those who underwent general anesthesia (GA) with those who underwent regional anesthesia (RA) in terms of their incidence of acute upper and lower respiratory infection during the one-month postoperative period. The study also identified related risk factors. MATERIAL AND METHODS: Approximately two million patients were randomly sampled from the NHIRD registry. We identified and enrolled patients with lower-limb fractures who were over 60 years old and underwent GA or RA during surgeries conducted between 2010 and 2017. We divided these patients into two groups for further analysis. The outcome of this study was the development of ARI during the one-month postoperative period. RESULTS: In total, 45,032 patients (GA group, 19,580 patients; RA group, 25,452 patients) with a mean age of 75.0 ± 8.9 years were included in our study. The incidence of postoperative ARI within one month of surgery was 8.0% (1562 patients) in the GA group and 9.5% (2412 patients) in the RA group, revealing a significant difference. The significant risk factors for the incidence of ARI were the application of RA for surgery, older age, hypertension, liver disease, and chronic obstructive pulmonary disease (COPD). A subgroup analysis revealed that the RA method was associated with a significantly higher ARI incidence relative to the GA method among patients aged between 60 and 80 years, among male patients, among the patients with or without any comorbidity and among the patients without COPD. CONCLUSION: The incidence of postoperative ARI within one month of surgery was higher among older patients with lower-limb fractures who received RA for surgery than among those who received GA for surgery. The other major risk factors for ARI were older age, hypertension, liver disease, and COPD. Therefore, we should focus on patients with a high risk of developing ARI, especially during the COVID-19 pandemic.
Subject(s)
Anesthesia, Spinal , COVID-19 , Fractures, Bone , Hypertension , Leg Injuries , Pulmonary Disease, Chronic Obstructive , Humans , Male , Aged , Middle Aged , Aged, 80 and over , Anesthesia, Spinal/adverse effects , Incidence , Quality of Life , Pandemics , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Anesthesia, General/adverse effects , Fractures, Bone/epidemiology , Fractures, Bone/surgery , Lower Extremity/surgery , Pulmonary Disease, Chronic Obstructive/etiology , Hypertension/complications , Retrospective Studies , Treatment OutcomeABSTRACT
Physiological changes during pregnancy and COVID-19 may affect one another. This report presents a 37-year-old female G4P10021 with gestational age 37+2 weeks infected with COVID-19 in Dr. Moewardi Hospital Surakarta, Central Java, Indonesia. The patient was diagnosed with antepartum hemorrhage due to total placenta previa with low-risk Morbidly Adherent Placenta score, a history of cesarean section, and ovarian cyst. The patient underwent conversion from spinal anesthesia to general anesthesia. Within 40 min after spinal anesthesia, the patient complained shortness of breath, which then worsened into decreased consciousness and inadequate spontaneous breathing. This may be complicated by the COVID-19 infection which has several effects on pregnancy.
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Background Associated advantages of ilioinguinal/iliohypogastric block and sedation versus general anesthesia (GA) for inguinal hernia repair have not been reported. The use of regional anesthesia (RA) is advantageous during the COVID-19 pandemic as it eliminates the need for airway manipulation.This study aimed to determine the association between postoperative recovery time when ilioinguinal/iliohypogastric block and sedation were utilized for inguinal hernia versus GA. Method This single-center retrospective study used multivariable logistic regression to model the anesthetic modality as a function of age, sex, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status, major comorbidities to generate a propensity score for each patient for matching. Results After screening 295 patients, 80 patients each in the general and regional anesthesia groups were matched.RA was associated with a 35.6 minutes (95% CI: -46.6 to -25.0) shorter total postoperative recovery time when compared to GA without the increased preoperative time and adverse outcomes. Conclusions Inguinal hernia repair, when performed under ilioinguinal/iliohypogastric block and sedation, was associated with reduced postoperative recovery time. This can be advantageous during the time of the COVID-19 pandemic to reduce the risk of aerosol generation and shorten hospital stay. Future research can focus on establishing a causal relationship.
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Objective: To quantify the impact of Coronavirus disease (COVID-19) pandemic and lockdown over the pattern of hospitalisation surgical burden and changes in the surgical practices of patients at department of General Surgery, MY Hospital, Indore. Methods: Data pertaining to the hospital admission in department of surgery, MY Hospital, Indore during the period of 25th March till 14th April 2019 and between January 1, 2020 to June 30, 2020 was collected and evaluated for multiple parameters like the duration and cause of admission in the hospital, treatment offered and outcomes. This data was thoroughly assessed and looked for the differences in monthly hospitalisation, disease specific hospitalisation rate, mortality status and other parameters during precovid, covid and post covid era. Results: During covid phase, discharge percentage decreased from 74.70 % to 39.47 %, the LAMA percentage rose from 12.47 % to 31.58 % and death percentage increased from 12.65 % to 27.63 %. The emergency admissions were the major indications for admission during both the phases, however elective admissions fell from 233 (39.89 %) in the non-lockdown phase (2019) to 0 in the lockdown phase (2020). The percentage of non-referred patients increased during the lockdown phase (2020). The difference between the two groups was not found to be statistically significant. Overall conservative management was the most commonly followed approach in both the phases. The percentage of conservative management increased from 42.90 % during the Non-Lockdown phase (2019) to 73.68 % during the lockdown phase. All surgeries performed during the Lockdown 01 Phase were emergency surgeries. Conclusion: The other changes in the surgical practices within the Department of Surgery included significant decrease in the number of elective admissions and elective surgeries, increased preference for conservative management over surgical management, increased preference for regional anaesthesia, a decreased mean duration of stay for a patient in the hospital. Changes noted in surgical practices also included significantly reduced number of laparoscopic procedures. These changes appear to be a response towards the COVID 19 pandemic to prevent the spread of infection within the hospital as well as an attempt to secure the healthcare resources for the mitigation of ongoing COVID 19 pandemic.
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B415 Table 1 B415 Table 2ConclusionsWe noticed an increase in performing regional anaesthesia after the pandemic in our institute. Although we observed more complications in the pandemic than in 2019;postoperative complications,including pulmonary were lower in patients had regional anaesthesia.
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Background and AimsThe present survey was designed to ascertain impact of pandemic on regional anaesthesia(RA) practice, the strategies necessary to counter the hinderances and improve its safe utilization.MethodsAfter IRB approval and CTRI, this validated google form based cross-sectional survey was circulated through social-media platforms to various anaesthesiologists using a snowball sampling technique. The participation was voluntary and survey included questions to assess the challenges faced in pursuing RA during COVID era, effect of PPE, effect on training/research activities related to RA and the strategies adopted to overcome challenges.ResultsA total of 532 anaesthesiologists filled the survey and majority(86%) were from a teaching hospital. 68.5% felt there was an increase in RA use post COVID -19. A web-based learning for regional anaesthesia was provided to 61% of respondents. While performing RA in positive patients, majority felt that PPE resulted in poor vision due to fogging(91%), increased attempts( 63%) and performance time(46.9%). Disposable plastic drapes were preferred by most( 75%) and sharps were collected in separate bags for disposal(53%). After surgery, the OR was cleaned using sodium hypochlorite (37.6%), hydrogen peroxide ( 37%) or 75% alcohol ( 55.26%) and a sterile camera cover was used by most (65.8%) respondents.ConclusionsRA was preferred if feasible in COVID-19 patients and its utilization increased during COVID. Use of PPE hindered the performance of blocks. Regarding sterility practices, disposable drapes were preferred, and more stringent measures were used for cleaning the ultrasound machine used and the OT following the case in COVID era.
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Background: Recent renewed interest in regional anaesthesia during the COVID-19 pandemic has inspired the application of neuraxial anaesthesia for previously unconventional indications, such as awake abdominal surgeries. These patients needed little sedation, since studies demonstrate that neuraxial anaesthesia causes sedation as measured by Bispectral Index (BIS). In contrast, no studies have investigated the possible sedative effects of non-neuraxial regional anaesthesia. Aim: This pilot randomised controlled trial (RCT) was designed as a template for, and to test the feasibility of performing a definitive RCT to establish if non-neuraxial regional anaesthesia has any sedative effect. Methods: Forty patients presenting for forearm surgery were randomly allocated to two treatment arms (supraclavicular block and control). Their level of sedation was quantitatively monitored before surgery for 60 minutes. Specific feasibility outcomes were planned and data collected according to CONSORT 2010 recommendations. Results: Out of 48 patients screened, 41 (85.42%) were invited to participate, 40 (97.56%) consented and 100% completed the study. Four (10.00%) BIS electrodes needed replacement, inadequate contact was shown in three patients (7.50%), data collection and form completion were deemed “easy”, and block success rate was 100%. Differences in mean BIS between groups were < 5, and a difference of 10% between groups in the incidence of BIS < 80 (85% block group, 75% control group) was shown. Conclusion: We propose that progression to formal RCT is feasible with modifications. Decrease in BIS value from baseline should be measured per patient, and clinically significant decrease should be estimated (we suggest a decrease of 10 or more), exclusion of emergency patients (starved for longer, more anxious, may affect BIS), the sample size should be 500 patients and multi-site involvement implemented.
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Haley Daigle Augusta GA1, Megan Shepherd Knoxville TN1, Robert Heidel Knoxville TN1, Kyle Kleppe Knoxville TN1, Matt Mancini knoxville TN1, Greg Mancini Knoxville TN1 University of Tennessee Medical Center Knoxville1 Perioperative pain control has been a rate-limiting step for discharge. Postoperative opioids increase nausea and reduce compliance with early ambulation in enhanced recovery pathways. Low opioid enhanced recovery pathways may enable same day discharge and reduce post-operative opioid use. This study looks at a unique time point: same day discharges during the COVID epidemic. The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) introduced the Bariatric Surgery Targeting Opioid Prescriptions (BSTOP) quality improvement collaborative to provide bariatric centers with guidance to reduce opioid use through patient education, multimodal pain control strategies, use of regional anesthesia, to minimize perioperative opioid use. Our center participated in BSTOP, collecting data on post-operative opioid use through examination of medication administration records, and patients’ at-home opioid use. During the COVID pandemic, due to bed shortages, we began providing outpatient bariatric surgery. One barrier to the move to routine outpatient bariatric surgery is fear that pain will not be adequately controlled at home, which will lead to decreased ambulation, increasing risk for post-operative complications. In our sample of 94 patients (47 inpatient, 47 outpatient), inpatients used significantly more opioids (measured as milligram of morphine equivalents, or MME) than outpatients, with a median of 39.5 MME, compared to 27 MME (p=0.016). The idea that bariatric surgery recovery is too painful to allow for same day discharge is false and outpatient bariatric surgery results in less perioperative opioid exposure. If we want patients exposed to less opioids, we should get them out of the hospital sooner.