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1.
Anaesthesia ; JOUR:37, 77(Supplement 4).
Article in English | EMBASE | ID: covidwho-2088125

ABSTRACT

The COVID-19 pandemic has resulted in all anaesthetic exams being moved to an online virtual format. In addition, the relocation of trainees to the intensive care unit (ICU) and the avoidance of face-to-face meetings have meant that opportunities for viva practice have been limited. We decided to trial setting up a virtual viva club within our school of anaesthesia to see if this would increase the opportunities for trainees to practice, increase comfort with a virtual examination format and optimise success in the exam. Methods The course commenced ahead of the December 2021 Final FRCA SOE exam with 13 sessions lasting 1 h in length. Sessions were late evening on Tuesdays and Thursdays to optimise numbers able to attend. Each session focused on one element of the exam (short cases, long cases and basic science questions) and would begin with a basic introduction before trainees would enter a breakout room in pairs. Questions were provided to the trainees who would alternate being examined, pausing for feedback in between. Facilitators would drop into breakout rooms and provide some individualised feedback where able and sessions ended with exam hints and tips provided by facilitators. Results A total of 11 trainees attended at least one session, with eight attending regularly. Six of the eight (75%) regular attenders were successful in passing the exam. This compares to an overall pass rate for this sitting of the exam at 69%. Feedback from trainees was very positive with all trainees scoring over 4/5 for usefulness in preparing them for the exam. Trainees enjoyed the regularity and the structure of the sessions and the preparation of material for them to use. Discussion Overall, this course can be considered a success. Areas identified for improvement include using different technologies to distribute material and optimising our use of video call software to improve efficiency of the sessions. In summary, this course has provided trainees within our school multiple opportunities to practice for the exam at a time when opportunities are limited. Success of this course relied upon the regularity of sessions, timing of sessions to optimise available attendees and provision of question material to ability to attend without time spent preparing. The course has been expanded to accept attendees from other schools, now takes advantage of more advanced presentation and video call technology and we feel that it will still have a role when exams return to a face-to-face format.

3.
J Vasc Surg ; 2022 Oct 21.
Article in English | MEDLINE | ID: covidwho-2083191

ABSTRACT

OBJECTIVES: Hospital resource utilization is under constant review and the extent and intensity of postoperative care requirements for vascular surgical procedures is particularly relevant in the setting of the COVID19 pandemic and its impact on staffed ICU beds. We sought to evaluate the feasibility of regional anesthesia and low-intensity postoperative care for patients undergoing transcarotid artery revascularization (TCAR) at our institution. METHODS: All patients undergoing TCAR at a single institution from 2018-2020 were reviewed. Perioperative management (anticoagulation/antiplatelet therapy, hemodynamic monitoring, neurovascular exam, nursing instructions) was standardized by use of an institutional protocol. Anesthetic modality was at the surgeon's preference. Patients were transferred to PACU for 2 hours followed by the step-down unit, to PACU for 4 hours followed by the floor, or alternatively transferred to ICU. IV blood pressure medications could be administered at all environments except the floor. Recovery location and length of stay (LOS) were recorded. RESULTS: A total of 83 patients underwent TCAR during the study period. Mean age 72 +/- 9, 59% male. Thirty-six percent were symptomatic. Regional anesthesia was utilized for 84% with none converted to general anesthesia intraoperatively. Post operatively only 7 (8%) patients out of all 83 patients included in this study were monitored in an ICU overnight (decided perioperatively), mostly for patients with prior neurological symptoms but in one case for postoperative neurological event and in another due to pulseless electrical activity arrest. Six patients required IV antihypertensives and eight required IV vasoactive support postoperatively. Mean length of ICU stay was 3.7 +/- 5.1 days. Mean length of hospital stay for all patients was 2.4 +/- 3.3 days. The length of stay for patients undergoing TCAR with general anesthesia was higher than those undergoing TCAR with regional anesthesia (4.2 +/- 4.9 days versus 1.4 +/- 1.2 days, respectively; p=0.066). Incidence of stroke, death, and MI was 2.4%. There was 1 postoperative stroke considered to be a recrudescence of prior stroke, and one respiratory arrest fatality in a frail patient with neck hematoma both of whom were treated under GA. CONCLUSION: Using perioperative care protocols, TCAR can safely be performed while avoiding both general anesthesia and an ICU stay in most patients.

4.
Anaesthesia Pain & Intensive Care ; 26(4):546-550, 2022.
Article in English | Web of Science | ID: covidwho-2072497

ABSTRACT

At the beginning of COVID-19 pandemic the use of NSAIDS was avoided. This was because the previous studies suggesting that NSAIDs may be linked to an increased risk of lower respiratory tract infection consequences. Later on studies involved the patients who used NSAIDs for some chronic conditions and showed no additional harm among these patients. Then many studied assessed the benefit of using NSAIDs in COVID-19 patients for management of pain and fever and showed no additional risk among these patients.

5.
Cureus ; 14(9): e28745, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2067182

ABSTRACT

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.

6.
Open Access Macedonian Journal of Medical Sciences ; 10:1946-1949, 2022.
Article in English | EMBASE | ID: covidwho-2066707

ABSTRACT

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.

7.
CMAJ. Canadian Medical Association Journal ; 64(5 Supplement 1):S39, 2021.
Article in English | EMBASE | ID: covidwho-2065169

ABSTRACT

Background: Trauma calls with substantial injuries are low volume;exposure per fellow is low. A pilot questionnaire demonstrated that fellows were unaware of colleagues' trauma workload. There was no standardized process for departmental case review. With COVID-19 precautions limiting face-to-face time with colleagues, we were concerned that learning may be affected. We aimed to improve education by identifying cases with high potential for shared learning or system improvement and instigating a triannual Coffee and Cases meeting. Method(s): We devised a feedback form for trainees to fill in following each trauma team activation. These data were combined with trauma registry data to provide an overall perspective on the anesthesia workload for trauma and presented via Teams to the entire department. Infographics were used to illustrate cases and highlight important learning points. These were combined with up-to-date literature regarding pediatric trauma management. Trainees were reaudited following the talk. Result(s): During the pilot questionnaire, just 14.3% of fellows agreed with the statement: I am aware of the number of trauma calls, mechanisms of trauma and injuries sustained, presenting to Sick Kids in the previous month. In total, 71.4% disagreed and 14.3% strongly disagreed. Reaudit in November 2020 following the Coffee and Cases meeting online via Teams showed 100% agreement, with 71.4% strongly agreeing. Because of clinical commitments, it is often not possible for all relevant and interested staff members to attend such meetings, so a supplementary update PDF was provided via hospital email. Issues were identified regarding communication (team briefing), billing and prompt drug availability. These issues were addressed and reaudited. Conclusion(s): The questionnaire allowed us to collect real-time feedback on our trauma service and collate learning points from cases. This was integrated with up-to-date literature. Trauma patients may present critically unwell, yet the environment may be unfamiliar to rotating staff. Education is vital. Infographics helped us to illustrate cases, highlighting important learning points. These are 30 times more likely to be read than text so can successfully improve readership and learning of information..

8.
Archives of Disease in Childhood ; 107(Supplement 2):A338, 2022.
Article in English | EMBASE | ID: covidwho-2064039

ABSTRACT

Aims Oral disease poses significant health, social and economic burden globally, often causing pain, infection, hospital admission and mortality. Dental caries (tooth decay) is amongst the most common health conditions despite being non-communicable and entirely preventable. The Global Burden of Disease Study estimated that greater than 530 million children suffer from caries in their primary dentition (WHO, 2020). Within the NHS, is it estimated that 25-30% of the overall paediatric waiting list consists of cases that require removal of grossly decayed teeth under general anaesthesia (GA) (figure 1). Between 2015 and 2016, the financial cost to the NHS of extractions amounted to 50.5M. Before the COVID-19 pandemic, there was an existing burden within London NHS trusts of children on waiting lists for exodontia under GA. This issue has been further compounded by the cessation of elective dental activity in primary and secondary care settings due to the pandemic. Project Tooth Fairy was thus conceived to manage the growing paediatric GA waiting list. Methods Project Tooth Fairy is a collaborative, pan-London initiative designed to address London's growing paediatric GA waiting list. The new facility will employ clinical and non-clinical staff in a passport-type scheme allowing clinicians from different units to deliver care centrally in a purpose-built unit. The initiative started in November 2021. The project will deliver paediatric extractions, comprehensive care and complex oral surgery under GA. It will also serve as a source of training for dental trainees and anaesthetic trainees. Results Early results demonstrate that Project Tooth Fairy has treated over 250 children over two months, working with staff from over six NHS trusts, most cases comprising paediatric dental extractions. In March 2021, the total number of children waiting for paediatric GA across 19 London hospitals was around 14,400. To tackle the existing (and future) paediatric GA waiting lists in London, Project Tooth Fairy aims to increase capacity to treat 290 children over six days each week across three procedure rooms. Demand and capacity analysis suggests that approximately 212 procedures would be required each week (not including the backlog resulting from the pandemic). The backlog has seen a 61% increase from approximately 2,500 children waiting in March 2020 to an estimated 4,000 today, with projections of 7,000 by the time capacity is restored for P4 category work across London. It is estimated that 72% of these children have waited longer than 30 weeks, with greater than 1000 children waiting more than 52 weeks - a 96% increase in 52 week-waits compared to pre-COVID figures. The initiative also provides a more cost-effective solution due to the collaborative approach between trusts and staffing with an estimated saving of approximately 850,000 over 17 months compared to a more traditional system using two modular theatres. Conclusion Project Tooth Fairy is a more cost-effective and collaborative approach to tackling spiralling waiting lists within individual trusts. Nonetheless, a conceptual shift is needed away from 'downstream' strategies and those addressing the 'upstream' underlying inequalities in oral health across the population to achieve a more sustainable healthcare system.

9.
Cardiology in the Young ; 32(Supplement 2):S171-S172, 2022.
Article in English | EMBASE | ID: covidwho-2062129

ABSTRACT

Background and Aim: Cardiac involvement is seen in the majority of cases with multisystem inflammatory syndrome in children (MIS-C). Various rhythm and conduction disturbances, as well as repolarization abnormalities, have been described by more than 50% of the patients, while there are few cases with complete heart block or with asystole. Method(s): Case report Results: 8-year old girl presented with a 5-day history of fever, cough, headache, and abdominal pain. Because of the critical con-dition, with respiratory insufficiency and heart failure symptoms, the child was intubated and started on inotropic support. ECG showed complete AV-block with a ventricular rate of 75/min and with ST-T changes;echocardiography revealed dilated left ventricle with reduced contractility, CT-scan of the lungs showed bilateral pneumonia, the inflammatory markers were elevated, in combination with high troponin levels, and positive SARS-CoV2-IgG antibodies. The diagnosis MIS-C was made and treatment with immunoglobulins, antibiotics, corticosteroids, and anticoagulants was initiated. During the next 2 days, the cardiac function deteriorated further, and while still on mechanical ventilation and inotropic support, extreme bradycardia with a ventricular rate of 35/min was regis-tered, and the patient was indicated for temporary emergency pac-ing. Upon induction of anesthesia, the child became asystolic, requiring extensive resuscitation. After circulation recovery, the ECG showed nodal tachycardia with a heart rate of 140-170/min. A temporary transvenous pacemaker (PM) was inserted, and the patient was started on intravenous amiodarone which resulted in a slower ventricular rate of 70/min. 3 days later sinus rhythm was restored, with first-degree AV-block, which allowed removal of the PM 5 days after its insertion. Left ventricular dimensions were normalized and contractility remained low-normal (EF 56%). During the 6-month follow-up, the ECG and the Holter-monitoring showed sinus rhythm with first-degree AV-block. Magnetic resonance imaging (MRI) on day 15 of the hospital stay demonstrated scattered areas of myocarditis and ischemia predominantly in the left ventricle, as well as thickening of the basal septum. Six months later the MRI changes were reduced but still persistent. Conclusion(s): MIS-C can present with serious and life-threatening rhythm and conduction disturbances in children;this is why extensive cardiac monitoring is obligatory by all patients.

10.
Hpb ; 24(Supplement 1):S150-S151, 2022.
Article in English | EMBASE | ID: covidwho-2061210

ABSTRACT

Introduction: The hepato-pancreato-biliary (HPB) unit had to scale down the clinical workload and reallocate resources to combat COVID-19. We report local audit evaluating the impact of COVID-19 on the unit and its impact on cancer surgery. Method(s): We performed a comparative audit of the HPB team surgical workload for January-June 2019 (baseline) and 2020 (COVID-19). Elective and emergency cases performed under general anesthesia were audited. Elective cases included hernia surgeries, biliary surgeries (cholecystectomy and complex biliary resections), liver, and pancreatic resections. Emergency cases included cholecystectomies and laparotomies performed for general surgical indications. We excluded endoscopy and procedures done under local anaesthesia. Result(s): Elective surgical workload decreased by 42.3% during the COVID-19 pandemic (n=200 (2019) vs. 347 (2020)). Hernia surgery decreased by 63.9% (n=155 (2019) vs. 56 (2020)) and cholecystectomy by 40.3% (n=144 (2019) vs. 86 (2020)). Liver and pancreatic resection volume increased by 16.7% (n=30 (2019) vs. 35 (2020)) and 111.1% (n=9 (J 2019) vs. 19 (2020)). The emergency surgical workload reduced by 40.9% (n=193 (2019) vs. 114 (2020)). Conclusion(s): Reallocation of resources due to the COVID-19 pandemic did not adversely impact elective HPB oncology work. With prudent measures in place, essential surgical services can be maintained during a pandemic. Copyright © 2022

11.
Gastroenterology Clinics of North America ; 2022.
Article in English | ScienceDirect | ID: covidwho-2061193
12.
Chest ; 162(4):A2699, 2022.
Article in English | EMBASE | ID: covidwho-2060984

ABSTRACT

SESSION TITLE: Late Breaking Pulmonary and Education Topics Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Healthcare professionals working in intensive care units (ICU) report high burnout levels, especially during the COVID-19 pandemic. Residents are particularly at risk for burnout and sleep deprivation, associated with increased medical errors. However, the relationship between sleep, burnout, and psychomotor vigilance has not been extensively studied in residents working in the medical ICU. METHODS: Fifty residents rotating in the ICU at an academic, tertiary care center were recruited for a prospective controlled trial during a consecutive four-week period from August 2021 – May 2022. Study parameters for two weeks in non-ICU rotations were compared with two week during ICU rotation. Residents wore a wearable sleep tracker for two weeks before and during their ICU rotation. ICU rotation dates were randomized based on a fixed annual schedule. Residents ranged in post-graduate training years one through four. Specialties included internal medicine, transitional year, emergency medicine, anesthesia, and medicine/pediatrics combined residency. Data collected included the Oldenburg burnout inventory score, Epworth Sleepiness Scale (ESS), a computer-based psychomotor vigilance test, American Academy of Sleep Medicine sleep diary, and wearable sleep tracker data. Statistical analysis was performed in Excel and R statistical software. RESULTS: Total sleep minutes detected by the wearable sleep-tracker decreased from 402 minutes (95% CI: 377-427) before ICU to 389 minutes (95%CI: 360-418) during ICU (p<0.05). Residents overestimated the amount of sleep they obtained via their validated daily log at 464 (95% CI: 452-476) minutes before ICU and 442 (95% CI: 430-454) minutes during ICU, which reflected a decrease in sleep of 22 minutes (p<0.02). ESS increased significantly from 5.93 (95% CI: 4.89, 7.07) before to 8.33 (95% CI: 7.09,9.58) during ICU (p<0.01). Oldenburg burnout inventory scores significantly increased during ICU by 8.30 (p<0.001). The total score before ICU was 34.50 (95% CI: 32.87-36.15) and after was 42.82 (95% CI: 40.65-44.98). Exhaustion and disengagement sub-scores significantly increased during ICU (3.94, 4.64, respectively;p<0.001). Interestingly, psychomotor vigilance testing scores showed no significant difference during ICU. CONCLUSIONS: ICU rotations are associated with significantly reduced sleep as objectively measured by sleep wearable and decreased self-reported sleep minutes. Residents overestimate the amount of sleep they obtain. Significant worsening of ESS was noted along with increased burnout in residents working in the ICU. Interestingly, the psychomotor testing remains unchanged. Further research is needed in this area to better understand this phenomenon. CLINICAL IMPLICATIONS: Residents may benefit from increased mandatory wellness events or days off to combat burnout and fatigue while in the ICU. DISCLOSURES: No relevant relationships by Varun Badami No relevant relationships by Danielle DeCicco No relevant relationships by Abhinav Mittal No relevant relationships by Christopher Pham No relevant relationships by Steven Sagun No relevant relationships by Sunil Sharma No relevant relationships by Robert Stansbury No relevant relationships by Jesse Thompson

13.
Chest ; 162(4 Supplement):A2650-A2651, 2022.
Article in English | EMBASE | ID: covidwho-2060977

ABSTRACT

SESSION TITLE: Late Breaking Procedures Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: The Galaxy SystemTM (Noah Medical, San Carlos, CA) is a novel robotic endoluminal platform using electromagnetic navigation combined with integrated tomosynthesis technology and augmented fluoroscopy. It provides intraprocedural imaging to correct CT-to-body divergence and novel confirmation of tool-in-lesion. The primary aim of this study was to assess the tool-in-lesion accuracy of the robotic bronchoscope with integrated digital tomosynthesis and augmented fluoroscopy. METHOD(S): Over four separate days, four operators (the authors) conducted the experiment using four pigs. Each physician performed between 4 and 6 nodule biopsies for 20 lung nodule biopsies. A porcine model (S. s. domesticus) was utilized. Each pig was anesthetized with volatile gas and underwent tracheostomy with an 8.5 endotracheal tube and bilateral chest tube thoracostomy. Anesthesia was monitored by a veterinarian with invasive hemodynamic monitoring. Under CT fluoroscopic guidance, simulated lung nodules were created by percutaneous injection of a gelatinous agar solution containing purple dye and radiopaque material into the lung periphery. A CT was then performed for pre-procedure planning. Using Galaxy's "Tool in Lesion TOMO+" with augmented fluoroscopy, the physician navigated to the lung nodules and a tool (needle) was placed into the lesion. Tool in lesion was defined by the needle in or tangential to the lesion determined by CBCT. Center strike was defined as the needle in the middle third in three orthogonal angles (axial, sagittal, and coronal) on CBCT. RESULT(S): Lung nodules' average size was 16.3+/-0.97 mm and were predominantly in the lower lobes (65%). Only 15% (3/20) had a bronchus sign and the average distance to the pleura was 6.88+/-5.5 mm. All four operators successfully navigated to all (100%) of the lesions in an average of 3 minutes and 39 seconds. The median number of tomosynthesis sweeps was 3 and augmented fluoroscopy was utilized in most cases (17/20 or 85%). Tool in lesion after final tomography sweep was 100% (20/20). Biopsy yielding purple pigmentation on microscopic or gross examination was also 100% (20/20). Center strike rate was 60%. CONCLUSION(S): The Galaxy SystemTM demonstrated successful digital tomography confirmed tool in lesion success in 100% (20/20) of lesions as confirmed by CBCT. Successful biopsy was achieved in 100% of lesions as confirmed by intralesional pigment acquisition. CLINICAL IMPLICATIONS: The combination of robotic navigation, catheter maneuverability and real-time correction for CT body divergence capitalizes on the strengths of all three technologies to improve diagnosis. Additional clinical trials are warranted to see if high success rates can be reproduced in patients. DISCLOSURES: Consultant relationship with Medtronic ILS Please note: $20001 - $100000 by Krish Bhadra, value=Consulting fee Consultant relationship with Veractye Please note: $1-$1000 by Krish Bhadra, value=Consulting fee Consultant relationship with Bodyvision Please note: $1001 - $5000 by Krish Bhadra, value=Consulting fee Consultant relationship with Merit Endotek Please note: $1001 - $5000 by Krish Bhadra, value=Consulting fee Consultant relationship with Boston Scientific Please note: $1001 - $5000 by Krish Bhadra, value=Consulting fee Human Factor Testing relationship with Auris Surgical Robotics Please note: $1001 - $5000 by Krish Bhadra, value=Consulting fee Consultant relationship with Intuitive Surgical Robotics Please note: $5001 - $20000 by Krish Bhadra, value=Consulting fee Consultant relationship with Biodesix Please note: $5001 - $20000 by Krish Bhadra, value=Consulting fee Consultant relationship with Noah Medical Please note: 5/2020 Added 06/01/2022 by Krish Bhadra, value=Consulting fee Speaker relationship with Body Vision Please note: 2015 - present Added 05/29/2022 by Douglas Hogarth, value=Ownership interest Consultant relationship with Magnisity Please note: 2021 - present Added 05/29/2022 by Douglas Hogarth, value=Ownership interest Consultant relationship with Auris (J&J Ethicon) Please note: 2014-present Added 05/29/2022 by Douglas Hogarth, value=Honoraria Consultant relationship with Boston Scientific Please note: 2008 - present Added 05/29/2022 by Douglas Hogarth, value=Consulting fee Consultant relationship with Medtronic Please note: 2010-2019 Added 05/29/2022 by Douglas Hogarth, value=Consulting fee Consultant relationship with Broncus Please note: 2017-2021 Added 05/29/2022 by Douglas Hogarth, value=Consulting fee Consultant relationship with PulmonX Please note: $5001 - $20000 by Douglas Hogarth, value=Consulting fee Removed 06/08/2022 by Douglas Hogarth Consultant relationship with Spiration Please note: $5001 - $20000 by Douglas Hogarth, value=Consulting fee Removed 06/08/2022 by Douglas Hogarth Consultant relationship with Eolo Please note: $20001 - $100000 by Douglas Hogarth, value=Ownership interest Removed 06/08/2022 by Douglas Hogarth Consultant relationship with Noah Please note: 2019 - present Added 06/08/2022 by Douglas Hogarth, value=Ownership interest Consultant relationship with Noah Please note: 2019 - present Added 06/08/2022 by Douglas Hogarth, value=Consulting fee Consultant relationship with Medtronic Corporation Please note: $5001 - $20000 by Amit Mahajan, value=Consulting fee Consultant relationship with Boston Scientific Corporation Please note: $1001 - $5000 by Amit Mahajan, value=Consulting fee Consultant relationship with Pulmonx Corporation Please note: $5001 - $20000 by Amit Mahajan, value=Consulting fee Consultant relationship with Ambu USA Please note: $1-$1000 by Amit Mahajan, value=Consulting fee Consultant relationship with Circulogene Please note: $1001 - $5000 by Amit Mahajan, value=Consulting fee Consultant relationship with Medtronic/Covidien Please note: $1001 - $5000 by Otis Rickman, value=Consulting fee Copyright © 2022 American College of Chest Physicians

14.
Journal of Pediatric Endoscopic Surgery ; 4(Supplement 1):S8, 2022.
Article in English | EMBASE | ID: covidwho-2060159

ABSTRACT

Background: Foreign bodies of the Aerodigestive tract in children are increasingly common and reached a peak during the Covid Pandemic. They usually present as a acute respiratory emergency. Management of these foreign bodies pose a technical challenge and have a definite risk of morbidity and mortality even in expert hands. Method(s): Our retrospective study is from November 2016 to November 2021. Result(s): We had 29 patients in this study period. 16 boys and 13 girls. Youngest child was 11 months and oldest child was 17 years. Most children were below 5 years (19)-65%. Metal foreign bodies was the highest (11)-37% in our series. Outcomes were analyzed in terms of types of foreign body, duration of procedure, postoperative ventilation, ICU care and morbidity. Conclusion(s): Most patients were treated successfully by endoscopy (27/29)-93%. 2 patients underwent a surgery-(2/29)-7%. we encountered no deaths in our series. Endoscopic retrieval of foreign bodies is a technical challenge in small children. Maximum technical difficulty was with vegetable foreign bodies as they enlarge in size with time. We report the successful management of the foreign bodies in a tertiary care setup with excellent anaesthesia help and Pediatric Intensive Care Unit (PICU) backup.

15.
International Journal of Toxicological and Pharmacological Research ; 12(9):195-203, 2022.
Article in English | EMBASE | ID: covidwho-2058646

ABSTRACT

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.

16.
European Journal of Molecular and Clinical Medicine ; 9(6):778-784, 2022.
Article in English | EMBASE | ID: covidwho-2057897

ABSTRACT

Background and Aims: Coronavirus disease 2019 (COVID-19) adds more challenges to the perioperative management of pregnant women. The aim of this study is to examine severity of COVID-19 disease and maternal and foetal outcome among COVID-19 positive pregnant women undergoing caesarean section. Methods: This retrospective observational study was conducted at a tertiary teaching hospital in Karnataka between 1stApril to 31st July 2021, during which 100 COVID-19 positive pregnant women with ASA physical class II, III and IV who have undergone lower segment emergency caesarean section were selected on the basis of simple random sampling method. Results: A total of 100 women who had undergone caesarean section under spinal anaesthesia with positive SARS-CoV-2 PCR tests were assessed. Mean age was 24.45± 4.3 years, eight women were having severe covid-19 infection and overall mortality rate was 5% (5/100) in women and 1 woman had HELPP syndrome and one met with PPH (post-partum haemorrhage). Seven (7%) COVID-19 pregnant women required intensive care in the perioperative period. Eight neonates required NICU admission and had APGAR score less than 7. Fifty-five (55%) women were asymptomatic. While the rate of pneumonia in symptomatic women was 3.6% (8/45), the pneumonia incidence among all SARS-CoV-2 PCR (+) pregnant women was 8% (8/100). Conclusion: In our study, 61% of patients had pulmonary involvement and the mortality rate was 8% among mothers and 1% in neonates.

17.
AANA Journal ; 90(5):359-365, 2022.
Article in English | ProQuest Central | ID: covidwho-2058151

ABSTRACT

Post-traumatic stress disorder (PTSD) is a common psychological condition identified in combat veterans and individuals who have experienced natural or manmade disasters or other traumatic experiences. PTSD is known to increase a patient's risk of emergence delirium after undergoing general anesthesia. While this is well known by certified registered nurse anesthetists in practice, particularly those in military hospitals, recommendations for anesthetic management of patients with PTSD is notably lacking. The aim of this article is to provide anesthesia considerations synthesized from available literature. At the conclusion of this article, the reader will be able to incorporate evidence-based practice guidelines to care for patients from the preoperative period through the postanesthesia care unit stay.

18.
Perioper Care Oper Room Manag ; 29: 100289, 2022 Dec.
Article in English | MEDLINE | ID: covidwho-2049735

ABSTRACT

COVID-19 is a novel virus spread via airborne particles. Given the inherent risk to the anesthesia provider, intubation and airway management guidelines have been recently established. Various studies have been published advocating and detailing the results of different intubation devices designed to decrease the number of airborne particles. Currently, little literature exists regarding devices designed to mitigate the spread of COVID-19 airborne particles during extubation. The purpose of this prospective in situ simulated manikin study was to measure the effectiveness of an aerosolized containment device during passive (deep) and forced (simulated coughing) extubation. Airborne particles were measured at the 0.3, 0.5, 1, 2, 5, 10-micron level. Statistically significant decreases were seen with the use of a barrier device during both passive and forced extubation.

19.
AORN Journal ; 116(4):P2-P3, 2022.
Article in English | ProQuest Central | ID: covidwho-2044885

ABSTRACT

Examples include training security staff members to be responsive, clearly identifying health care workers (eg, identification cards), securing highrisk areas with access controls, improving internal communication (eg, frequent meetings to discuss security concerns), supporting survivors of violence (eg, legal help, counseling), creating time and space for workers to rest, encouraging team building and peer support, and implementing a no-weapons policy. Surgery After COVID-19 in Vaccinated Patients May Not Be Linked to Risks Authors of a retrospective study published in the Annals of Surgery wanted to determine if COVID-19 vaccination affected rates of perioperative complications (ie, arrythmia, deep vein thrombosis, pulmonary embolism, pneumonia, respiratory failure, renal failure, sepsis, urinary tract infection) experienced after SARS-CoV-2 infection. Coaching Programs Support the Mental Health of Health Care Personnel In a study published in JAMA Network Open, researchers evaluated if a group skills-based coaching program delivered via video conference could decrease stress and increase resilience in health care personnel.

20.
Open Access Emerg Med ; 14: 515-524, 2022.
Article in English | MEDLINE | ID: covidwho-2043249

ABSTRACT

Background: The first wave of COVID-19 in 2020 created massive challenges in providing safe surgery for pediatric patients with COVID-19. Inevitably, emergency surgery and the unknown nature of the disease place a burden on the heavily challenged surgical services for pediatrics in a developing country. Lessons from the pandemic are important for future disaster planning. Aim: To describe the characteristics of pediatric surgical patients with COVID-19 undergoing emergency surgery during the first wave and its perioperative narrative in a developing country. Methods: The study was a multicenter retrospective descriptive study in eight Indonesian government-owned referral and teaching hospitals. The authors reviewed confirmed COVID-19 pediatric patients (≤18 years old) who underwent surgery. Institutional review board clearances were acquired, and data were evaluated in proportion and percentages. The writing of this paper follows the STROBE guidelines. Results: About 7791 pediatric surgical cases were collected, 73 matched the study criteria and 24 confirmed cases were found. Cases were more common in females (58.3%), who were above 12 years old (37.5%) and who were asymptomatic (62.5%). Laparotomy (33.3%), general anesthesia (90.4%) and intubation (80.8%) were common, while use of video laryngoscopy (40%) and rapid sequence intubation (28.8%) were rare. The mean length of stay was 12 ±13.3 days, and in-hospital mortality was 8.3%. Discussions: Lockdown and school closure were successful in protecting children, hence the low incidence of pediatric surgical cases with COVID-19 during the first wave. Many hospitals were unprepared to perform surgery for a droplet or airborne infectious disease, and COVID-19 testing was not available nationally in the early pandemic, hence the use of protective protection equipment  during these early pandemic times are often not efficient. Conclusion: The incidence of COVID-19 in pediatric surgical patients is low. The rapidity and availability of preoperative testing for a new emerging disease are essential in a pandemic.

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