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2.
Curr Opin Anaesthesiol ; 34(3): 292-298, 2021 Jun 01.
Article in English | MEDLINE | ID: covidwho-1334265

ABSTRACT

PURPOSE OF REVIEW: The purpose of this review is to provide the latest evidence for delivering safe and effective anesthesia care for pediatric patients with coronavirus disease 2019 (COVID-19) and to highlight continuing gaps in the literature. RECENT FINDINGS: Safe and efficient care of pediatric patients with COVID-19 can be delivered with the proper planning, coordination, supplies, and staff preparation. From the start of the pandemic, pediatric anesthesiologists from around the world contributed important insights and shared experience as to how best to adapt anesthesia care for children with COVID-19 requiring general anesthesia and sedation. Although initial efforts focused on creating safe airway management processes, the role of anesthesiologists as perioperative leaders quickly extended to ensuring well-coordinated management of COVID-19 patients throughout the hospital for procedures, including preprocedure testing, patient transport, operating room setup, and ensuring the safety of staff. Several important areas remain not well studied including, the timing of rescheduling elective procedures following COVID-19 infection, the perioperative implications of re-infection, and future considerations of managing vaccinated children. SUMMARY: Pediatric anesthesia care can be safely delivered to children with COVID-19 and after COVID-19 infection. More attention needs to be focused on the perioperative management of COVID-19 children in recovery requiring anesthesia.


Subject(s)
Anesthesia , COVID-19 , Anesthesia/adverse effects , Anesthesiologists , Child , Humans , Pandemics , SARS-CoV-2
3.
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
4.
Anesth Analg ; 133(2): 483-490, 2021 08 01.
Article in English | MEDLINE | ID: covidwho-1311272

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is associated with high perioperative morbidity and mortality among adults. The incidence and severity of anesthetic complications in children with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. We hypothesized that there would be an increased incidence of intra- and postoperative complications in children with SARS-CoV-2 infection as compared to those with negative testing. METHODS: We conducted a retrospective cohort study analyzing complications for children <18 years of age who underwent anesthesia between April 28 and September 30, 2020 at a large, academic pediatric hospital. Each child with a positive SARS-CoV-2 test within the prior 10 days was matched to a patient with a negative SARS-CoV-2 test based on American Society of Anesthesiologists (ASA) physical status, age, gender, and procedure. Children who were intubated before the procedure, underwent organ transplant surgery, or had severe COVID-19 were excluded. The primary outcome was the risk difference of a composite of intra- or postoperative respiratory complications in children positive for SARS-CoV-2 compared to those with negative testing. Secondarily, we used logistic regression to determine the odds ratio for respiratory complications before and after adjustment using propensity scores weighting to adjust for possible confounders. Other secondary outcomes included neurologic, cardiovascular, hematologic, and renal complications, unanticipated postoperative admission to the intensive care unit, length of hospital stay, and mortality. RESULTS: During the study period, 9812 general anesthetics that had a preoperative SARS-CoV-2 test were identified. Sixty encounters occurred in patients who had positive SARS-CoV-2 testing preoperatively and 51 were included for analysis. The matched controls cohort included 99 encounters. A positive SARS-CoV-2 test was associated with a higher incidence of respiratory complications (11.8% vs 1.0%; risk difference 10.8%, 95% confidence interval [CI], 1.6-19.8; P = .003). After adjustment, the odds ratio for respiratory complications was 14.37 (95% CI, 1.59-130.39; P = .02) for SARS-CoV-2-positive children as compared to controls. There was no occurrence of acute respiratory distress syndrome, postoperative pneumonia, or perioperative mortality in either group. CONCLUSIONS: Pediatric patients with nonsevere SARS-CoV-2 infection had higher rates of perianesthetic respiratory complications than matched controls with negative testing. However, severe morbidity was rare and there were no mortalities. The incidence of complications was similar to previously published rates of perianesthetic complications in the setting of an upper respiratory tract infection. This risk persisted after adjustment for preoperative upper respiratory symptoms, suggesting an increased risk in symptomatic or asymptomatic SARS-CoV-2 infection.


Subject(s)
Anesthesia/adverse effects , COVID-19/epidemiology , Intraoperative Complications/epidemiology , Postoperative Complications/epidemiology , Adolescent , Age Factors , COVID-19/diagnosis , COVID-19/mortality , Child , Child, Preschool , Female , Hospital Mortality , Humans , Incidence , Intensive Care Units, Pediatric , Intraoperative Complications/diagnosis , Intraoperative Complications/mortality , Intraoperative Complications/therapy , Length of Stay , Male , Patient Admission , Postoperative Complications/diagnosis , Postoperative Complications/mortality , Postoperative Complications/therapy , Prognosis , Retrospective Studies , Risk Assessment , Risk Factors , Texas/epidemiology , Time Factors
6.
Anaesth Intensive Care ; 48(3_suppl): 28-38, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-1263985

ABSTRACT

The infectious pandemics and epidemics of the past 200 years have caused millions of deaths. However, these devastating events have also led to creative thinking, imaginative experimentation and the evolution of medical care. As a result, the history of critical care medicine is entwined with the story of these global disasters. This article will take case studies from recent pandemics and epidemics and examine their impact on the development of anaesthesia and intensive care medicine.


Subject(s)
Anesthesia , COVID-19 , Cholera , Medicine , Anesthesia/adverse effects , Cholera/epidemiology , Critical Care , Humans , Pandemics , SARS-CoV-2
7.
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
10.
J Healthc Qual Res ; 36(3): 160-167, 2021.
Article in Spanish | MEDLINE | ID: covidwho-1039448

ABSTRACT

BACKGROUND: The interruption of surgical care in Spain caused by the pandemic must end. Recovery from this activity must be carried out on an elective basis and in conjunction with possible cases of COVID-19. The objective of this review was to incorporate good practice criteria related to COVID-19 into the context of safe surgery, which would make it possible to develop a proposed surgical safety checklist adapted to patients with this disease. METHODS: Narrative literature review, following the PRISMA protocol, in the Medline and Cochrane directories, using the MeSH terms (coronavirus, infections, safety, surgical procedures, operative, checklist) and the Boolean operator AND. In addition, recommendations from scientific bodies and societies were reviewed (grey literature). RESULTS: Thirty-three final studies were included with recommendations for safe surgery and surgical safety checklist adapted for COVID-19, the most frequent being aspects related to treatment (41.3%) and prevention and control measures (27.6%). CONCLUSIONS: The existence of a broad consensus on good practices recommended for COVID surgical patients makes it possible to make a proposal for surgical safety checklist to these patients.


Subject(s)
COVID-19/prevention & control , Pandemics , SARS-CoV-2 , Surgical Procedures, Operative , Airway Management , Anesthesia/adverse effects , Anesthesia/methods , Antibiotic Prophylaxis , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/transmission , COVID-19 Testing , Checklist , Consensus , Cross Infection/prevention & control , Elective Surgical Procedures , Emergencies , Equipment Contamination , Humans , Hygiene , Infection Control/methods , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Medical Waste Disposal , Operating Rooms , Patient Safety , Personal Protective Equipment , Practice Guidelines as Topic/standards , Recovery Room , SARS-CoV-2/isolation & purification , SARS-CoV-2/physiology , Spain/epidemiology , Time-to-Treatment
11.
Anesth Analg ; 131(5): 1342-1354, 2020 11.
Article in English | MEDLINE | ID: covidwho-881133

ABSTRACT

Many health care systems around the world continue to struggle with large numbers of SARS-CoV-2-infected patients, while others have diminishing numbers of cases following an initial surge. There will most likely be significant oscillations in numbers of cases for the foreseeable future, based on the regional epidemiology of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Less affected hospitals and facilities will attempt to progressively resume elective procedures and surgery. Ramping up elective care in hospitals that deliberately curtailed elective care to focus on SARS-CoV-2-infected patients will present unique and serious challenges. Among the challenges will be protecting patients and providers from recurrent outbreaks of disease while increasing procedure throughput. Anesthesia providers will inevitably be exposed to SARS-CoV-2 by patients who have not been diagnosed with infection. This is particularly concerning in consideration that aerosols produced during airway management may be infective. In this article, we recommend an approach to routine anesthesia care in the setting of persistent but variable prevalence of SARS-CoV-2 infection. We make specific recommendations for personal protective equipment and for the conduct of anesthesia procedures and workflow based on evidence and expert opinion. We propose practical, relatively inexpensive precautions that can be applied to all patients undergoing anesthesia. Because the SARS-CoV-2 virus is spread primarily by respiratory droplets and aerosols, effective masking of anesthesia providers is of paramount importance. Hospitals should follow the recommendations of the Centers for Disease Control and Prevention for universal masking of all providers and patients within their facilities. Anesthesia providers should perform anesthetic care in respirator masks (such as N-95 and FFP-2) whenever possible, even when the SARS-CoV-2 test status of patients is negative. Attempting to screen patients for infection with SARS-CoV-2, while valuable, is not a substitute for respiratory protection of providers, as false-negative tests are possible and infected persons can be asymptomatic or presymptomatic. Provision of adequate supplies of respirator masks and other respiratory protection equipment such as powered air purifying respirators (PAPRs) should be a high priority for health care facilities and for government agencies. Eye protection is also necessary because of the possibility of infection from virus coming into contact with the conjunctiva. Because SARS-CoV-2 persists on surfaces and may cause infection by contact with fomites, hand hygiene and surface cleaning are also of paramount importance.


Subject(s)
Anesthesia , Betacoronavirus/pathogenicity , Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Infection Control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Infectious Disease Transmission, Professional-to-Patient/prevention & control , Inhalation Exposure/prevention & control , Intubation, Intratracheal , Occupational Exposure/prevention & control , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Aerosols , Anesthesia/adverse effects , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Coronavirus Infections/virology , Cross Infection/diagnosis , Cross Infection/transmission , Cross Infection/virology , Equipment Contamination/prevention & control , Eye Protective Devices , Hand Hygiene , Host-Pathogen Interactions , Humans , Inhalation Exposure/adverse effects , Intubation, Intratracheal/adverse effects , Occupational Exposure/adverse effects , Occupational Health , Patient Safety , Personal Protective Equipment , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Pneumonia, Viral/virology , Protective Factors , Respiratory Protective Devices , Risk Assessment , Risk Factors , SARS-CoV-2 , Surgical Attire
12.
Curr Opin Anaesthesiol ; 33(4): 554-560, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-618764

ABSTRACT

PURPOSE OF REVIEW: With an ageing population, mounting pressure on the healthcare dollar, significant advances in medical technology, and now in the context of coronavirus disease 2019, the traditional paradigm in which operative procedures are undertaken is changing. Increasingly, procedures are performed in more distant, isolated and less familiar locations, challenging anaesthesiologists and requiring well developed situational awareness. This review looks at implications for the practitioner and patient safety, outlining considerations and steps involved in translation of systems and processes well established in the operating room to more unfamiliar environments. RECENT FINDINGS: Despite limited nonoperating room anaesthesia outcome data, analysis of malpractice claims, anaesthesia-related medical disputes and clinical outcome registries have suggested higher morbidity and mortality. Complications were often associated with suboptimal monitoring, nonadherence to recommended guidelines and sedationist or nonanaesthesiologist caregivers. More recently, clear monitoring guidelines, global patient safety initiatives and widespread implementation of cognitive aids may have contributed to nonoperating room anaesthesia (NORA) outcomes approaching that of traditional operating rooms. SUMMARY: As NORA caseloads increase, understanding structural and anaesthetic requirements is essential to patient safety. The severe acute respiratory syndrome coronavirus 2 pandemic has provided an opportunity for anaesthesiologists to implement lessons learned from previous analyses, share expertise as patient safety leaders and provide valuable input into protecting patients and caregivers.


Subject(s)
Anesthesia/standards , Anesthesiology/standards , Coronavirus Infections , Pandemics , Pneumonia, Viral , Anesthesia/adverse effects , Betacoronavirus , COVID-19 , Checklist , Cognition , Humans , Operating Rooms , Patient Safety , SARS-CoV-2
14.
J Anesth ; 35(3): 345-350, 2021 06.
Article in English | MEDLINE | ID: covidwho-705281

ABSTRACT

Coronavirus disease 2019 (COVID-19) has affected anesthetic care worldwide, including the provision of anesthesia for pediatric patients. Hospitals have balanced the risks associated with the potential surges of resource-intensive COVID-19 patients against the probable morbidity of delaying elective surgical procedures. These decisions are complicated by the unclear influence that COVID-19 has on the perioperative risk for disease-positive pediatric patients. We conducted a comprehensive literature search on MEDLINE for publications involving pediatric patients with COVID-19 who underwent general anesthesia. A total of eight publications met inclusion criteria, and together described 20 patients. Nine patients had documented preoperative COVID-19 symptoms and one perioperative death was reported. Overall, further studies are needed to increase patient numbers and properly assess the perioperative risk. As we continue to provide care without clear guiding data, we present a discussion of modified anesthetic techniques for pediatric patients with suspected or confirmed COVID-19.


Subject(s)
Anesthesia , COVID-19 , Anesthesia/adverse effects , Child , Elective Surgical Procedures , Humans , SARS-CoV-2
15.
Anaesth Crit Care Pain Med ; 39(3): 395-415, 2020 06.
Article in English | MEDLINE | ID: covidwho-549176

ABSTRACT

OBJECTIVES: The world is currently facing an unprecedented healthcare crisis caused by the COVID-19 pandemic. The objective of these guidelines is to produce a framework to facilitate the partial and gradual resumption of intervention activity in the context of the COVID-19 pandemic. METHODS: The group has endeavoured to produce a minimum number of recommendations to highlight the strengths to be retained in the 7 predefined areas: (1) protection of staff and patients; (2) benefit/risk and patient information; (3) preoperative assessment and decision on intervention; (4) modalities of the preanaesthesia consultation; (5) specificity of anaesthesia and analgesia; (6) dedicated circuits and (7) containment exit type of interventions. RESULTS: The SFAR Guideline panel provides 51 statements on anaesthesia management in the context of COVID-19 pandemic. After one round of discussion and various amendments, a strong agreement was reached for 100% of the recommendations and algorithms. CONCLUSION: We present suggestions for how the risk of transmission by and to anaesthetists can be minimised and how personal protective equipment policies relate to COVID-19 pandemic context.


Subject(s)
Analgesia/standards , Anesthesia/standards , Betacoronavirus , Coronavirus Infections , Infection Control/standards , Pandemics , Pneumonia, Viral , Adult , Airway Management , Analgesia/adverse effects , Analgesia/methods , Anesthesia/adverse effects , Anesthesia/methods , COVID-19 , COVID-19 Testing , Child , Clinical Laboratory Techniques , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Critical Pathways , Cross Infection/prevention & control , Cross Infection/transmission , Disinfection , Elective Surgical Procedures , Equipment Contamination/prevention & control , Health Services Accessibility , Humans , Infection Control/methods , Informed Consent , Occupational Diseases/prevention & control , Operating Rooms/standards , Pandemics/prevention & control , Patient Isolation , Personal Protective Equipment/supply & distribution , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Preoperative Care , Professional Staff Committees , Risk , SARS-CoV-2 , Symptom Assessment , Universal Precautions
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