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4.
Ann Glob Health ; 87(1): 17, 2021 02 15.
Article in English | MEDLINE | ID: covidwho-1106313

ABSTRACT

Member States at this year's World Health Assembly 73 (WHA73), held virtually for the first time due to the COVID-19 pandemic, passed multiple resolutions that must be considered when framing efforts to strengthen surgical systems. Surgery has been a relatively neglected field in the global health landscape due to its nature as a cross-cutting treatment rather than focusing on a specific disease or demographic. However, in recent years, access to essential and emergency surgical, obstetric, and anesthesia care has gained increasing recognition as a vital aspect of global health. The WHA73 Resolutions concern specific conditions, as has been characteristic of global health practice, yet proper care for each highlighted disease is inextricably linked to surgical care. Global surgery advocates must recognize how surgical system strengthening aligns with these strategic priorities in order to ensure that surgical care continues to be integrated into efforts to decrease global health disparities.


Subject(s)
Anesthesia/standards , COVID-19 , General Surgery , Global Health , Health Services Accessibility/organization & administration , Healthcare Disparities/organization & administration , Obstetrics/standards , COVID-19/epidemiology , COVID-19/therapy , General Surgery/organization & administration , General Surgery/standards , Global Health/standards , Global Health/trends , Humans , Quality Improvement , SARS-CoV-2
5.
AANA J ; 89(1): 62-69, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1049415

ABSTRACT

The coronavirus disease 2019 (COVID-19) respiratory illness has increased the amount of people needing airway rescue and the support of mechanical ventilators. In doing so, the pandemic has increased the demand of healthcare professionals to manage these critically ill individuals. Certified Registered Nurse Anesthetists (CRNAs), who are trained experts in airway management and mechanical ventilation with experience in intensive care units (ICUs), rise to this challenge. However, many CRNAs may be unfamiliar with advancements in critical care ventilators. The purpose of this review is to provide a resource for CRNAs returning to the ICU to manage patients requiring invasive mechanical ventilation. The most common ventilator modes found in anesthesia machine ventilators and ICU ventilators are reviewed, as are the lung-protective ventilation strategies, including positive end-expiratory pressure, used to manage patients with COVID-19-induced acute respiratory distress syndrome. Adjuncts to mechanical ventilation, recruitment maneuvers, prone positioning, and extracorporeal membrane oxygenation are also reviewed. More research is needed concerning the management of COVID-19-infected patients, and CRNAs must become familiar with their ICU units' individual ventilator machine, but this brief review provides a good place to start for those returning to the ICU.


Subject(s)
Anesthesia/statistics & numerical data , Anesthesia/standards , COVID-19/therapy , Critical Care/standards , Respiration, Artificial/standards , Respiratory Distress Syndrome/therapy , Ventilators, Mechanical/standards , Critical Care/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Pandemics , Practice Guidelines as Topic , Respiration, Artificial/statistics & numerical data , SARS-CoV-2 , Ventilators, Mechanical/statistics & numerical data
7.
Anaesthesia ; 76(2): 225-237, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-960777

ABSTRACT

We convened a multidisciplinary Working Party on behalf of the Association of Anaesthetists to update the 2011 guidance on the peri-operative management of people with hip fracture. Importantly, these guidelines describe the core aims and principles of peri-operative management, recommending greater standardisation of anaesthetic practice as a component of multidisciplinary care. Although much of the 2011 guidance remains applicable to contemporary practice, new evidence and consensus inform the additional recommendations made in this document. Specific changes to the 2011 guidance relate to analgesia, medicolegal practice, risk assessment, bone cement implantation syndrome and regional review networks. Areas of controversy remain, and we discuss these in further detail, relating to the mode of anaesthesia, surgical delay, blood management and transfusion thresholds, echocardiography, anticoagulant and antiplatelet management and postoperative discharge destination. Finally, these guidelines provide links to supplemental online material that can be used at readers' institutions, key references and UK national guidance about the peri-operative care of people with hip and periprosthetic fractures during the COVID-19 pandemic.


Subject(s)
Case Management/standards , Hip Fractures/therapy , Anesthesia/standards , COVID-19 , Guidelines as Topic , Hip Fractures/surgery , Humans , Pandemics , Quality Improvement
8.
Best Pract Res Clin Anaesthesiol ; 35(3): 415-424, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-938789

ABSTRACT

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


Subject(s)
Ambulatory Surgical Procedures/standards , Anesthesia/standards , COVID-19/prevention & control , Patient Care/standards , Personal Protective Equipment/standards , Practice Guidelines as Topic/standards , Ambulatory Surgical Procedures/trends , Anesthesia/trends , COVID-19/epidemiology , Humans , Patient Care/trends , Personal Protective Equipment/trends
10.
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
11.
J Cardiothorac Vasc Anesth ; 34(12): 3211-3217, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-665472

ABSTRACT

Anesthesia for thoracic surgery requires specialist intervention to provide adequate operating conditions and one-lung ventilation. The pandemic caused by severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2) is transmitted by aerosol and droplet spread. Because of its virulence, there is a risk of transmission to healthcare workers if appropriate preventive measures are not taken. Coronavirus disease 2019 (COVID-19) patients may show no clinical signs at the early stages of the disease or even remain asymptomatic for the whole course of the disease. Despite the lack of symptoms, they may be able to transfer the virus. Unfortunately, during current COVID-19 testing procedures, about 30% of tests are associated with a false-negative result. For these reasons, standard practice is to assume all patients are COVID-19 positive regardless of swab results. Here, the authors present the recommendations produced by the Israeli Society of Anesthesiologists for use in thoracic anesthesia for elective surgery during the COVID-19 pandemic for both the general population and COVID-19-confirmed patients. The objective of these recommendations is to make changes to some routine techniques in thoracic anesthesia to augment patients' and the medical staff's safety.


Subject(s)
Anesthesia/standards , Anesthesiologists/standards , COVID-19/epidemiology , Elective Surgical Procedures/standards , Pandemics , Thoracic Surgical Procedures/standards , Anesthesia/methods , COVID-19/prevention & control , Consensus , Elective Surgical Procedures/methods , Humans , Israel/epidemiology , Pandemics/prevention & control , Societies, Medical/standards , Thoracic Surgical Procedures/methods
13.
Psychother Psychosom ; 89(5): 314-319, 2020.
Article in English | MEDLINE | ID: covidwho-607232

ABSTRACT

INTRODUCTION: Electroconvulsive therapy (ECT) is a critical procedure in psychiatric treatment, but as typically delivered involves the use of bag-mask ventilation (BMV), which during the COVID-19 pandemic exposes patients and treatment staff to potentially infectious aerosols. OBJECTIVE: To demonstrate the utility of a modified anesthesia protocol for ECT utilizing preoxygenation by facemask and withholding the use of BMV for only those patients who desaturate during the apneic period. METHODS: This chart review study analyzes patients who were treated with ECT using both the traditional and modified anesthesia protocols. RESULTS: A total of 106 patients were analyzed, of whom 51 (48.1%) required BMV using the new protocol. Of clinical factors, only patient BMI was significantly associated with the requirement for BMV. Mean seizure duration reduced from 52.0 ± 22.4 to 46.6 ± 17.1 s, but seizure duration was adequate in all cases. No acute physical, respiratory, or psychiatric complications occurred during treatment. CONCLUSIONS: A modified anesthesia protocol reduces the use of BMV by more than 50%, while retaining adequate seizure duration.


Subject(s)
Aerosols , Anesthesia/standards , Clinical Protocols/standards , Coronavirus Infections/prevention & control , Electroconvulsive Therapy/standards , Oxygen Inhalation Therapy/standards , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Process Assessment, Health Care , Respiration, Artificial/standards , Adult , Body Mass Index , COVID-19 , Female , Humans , Male , Retrospective Studies
14.
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
15.
Curr Opin Anaesthesiol ; 33(4): 594-600, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-620546

ABSTRACT

PURPOSE OF REVIEW: To provide aids to deal with increasing amount of several comorbidities in nonoperating room anesthesia (NORA). RECENT FINDINGS: New indexes for assessment of comorbidities are described and guidelines for the care of patients with obesity, obstructive sleep apnea, chronic obstructive pulmonary disease (COPD), diabetes and COVID19 in NORA summarized. SUMMARY: In addition to ASA classification, such instruments as Charlson Comorbidity Index, Frailty Index, Surgical Complexity Score and Revised Cardiac Risk could supplement the prospective assessment of the risk of comorbidities. Using institutional protocols patients with significant obesity, obstructive sleep apnea, COPD, diabetes and COVID19 can be safely cared in NORA. However, the individual functioning and the severity are more important than only the number of diseases.


Subject(s)
Anesthesia/standards , Anesthesiology/standards , Comorbidity , Betacoronavirus , COVID-19 , Coronavirus Infections , Diabetes Mellitus , Humans , Obesity , Pandemics , Pneumonia, Viral , Practice Guidelines as Topic , Prospective Studies , Pulmonary Disease, Chronic Obstructive , SARS-CoV-2 , Sleep Apnea, Obstructive
16.
Paediatr Anaesth ; 30(7): 737-742, 2020 07.
Article in English | MEDLINE | ID: covidwho-326942

ABSTRACT

After a novel human coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was reported in China in December 2019, the disease quickly reached pandemic level. On January 30, 2020, the World Health Organization (WHO) declared that the SARS-CoV-2 outbreak constituted a Public Health Emergency of International Concern. The caseload has increased exponentially, with WHO reporting 182 000 global cases by March 17, 2020, and over 2.6 million by 23 April. The clinical situation is complex, with children presenting different clinical features compared to adults. Several articles with recommendations on the anesthetic management of adult patients with COVID-19 have been published, but no specific recommendations for pediatric anesthesiologists have been made yet. This article addresses specific concerns for the anesthetic management of the pediatric population with COVID-19.


Subject(s)
Anesthesia/standards , Anesthetics/therapeutic use , Coronavirus Infections/epidemiology , Pediatrics/standards , Pneumonia, Viral/epidemiology , Anesthesia/methods , COVID-19 , Child , China/epidemiology , Disease Outbreaks , Humans , Pandemics , Pediatrics/methods , Practice Guidelines as Topic
17.
World J Emerg Surg ; 15(1): 33, 2020 05 15.
Article in English | MEDLINE | ID: covidwho-268764

ABSTRACT

BACKGROUND: A novel coronavirus pneumonia outbreak began in Wuhan, Hubei Province, in December 2019; the outbreak was caused by a novel coronavirus previously never observed in humans. China has imposed the strictest quarantine and closed management measures in history to control the spread of the disease. However, a high level of evidence to support the surgical management of potential trauma patients during the novel coronavirus outbreak is still lacking. To regulate the emergency treatment of trauma patients during the outbreak, we drafted this paper from a trauma surgeon perspective according to practical experience in Wuhan. MAIN BODY: The article illustrates the general principles for the triage and evaluation of trauma patients during the outbreak of COVID-19, indications for emergency surgery, and infection prevention and control for medical personnel, providing a practical algorithm for trauma care providers during the outbreak period. CONCLUSIONS: The measures of emergency trauma care that we have provided can protect the medical personnel involved in emergency care and ensure the timeliness of effective interventions during the outbreak of COVID-19.


Subject(s)
Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Infection Control/standards , Pandemics , Pneumonia, Viral , Wounds and Injuries/diagnosis , Wounds and Injuries/therapy , Algorithms , Anesthesia/standards , COVID-19 , China , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Emergencies , Hospital Units/standards , Humans , Pandemics/prevention & control , Perioperative Care/standards , Personal Protective Equipment/standards , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Surgical Procedures, Operative/standards , Tomography, X-Ray Computed/standards , Triage/standards
18.
Semin Cardiothorac Vasc Anesth ; 24(2): 127-137, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-125020

ABSTRACT

Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome-Coronavirus-2 (SARS-CoV-2), was first reported in Wuhan, Hubei, China, and has spread to more than 200 other countries around the world. COVID-19 is a highly contagious disease with continuous human-to-human transmission. The origin of the virus is unknown. Airway manipulations and intubations, which are common during anesthesia procedures may increasingly expose anesthesia providers and intensive care unit team members to SARS-CoV-2. Through a comprehensive review of existing studies on COVID-19, this article presents the epidemiological and clinical characteristics of COVID-19, reviews current medical management, and suggests ways to improve the safety of anesthetic procedures. Owing to the highly contagious nature of the virus and the lack of therapeutic drugs or vaccines, precautions should be taken to prevent medical staff from COVID-19.


Subject(s)
Anesthesia/standards , Anesthesiology/standards , Coronavirus Infections/transmission , Infection Control/standards , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Perioperative Care/standards , Pneumonia, Viral/transmission , Aerosols/adverse effects , Anesthesia/methods , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Coronavirus Infections/therapy , Humans , Intubation, Intratracheal/adverse effects , Intubation, Intratracheal/standards , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Pneumonia, Viral/therapy , Risk , SARS-CoV-2
19.
J Cardiothorac Vasc Anesth ; 34(5): 1125-1131, 2020 05.
Article in English | MEDLINE | ID: covidwho-40445

ABSTRACT

OBJECTIVES: The aim of the present study was to prevent cross-infection in the operating room during emergency procedures for patients with confirmed or suspected 2019 novel coronavirus (2019-nCoV) by following anesthesia management protocols, and to document clinical- and anesthesia-related characteristics of these patients. DESIGN: This was a retrospective, multicenter clinical study. SETTING: This study used a multicenter dataset from 4 hospitals in Wuhan, China. PARTICIPANTS: Patients and health care providers with confirmed or suspected 2019-nCoV from January 23 to 31, 2020, at the Wuhan Union Hospital, the Wuhan Children's Hospital, The Central Hospital of Wuhan, and the Wuhan Fourth Hospital in Wuhan, China. INTERVENTIONS: Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in 4 hospitals in Wuhan. MEASUREMENTS AND MAIN RESULTS: Cross-infection in the operating rooms of the 4 hospitals was effectively reduced by implementing the new measures and procedures. The majority of patients with laboratory-confirmed 2019-nCoV infection or suspected infection were female (23 [62%] of 37), and the mean age was 41.0 years old (standard deviation 19.6; range 4-78). 10 (27%) patients had chronic medical illnesses, including 4 (11%) with diabetes, 8 (22%) with hypertension, and 8 (22%) with digestive system disease. Twenty-five (68%) patients presented with lymphopenia, and 23 (62%) patients exhibited multiple mottling and ground-glass opacity on computed tomography scanning. CONCLUSIONS: The present study indicates that COVID 19-specific guidelines for emergency procedures for patients with confirmed or suspected 2019-nCoV may effectively prevent cross-infection in the operating room. Most patients with confirmed or suspected COVID 19 presented with fever and dry cough and demonstrated bilateral multiple mottling and ground-glass opacity on chest computed tomography scans.


Subject(s)
Anesthesia , Coronavirus Infections , Cross Infection , Emergency Medical Services , Infection Control , Pandemics , Pneumonia, Viral , Adolescent , Adult , Aged , Anesthesia/methods , Anesthesia/standards , Betacoronavirus , COVID-19 , Child , Child, Preschool , China , Chronic Disease , Comorbidity , Coronavirus Infections/complications , Cross Infection/prevention & control , Emergency Medical Services/standards , Female , Humans , Infection Control/standards , Male , Middle Aged , Operating Rooms , Pneumonia, Viral/complications , Practice Guidelines as Topic , Retrospective Studies , SARS-CoV-2 , Young Adult
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