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2.
Anesth Analg ; 133(5): 1206-1214, 2021 Nov 01.
Article in English | MEDLINE | ID: covidwho-846281

ABSTRACT

BACKGROUND: Prolonged times to tracheal extubation are those from end of surgery (dressing on the patient) to extubation 15 minutes or longer. They are so long that others in the operating room (OR) generally have exhausted whatever activities can be done. They cause delays in the starts of surgeons' to-follow cases and are associated with longer duration workdays. Anesthesiologists rate them as being inferior quality. We compare prolonged times to extubation between a teaching hospital in the United States with a phase I postanesthesia care unit (PACU) and a teaching hospital in Japan without a PACU. Our report is especially important during the coronavirus disease 2019 (COVID-19) pandemic. Anesthesiologists with some patients undergoing general anesthetics and having initial PACU recovery in the ORs where they had surgery can learn from the Japanese anesthesiologists with all patients recovering in ORs. METHODS: The historical cohort study included all patients undergoing gynecological surgery at a US hospital (N = 785) or Japanese hospital (N = 699), with the time from OR entrance to end of surgery of at least 4 hours. RESULTS: The mean times from end of surgery to OR exit were slightly longer at the US hospital than at the Japanese hospital (mean difference 1.9 minutes, P < .0001). The mean from end of surgery to discharge to surgical ward at the US hospital also was longer (P < .0001), mean difference 2.2 hours. The sample standard deviations of times from end of surgery until tracheal extubation was 40 minutes for the US hospital versus 4 minutes at the Japanese hospital (P < .0001). Prolonged times to tracheal extubation were 39% of cases at the US hospital versus 6% at the Japanese hospital; relative risk 6.40, 99% confidence interval (CI), 4.28-9.56. Neither patient demographics, case characteristics, surgeon, anesthesiologist, nor anesthesia provider significantly revised the risk ratio. There were 39% of times to extubation that were prolonged among the patients receiving neither remifentanil nor desflurane (all such patients at the US hospital) versus 6% among the patients receiving both remifentanil and desflurane (all at the Japanese hospital). The relative risk 7.12 (99% CI, 4.59-11.05) was similar to that for the hospital groups. CONCLUSIONS: Differences in anesthetic practice can facilitate major differences in patient recovery soon after anesthesia, useful when the patient will recover initially in the OR or if the phase I PACU is expected to be unable to admit the patient.


Subject(s)
Airway Extubation/methods , Anesthesia Recovery Period , Hospital Units , Hospitals, Teaching/methods , Time-to-Treatment , Airway Extubation/standards , Cohort Studies , Hospital Units/standards , Hospitals, Teaching/standards , Humans , Japan/epidemiology , Time-to-Treatment/standards , United States/epidemiology
4.
Dig Endosc ; 32(7): 1105-1110, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-780816

ABSTRACT

Endoscopy is widely used as a clinical diagnosis and treatment method for certain hepatobiliary and pancreatic diseases. However, due to the distinctive epidemiological characteristics of severe acute respiratory syndrome coronavirus 2, the virus causing coronavirus disease-2019 (COVID-19), healthcare providers are exposed to the patient's respiratory and gastrointestinal fluids, rendering endoscopy a high risk for transmitting a nosocomial infection. This article introduces preventive measures for endoscopic treatment enacted in our medical center during COVID-19, including the adjustment of indications, the application of endoscope protective equipment, the design and application of endoscopic masks and splash-proof films, and novel recommendations for bedside endoscope pre-sterilization.


Subject(s)
Coronavirus Infections/prevention & control , Cross Infection/prevention & control , Disease Transmission, Infectious/prevention & control , Endoscopes/standards , Endoscopy, Gastrointestinal/standards , Infection Control/standards , Masks , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Air Microbiology , Betacoronavirus , COVID-19 , China/epidemiology , Coronavirus Infections/epidemiology , Equipment Contamination/prevention & control , Hospital Units/standards , Humans , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Sterilization
5.
Knee Surg Sports Traumatol Arthrosc ; 28(9): 2730-2746, 2020 Sep.
Article in English | MEDLINE | ID: covidwho-730928

ABSTRACT

PURPOSE: The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. METHODS: A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. RESULTS: The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. CONCLUSION: Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe return.


Subject(s)
Arthroplasty, Replacement, Hip , Arthroplasty, Replacement, Knee , Coronavirus Infections/epidemiology , Elective Surgical Procedures/methods , Pneumonia, Viral/epidemiology , Anthropology, Medical , Betacoronavirus , COVID-19 , Consensus , Delivery of Health Care/methods , Disinfection/methods , Disinfection/standards , Europe , Hospital Units/organization & administration , Hospital Units/standards , Humans , Operating Rooms/organization & administration , Operating Rooms/standards , Orthopedic Procedures , Orthopedics , Pandemics , Personal Protective Equipment , SARS-CoV-2 , Surveys and Questionnaires
6.
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
7.
J Gastroenterol Hepatol ; 35(5): 749-759, 2020 May.
Article in English | MEDLINE | ID: covidwho-196926

ABSTRACT

From its beginning in December 2019, the coronavirus disease 2019 outbreak has spread globally from Wuhan and is now declared a pandemic by the World Health Organization. The sheer scale and severity of this pandemic is unprecedented in the modern era. Although primarily a respiratory tract infection transmitted by direct contact and droplets, during aerosol-generating procedures, there is a possibility of airborne transmission. In addition, emerging evidence suggests possible fecal-oral spread of the virus. Clinical departments that perform endoscopy are faced with daunting challenges during this pandemic. To date, multiple position statements and guidelines have been issued by various professional organizations to recommend practices in endoscopic procedures. This article aims to summarize and discuss available evidence for these practices, to provide guidance for endoscopy to enhance patient safety, avoid nosocomial outbreaks, protect healthcare personnel, and ensure rational use of personal protective equipment. Responses adapted to national recommendations and local infection control guidelines and tailored to the availability of medical resources are imminently needed to fight the coronavirus disease 2019 pandemic.


Subject(s)
Coronavirus Infections/transmission , Disease Transmission, Infectious/prevention & control , Endoscopy, Gastrointestinal/standards , Hospital Units/standards , Infection Control/standards , Pandemics , Pneumonia, Viral/transmission , Aerosols/adverse effects , COVID-19 , Coronavirus Infections/prevention & control , Endoscopy/standards , Hospital Units/organization & administration , Humans , Infection Control/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Practice Guidelines as Topic
9.
J Dig Dis ; 21(4): 199-204, 2020 Apr.
Article in English | MEDLINE | ID: covidwho-42091

ABSTRACT

An epidemic of an acute respiratory syndrome caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Wuhan, China, now known as coronavirus disease 2019 (COVID-19), beginning in December 2019, has attracted an intense amount of attention worldwide. As the natural history and variety of clinical presentations of this disease unfolds, extrapulmonary symptoms of COVID-19 have emerged, especially in the digestive system. While the respiratory mode of transmission is well known and is probably the principal mode of transmission of this disease, a possibility of the fecal-oral route of transmission has also emerged in various case series and clinical scenarios. In this review article, we summarize four different aspects in published studies to date: (a) gastrointestinal manifestations of COVID-19; (b) microbiological and virological investigations; (c) the role of fecal-oral transmission; and (d) prevention and control of SARS-CoV-2 infection in the digestive endoscopy room. A timely understanding of the relationship between the disease and the digestive system and implementing effective preventive measures are of great importance for a favorable outcome of the disease and can help climnicians to mitigate further transmission by taking appropriate measures.


Subject(s)
Coronavirus Infections/transmission , Cross Infection/prevention & control , Digestive System Diseases , Endoscopy, Digestive System/standards , Gastroenterology/standards , Infection Control/standards , Pneumonia, Viral/transmission , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/virology , Cross Infection/etiology , Cross Infection/virology , Digestive System Diseases/diagnosis , Digestive System Diseases/etiology , Digestive System Diseases/microbiology , Digestive System Diseases/virology , Hospital Units/standards , Humans , Pandemics , Personal Protective Equipment/standards , Pneumonia, Viral/complications , Pneumonia, Viral/virology , SARS-CoV-2
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