Résumé
Introduction: Effective spinal anaesthesia for caesarean delivery (CD) is assumed to cause bilateral sympathetic blockade with increased feet skin temperature due to vasodilatation [1]. There has been no published study of peripheral skin temperature measurements during spinal anaesthesia for CD. Our study investigated foot skin temperature changes as spinal anaesthesia was established. Method(s): A single centre, prospective observational study with ethics committee approval (IRAS No. 263967). With informed consent, 60 healthy parturients, 37-42 weeks' gestation with singleton pregnancy scheduled for category 4 CD with spinal anaesthesia were recruited. Standard spinal anaesthesia used 0.5% hyperbaric bupivacaine and diamorphine with IV Phenylephrine and fluids. Skin temperature was measured on the dorsum of both feet with Covidien Mon-a-Therm© skin thermistor sensors prior to intrathecal injection and every minute after until completion of surgery. Theatre room temperature and ambient temperature under surgical drapes were recorded. Two controls were recruited. Result(s): All participants had successful spinal anaesthesia. The Figure shows mean (95% CI) skin temperature changes of both feet of participants during spinal anaesthesia and for controls. The maximum rate of skin temperature increase occurred 5-12 minutes after spinal injection with temperature change plateauing after 30 mins. The mean temperature range was 5.54degreeC (min = 29.7degreeC;max = 35.2degreeC). Discussion(s): This study characterises for the first time the peripheral temperature changes in the feet that occur with sympathetic block after spinal anaesthesia in parturients. Increased bilateral foot skin temperatures occur within 10 minutes of spinal injection. This may be useful for determining successful spinal anaesthesia for CD in addition to other assessments [2]. The insights may be useful for assessing epidural analgesia. The study was supported by an OAA research grant. Data collected by ROAR group.Copyright © 2023 Elsevier Ltd
Résumé
PURPOSE: COVID-19 has posed problems for oculoplastic surgeons. One issue we felt needed to be addressed was the way patients are draped for surgery. Traditionally patients are draped with their full face exposed, and as a result, aerosols generated from both the patient and surgical team put the other party at risk. METHODS: We created a new draping technique which would create a physical barrier. A regional survey was undertaken to compare regional oculoplastic draping practices with our practice locally in light of the COVID-19 pandemic. A patient satisfaction survey was also completed to understand the impact of our change in practice. RESULTS: Our regional survey generated 22 consultant responses. 36% (8) continued with their normal practice with the full face exposed. 18% (4) of the responders had modified a cataract drape and 45% (10) used a bespoke drape with or without a mask. We started using this modified drape in June 2020 and in the patient survey, 100 percent of patients felt the drape was comfortable and 30% of the patients commented on the relief that they did not have to wear a face mask during surgery. CONCLUSIONS: Our draping technique provides an alternative to the traditional full face exposure draping. It is simple, inexpensive, and readily available. It also addresses and resolves the issue of safety of the oculoplastic surgeon and surgical team whilst maintaining comfort for the patient throughout, particularly when risks the of COVID are ongoing and with the potential of more viruses in the future.
Résumé
To outline a set of recommendations on the management of pediatric cases who requiring airway surgery in the context of COVID 19 pandemic. A set of recommendations have been prepared based on National and International published scientific literature and recent updates on COVID 19. These has been implemented in our tertiary care centre. Due to the evolving nature of COVID 19 and existing knowledge gaps, these recommendations may have to be revised periodically. The incidence of COVID 19 is very low (1-5%) in the pediatric age group with relatively good prognosis. Pediatric airway surgeries should be restricted to emergency cases only. The decision of postponement of the surgical cases should be taken by the team of senior pediatric airway surgeons. Flexible laryngoscopy should be avoided. Foreign body cases should undergo a computed tomography scan to avoid diagnostic bronchoscopies. All the measures should be taken to prevent direct contact of aerosol so powered instruments should not be used unless mandatory. Protective draping method should be adopted to prevent aerosol exposure. As paediatric airway surgeries are aerosol generating procedure where the risk of contracting COVID 19 by the surgeons and support staff is very high, we suggest recommendations to prevent the contact with infected aerosol. We assure these recommendations are easy to follow and can impact good quality outcome during this pandemic crisis.