Perioperative management of the neurosurgical patient COVID-19

ABSTRACT

The disease made by the COVID-19 virus causes the infectious respiratory acute severe syndrome known as SARS-2, this virus can penetrate the central nervous system affecting neurons and glial cells, is clinically manifested as encephalitis, ischemic stroke, and even polyneuropathy. When we confront a neuroquirurgic patient with positive COVID-19 we require a fast but detailed evaluation of the general and neurological status of the sick. Every surgery in presence of a positive COVID-19 patient, must be realized with high-level protection measures while the surgery happens. The use of craniotomes and electrocautery should be minimized in order to reduce aerosol production. Transsphenoidal endonasal procedures should be avoided during the period of the pandemic. We’re based in the concense of experts made by the SNACC (Society for Neuroscience in Anesthesiology and Critical Care) to emit recommendations adapted to our environment. Endovascular therapy is a viable alternative to the intravenous trombolisis for the reestablishment of circulation. It has been observed better reperfusion in those patients who didn’t received sedation, or this was light compared with the ones who did received general anesthesia. In some cases it’s indispensable the post-surgical extubation (specially in those patients who’re infected with COVID-19), so it should be kept as deep sedation and should traslade the patient to UCI. Is important the remember that infection by COVID-19 has been shown in the principal systems, causing multi-organ damage in susceptible patients, reason of why we’ll have to look tightly after every data that takes us to think in dysfunction in small and medium term. Ethical decision making regarding which patient is a candidate to a urgent decompressive craniectomy or endovascular treatment, if more than a vase is occluded, this will have to be discussed with the treating team to not fall in therapeutic cruelty or well in the omission of a opportune treatment. © 2020, Colegio Mexicano de Anestesiologia A.C.. All rights reserved.