In view of the COVID-19 pandemic, the use of locoregional anaesthesia has gained popularity as the greatest number of the major abdominal surgical cases which were usually done under general anaesthesia (GA) is now shifted towards awake anaesthesia due to fear of aerosol generation. In a COVID era, with evolving risk of aerosol generation in surgery under GA and the urge for reserving ICU beds for needy patients, this study was undertaken to assess the adequacy of surgery and other benefits with awake anaesthesia. A retrospective observational study for 8 COVID-19 positive patients, undergoing emergency major abdominal surgeries with locoregional anaesthesia in pre-operatively diagnosed COVID positive from May 2020 to May 2021 was conducted. Low to medium risk patients (ASA 1-2) were considered following assessment by anaesthesiologist. We retrospectively analysed data including perioperative events, post-op follow up. The mean operative time was 103 minutes (minimum 50 minutes; maximum 170 minutes). In one case, conversion to general anaesthesia was necessary. Post-operative pain was always well controlled. None of them required postoperative intensive care support. No perioperative major complications (Clavien Dindo ≥3) occurred. Early readmission after surgery never occurred. In our experience in the COVID-19 era, RA may help to limit the intubation-related risk of contagions inside theatres and could be feasible, safe, and painless alternative to GA in selected cases and this approach could become part of an ICU-preserving strategy.
BACKGROUND: The COVID-19 pandemic is standing as a never before threat to the healthcare systems and hospital operations worldwide.Transmission of coronavirus (COVID-19) is a considerable risk during the perioperative period of surgery. Treatment algorithms have changed in general surgery clinics, as in other medical disciplines providing emergency services. OBJECTIVES: This study was aimed to evaluate the changes in approach to management and the perioperative outcome of patients with acute surgical emergency during COVID-19 pandemic. STUDY DESIGN AND METHODS:We performed a retrospective observational study in patients presented with acute surgical emergency between April 2020 to June 2021. RESULTS: A total of 298 patients were included, among whom 12 (3.4%) were COVID 19 positive. 274 non-COVID patients and 8 COVID-19 positive patients underwent emergency surgery.While 12 non-COVID (4.1%) and 4 COVID-19 positive patients (40%) underwent conservative management. None of the hospital staff involved in the surgeries of COVID-19 positive patients developed any symptoms related to COVID-19. CONCLUSION: This study showed that the patients with surgical emergency both with or without COVID-19 infection were successfully treated,without influencing each other,through appropriate isolation measures,although managed in the same hospital. Importance can also be given towards conservative management particularly for COVID-19 positive patients presenting with surgical emergency selectively with proper monitoring. So it can be concluded that, although the management of surgical patients during the COVID-19 pandemic is a global challenge,adequate preparedness and strategic plan to adjust the surgical services can reduce the exposures to this highly contagious virus.
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