Given the emphasis on social distancing and the possibility of a resurgence of COVID-19, we aim to highlight the evidence and best practices to continue comprehensive and effective opioid management during remote patient interactions to maximize safety for patients and providers, with an emphasis on drug monitoring regimens, while remaining cognizant of the public health challenges at hand. "

significant associations with psychological distress were found for the presence of multiple co-morbidities in staff, direct involvement in COVID-19 patient care, receiving a quarantine order, and redeployment outside normal professional boundaries (Table 1). Insomnia, based on the first item of the GHQ-12, was reported by 45 participants (16.7%). Redeployment to work outside areas of usual clinical practice was reported by 41.9% of participants. The majority (59.3%) perceived their workload to be similar to pre-pandemic levels. Just 12.2% of participants had family, friends, or colleagues diagnosed with COVID-19. Formal PPE training was received by 256 (94.8%) participants with 149 (55.2%) being confident in correct usage and their ability to protect from infection. Situations where recommended PPE was unavailable were encountered by 46 (17.0%). Risks of getting infected (83.6%) and infecting family members (78.0%) were the top two concerns (Supplementary Appendix 2). This study shows significant psychological distress amongst anaesthesiologists and nurses working in ICUs in the context of the COVID-19 pandemic. While lower than reported in the outbreak epicentre in China, which reported depression in 50.4% and anxiety in 44.6% of healthcare workers, we found a twofold higher prevalence of anxiety and up to threefold higher prevalence of depression than reported amongst general healthcare workers in Singapore and Italy during this pandemic. 3,4,7 Many would regard even pre-pandemic work in such high-acuity environments as stressful and emotionally exhausting, thus potentially accounting for the differences compared with general healthcare workers. Indeed, pre-pandemic studies of occupational stress identified similar levels of anxiety and stress (29.0e35.7%) in ICU physicians and nurses using the GHQ-12. 5,8 Thus, the contention that COVID-19 has provoked all the elements of psychological distress in respondents still requires testing. Our study has limitations. Socioeconomic status, which may influence outcomes and intervention planning, was not assessed. Neither a pre-crisis baseline nor follow-up to assess the temporal changes in psychological distress was available. Being a single-centre snapshot, further studies in other populations are necessary for generalisability. Lastly, clinical interviews by a psychiatrist would have been ideal. Nonetheless, we identified risk factors for psychological distress that may be useful for identifying at-risk individuals, and respondent concerns of the infection risk, adequacy of PPE, and redeployment outside normal professional boundaries are still issues that need to be addressed. The psychological distress prevalent amongst providing anaesthesia and intensive care providers during this pandemic necessitates policies for screening of at-risk individuals and adoption of early psychological support interventions for affected staff. 9,10

Introduction: Magnetic resonance imaging (MRI) conditional modes are a novel feature for certain Food and Drug Administration (FDA)approved spinal cord stimulation (SCS) devices. However, there is a paucity of literature around the limitation of MRI-conditional modes (''MRI safe''), specifically in clinical scenarios where urgent MRIs may be needed. One such limitation is load impedance, referring to the circuit's resistance to the current being generated by the system. High impedance can limit the MRIconditional mode capability, presenting potential harm to a patient undergoing an MRI or make an MRI unable to be completed. Methods: Three cases were identified, and informed consent was obtained. All information was obtained via retrospective chart review. Results: In this case series of three patients where MRI-conditional SCS systems were unable to be placed in ''MRI safe'' settings, preventing timely MRI study completion in the setting of high impedance, all three were required to undergo alternative imaging including CT scans, and two patients ultimately had the system explanted and one chose to be re-implanted after completion of scans. Conclusion: This case series highlights the need for further investigation of impedance in SCS systems and potential limitations for future MRI usage. The review of literature of impedance in SCS shows both device-and physiologic-related etiologies for changes in impedance that warrant consideration by the implanting physician.

The COVID-19 pandemic is revealing the unacceptable health disparities across New York City and in this country. The mortality rates of vulnerable and minority populations alone suggest a need to re-evaluate clinical decision making protocols, especially given the recently passed Emergency or Disaster Treatment Protection Act, which grants healthcare institutions full immunity from liability stemming from resource allocation/triage decisions. Here we examine the disparity literature against resource allocation guidelines, contending that these guidelines may propagate allocation of resources along ableist, ageist and racial biases. Finally, we make the claim that the state must successfully develop ones that ensure the just treatment of our most vulnerable.

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Peri-operative conversion disorder that manifests as postoperative muscle weakness is an uncommon diagnosis made through exclusion of neurological, metabolic or iatrogenic aetiologies. We present a case where a patient with a considerable history of physical and psychological trauma suffered from prolonged right-sided hemiparesis following a breast biopsy under moderate-to-deep sedation. Conversion disorder following moderate-to-deep sedation has yet to be discussed in the literature, as all previous cases have described postoperative conversion disorder in the setting of general or central neuraxial anaesthesia. Our recommendation is for practitioners to keep conversion disorder on the list of differential diagnoses, despite the depth of sedation or type of anaesthetic utilised, and perform the same detailed neurological, metabolic and psychiatric assessment when considering postoperative weakness.