Evolving and conflicting information about pathophysiology, clinical course and impact of corona virus disease (COVID-19) on perioperative outcome of patients has brought in new challenges while restarting elective surgeries. A roadmap to resume elective surgeries should detail timings for reopening elective surgeries, COVID-19 testing facilities, adequate PPE supplies, conservation policies for PPE and case prioritization and scheduling. We suggest a six-pronged strategy of minimizing chances of exposure, adherence to standard protocols, perioperative patient care, precautions while performing aerosol generating procedures, limiting movement of personnel within operating room and monitoring and managing health care professionals while scheduling elective surgeries to overcome the challenges this COVID-19 pandemic has brought in.

Objective Dexmedetomidine is an alpha 2-adrenergic agonist that prolongs analgesia as an adjuvant when added in neuraxial and peripheral nerve blocks. The aim of the present study was to evaluate the efficacy of dexmedetomidine as an adjuvant to bupivacaine in ultrasound (USG)-guided transverse abdominis plane (TAP) block for postoperative analgesia in laparoscopic appendicectomy. Methods A total of 60 American Society of Anesthesiologists I and II adult patients aged between 16 and 60 years planned for laparoscopic appendicectomy were randomised into two groups (A and B). Group A patients received 20 mL of 0.125% bupivacaine+1 μg kg −1 dexmedetomidine, whereas group B patients received 20 mL of 0.125% bupivacaine alone on both sides at the time of USG-guided TAP block. Haemodynamic variables, pain scores, sedation scores, time to first dose of rescue analgesic and side effects, if any, were assessed and compared between the groups. Results Demographic and operative characteristics were comparable in both groups. The mean duration of analgesia was more in group A (7.33 h) than in group B (4.8 h). The requirement of rescue analgesics was more in group B (80%) than in group A (56.7%). The sedation and pain scores at 2, 4 and 6 h were better in group A than in group B (p<0.05). The heart rate, systolic blood pressure and diastolic blood pressure were lower in group A during the postoperative period than in group B. Conclusion The addition of dexmedetomidine as an adjuvant to bupivacaine in TAP block provides prolonged postoperative analgesia and better pain control with reduced need for rescue analgesics than bupivacaine alone in patients undergoing laparoscopic appendicectomy.

Objective: Bleeding resulting in impaired intraoperative visibility and increased risk of injury to vital structures such as optic nerve and internal carotid artery requires effective control with controlled hypotension during functional endoscopic sinus surgeries. Our aim in this study is to assess the effectiveness of dexmedetomidine in reducing blood loss during functional endoscopic sinus surgeries (FESS) when it is used for controlled hypotension. Method: Ninety-two American Society of Anesthsiologists-ASA class I and II patients of comparable demographic profile, scheduled for elective FESS received either injectable dexmedetomidine (1 μk g hr-1) for the first 10 minutes and then 0.5 μ kg hr-1 as infusion (Group A) or equal volume of saline infusion (Group B). The hemodynamic changes, utilization of intraoperative rescue medication, intraoperative blood loss, emergence time, postoperative sedation and pain scores were recorded. Results: Patients in the dexmedetomidine group had a remarkable reduction in blood loss (p=0.000) with lesser intraoperative mean arterial blood pressure, heart rate, better sedation and pain scores postoperatively. The mean intraoperative rescue medication consumption was remarkably higher in patients of group B. Extubation time in group A patients was significantly higher (9.04 minutes) than in group B patients (5.07 minutes) (p=0.000). Conclusion: Dexmedetomidine is an optimal effective agent that reduces blood loss by controlled hypotension during FESS providing ideal surgical field with better sedative and analgesic properties.

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