A novel approach to spinal anaesthesia to avoid aerosol‐generating procedures in a patient with COVID‐19 presenting for laser prostate surgery

Abstract

General anaesthesia involves aerosol-generating procedures which, in the context of the coronavirus 2019 (COVID-19) pandemic, increases the risk of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission from patients to staff. This risk can be minimised by performing spinal or regional anaesthesia instead of general anaesthesia where possible. We report the successful management of a patient utilising spinal anaesthesia in a patient with COVID-19 undergoing urgent holmium laser enucleation of prostate for symptomatic benign prostatic hyperplasia. A combination of bupivacaine, diamorphine and midazolam was administered intrathecally which provided adequate anaesthesia despite the prolonged surgical duration. Nebulised lidocaine was also given to prevent coughing during the procedure. This report demonstrates that it is possible and safe to use spinal anaesthesia to perform prolonged surgical procedures that are normally conducted under general anaesthesia using a combination of intrathecal adjuncts to facilitate effective block duration. In addition, the novel use of nebulised lidocaine for its antitussive effects in a patient with COVID-19 is highlighted.

Case reports in the COVID‐19 pandemic: first responders to an emergency in evidence‐based medicine

“…Nevertheless, understanding and optimising the experiences of patients has been a prominent feature of our reports, perhaps most notably in Ramachandran's account of his personal experience as a junior doctor with severe COVID‐19, and his experiences of psychological and physical recovery [9]. Likewise, the report by Oon and Ha discusses the balance between staff safety and patient experience, which were both positive in this case [5]. The symptoms of COVID‐19 were also described, including Hoshijima et al's description of a severely hypoxic but only minimally symptomatic patients, experiencing what has come to be known as silent or ‘happy’ hypoxia [10, 11].…”

“…It is unsurprising that many of the reports we have published emphasised staff safety. Broadly, these fell into three categories First, is strategies for the avoidance of aerosol generating procedures, such as the novel approach to spinal anaesthesia to facilitate prolonged surgery in a patient with SARS-CoV-2 infection reported by Oon and Ha [5] Second, modifying existing procedures to minimise aerosol generation, including the approaches to tracheostomy described by Smith et al and Harper et al [6,7]. Third, ensuring proper availability, function and use of personal protective equipment (PPE), including Rotman et al's description of the vital role of team briefing in ensuring appropriate protection is worn by all team members during shared airway surgery in the context of COVID-19 [8].…”

A Cross-Sectional Study to Ascertain the Effect of COVID-19 Pandemic on Regional Anaesthesia Practices Amongst Anaesthesiologists of India

“…Though there are no studies regarding the incidence of respiratory depression following intrathecal opioids in COVID-positive patients, there can be increased risk theoretically in these groups of patients due to their associated respiratory illness. Non-opioid adjuncts should be preferred if needed [15].…”

Laparoscopy in Gynecologic and Abdominal Surgery in Regional (Spinal, Peridural) Anesthesia, the Utility of the Technique during COVID-19 Pandemic

“…Airway manipulation is linked with some of the highest percentages of COVID-19 transmission, and it is generally admitted to avoid Aerosol Generating Procedures (AGPs). RA decreases the risk of virus transmission from patient to the medical personnel [ 81 , 82 , 83 ]. Furthermore, RA enables excellent communication between patient, anesthesiologist and surgical team [ 84 , 85 , 86 ].…”