Anesthetic Implications of Ebola Patient Management

Abstract

As of mid-October 2014, the ongoing Ebola epidemic in Western Africa has affected approximately 10,000 patients, approached a 50% mortality rate, and crossed political and geographic borders without precedent. The disease has spread throughout Liberia, Guinea, and Sierra Leone. Isolated cases have arrived in urban centers in Europe and North America. The exponential growth, currently unabated, highlights the urgent need for effective and immediate management protocols for the various health care subspecialties that may care for Ebola virus disease patients. We conducted a comprehensive review of the literature to identify key areas of anesthetic care affected by this disease. The serious potential for "high-risk exposure" and "direct contact" (as defined by the Centers for Disease Control and Prevention) of anesthesiologists caring for Ebola patients prompted this urgent investigation. A search was conducted using MEDLINE/PubMed, MeSH, Cochrane Review, and Google Scholar. Key words included "anesthesia" and/or "ebola" combined with "surgery," "intubation," "laryngoscopy," "bronchoscopy," "stethoscope," "ventilation," "ventilator," "phlebotomy," "venous cannulation," "operating room," "personal protection," "equipment," "aerosol," "respiratory failure," or "needle stick." No language or date limits were applied. We also included secondary-source data from government organizations and scientific societies such as the Centers for Disease Control and Prevention, World Health Organization, American Society of Anesthesiologists, and American College of Surgeons. Articles were reviewed for primary-source data related to inpatient management of Ebola cases as well as evidence-based management guidelines and protocols for the care of Ebola patients in the operative room, infection control, and health care worker personal protection. Two hundred thirty-six articles were identified using the aforementioned terminology in the scientific database search engines. Twenty articles met search criteria for information related to inpatient Ebola virus disease management or animal virology studies as primary or secondary sources. In addition, 9 articles met search criteria as tertiary sources, representing published guidelines. The recommendations developed in this article are based on these 29 source documents. Anesthesia-specific literature regarding the care of Ebola patients is very limited. Secondary-source guidelines and policies represent the majority of available information. Data from controlled animal experiments and tuberculosis patient research provide some evidence for the existing recommendations and identify future guideline considerations.

Infection Prevention Measures for Surgical Procedures during a Middle East Respiratory Syndrome Outbreak in a Tertiary Care Hospital in South Korea

“…Because the N95 may fit inadequately if worn for a long time or after movement during surgery, wearing PAPR will be more beneficial. However, unlike HCWs dealing with Ebola virus, impermeable and fluid-resistant gowns are not required because body fluids are not infectious as with Ebola virus diseases 9,28,35,36 .…”

Anesthetist and pandemic: Past and present

“…The majority of the cases and fatalities were reported from these 3 countries but a small number of cases have also been reported from Nigeria, Mali, Senegal, the United States, and Europe [ 26 ]. Anaesthetists were at the frontline and played an important role while managing the complications of the Ebola virus [ 27 ]. This outbreak has shown the importance of quick control measures and safe medical practices that can minimize the transmission of the virus.…”

Ebola Infection in Pregnancy: A Global Perspective and Lessons Learned

“…Pain control should be offered and given with close coordination with anesthesia providing available options. Neuraxial anesthesia may represent high rates of complications as EVD may lead to thrombocytopenia 20 . Little data exists on whether delivery improves or worsens morbidity though case reports demonstrate that some patients survived EVD after expectant management of intrauterine fetal death 21,22 .…”