Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) Position Statement and Advisory for the Practice of Neuroanesthesia during COVID-19 Pandemic

Abstract

<jats:title>Abstract</jats:title><jats:p>The coronavirus disease 2019 (COVID-19) is a major health emergency in today’s time. In December 2019, a cluster of pneumonia cases in Wuhan, China was attributed to a novel coronavirus. The World Health Organization declared it as a pandemic. As the majority of the cases suffering from COVID-19 are mildly symptomatic or asymptomatic, it becomes a great challenge to identify the infected persons in the absence of extensive testing. In the hospital environment, it can infect several other vulnerable patients and healthcare providers, significantly impacting the hospital services. Anesthesiologists are at an increased risk of COVID-19 transmission from the patients, as they are frequently involved in several aerosol-generating procedures. It is not possible to identify asymptomatic COVID-19 patients solely based on history-taking during their first point of contact with the anesthesiologists at the preanesthetic checkup clinic.</jats:p><jats:p>Most of the neurosurgical conditions are of urgent in nature and cannot be postponed for a longer duration. In view of this, the position statement and practice advisory from the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) provides guidance to the practice of neuroanesthesia in the present scenario. The advisory has been prepared considering the current disease status of the COVID-19 pandemic, available literature, and consensus from experts in the field of neuroanesthesiology. Since the pandemic is still progressing and the nature of the disease is dynamic, readers are advised to constantly look for updated literature from ISNACC and other neurology and neurosurgical societies.</jats:p>

Implicaciones en Neuroanestesia durante la pandemia por COVID-19

“…Estratificar la necesidad quirúrgica en: emergente, urgente y electiva, estado COVID-19 (positivo, sospechoso o negativo), gravedad de la infección, riesgo de transmisión/infección 19,21 , incluida la prioridad de neurocirugía oncológica 33 y considerar EPP en 3 niveles según riesgos de la cirugía. 34 Separar casos positivos, negativos y sospechosos y posponer pacientes positivos hasta que los resultados sean negativos, siempre que sea posible 23,28 ; en neurocirugía de emergencia/urgencia y accidentes cerebrovasculares (ACV) deben ser tratados como COVID-19 positivo hasta que se demuestre lo contrario. [31][32] 14% de pacientes con COVID-19 requieren oxígeno (O 2 ) y al menos 5% ingreso en la unidad de cuidados intensivos (UCI), intubación traqueal (IT) y ventilación mecánica (VM).…”

“…21,38 Es importante consultar las recomendaciones de intubación y manejo perioperatorio de pacientes con COVID-19. 5,7,39,40 Se deben establecer objetivos claros y protocolizados de ventilación mecánica, manejo hemodinámico y sistémico por las condiciones clínicas críticas de los pacientes, quienes pueden presentar lesión miocárdica asociada o manifestaciones cardiovasculares, mayor riesgo de inestabilidad hemodinámica 27,28 y menor tolerancia a la hipoxemia.…”

“…26 A nivel internacional, las sociedades y grupos de neuroanestesia han establecido consenso de expertos y guías de recomendaciones para el manejo del paciente neuroquirúrgico, mediante el uso de algoritmos en emergencias neurológicas, reconversión hospitalaria y toma de decisiones conforme a las necesidades cambiantes de la pandemia. 18,25,27,28 El objetivo de este trabajo es presentar una serie de recomendaciones con base en la evidencia científica actual y la literatura disponible sobre las implicaciones para neuroanestesiólogos y el manejo anestésico perioperatorio del paciente neurocrítico y neuroquirúrgico durante la pandemia por COVID-19. Se propone una guía de estratificación con ejemplos, tiempo máximo y recomendaciones para el procedimiento, así como un algoritmo de apoyo para la programación de estos pacientes (Tabla 1 y Figura 1).…”

Sedation and Anesthesia for Magnetic Resonance Imaging during the COVID-19 Pandemic: Perspective

“…MRI study is mostly an elective procedure and may be postponed when possible. 5 All stakeholders should understand implications of conducting MRI during the pandemic. Need for sedation/anesthesia should also be judiciously considered.…”

Neuroanesthesia Practice during COVID-19: A Single-Center Experience

“…National and international guidelines, recommendations, and position statements help in the risk stratification, prioritization, and scheduling of neurosurgery and neurointervention procedures. [2][3][4][5][6][7] Our hospital is a tertiary care center located in suburban Mumbai. We present our experience of anesthetic management of 143 patients (76 neurosurgical and 67 neurointerventional) who underwent emergency and urgent procedures between March 25 and June 25, 2020 (►Table 1 and ►Fig.…”