The management of "fragile" and suspected COVID-19 surgical patients during pandemic: an Italian single-center experience

Romanzi, Andrea; Moroni, Rossella; Rongoni, Erica; Scolaro, Roberta; Regina, Davide La; Mongelli, Francesco; Putortì, Antonella; Rossi, Fabrizio; Zanardo, Michel; Vannelli, Alberto

doi:10.23736/s0026-4733.20.08466-7

Cited by 4 publications

(2 citation statements)

References 19 publications

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“…Continuous epidural analgesia was administered with an elastomeric pump. The protocols for the administration of CSE anaesthesia and the elastomeric pump settings adhered to the routine clinical practice in our institution (5,6).…”

Section: Awake Laparotomymentioning

confidence: 99%

Pain Distraction During Awake Major Colorectal Surgery: Supporting Patients Beyond the COVID-19 Era. Preliminary Findings

et al. 2021

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Introduction: During the coronavirus disease 2019 (COVID-19) pandemic, hospitals rapidly ran out of intensive care beds. Because minimally invasive surgery and general anaesthesia are both aerosol-generating procedures, their use has become controversial. We report a case series of awake undelayable colorectal surgeries which, innovatively, took advantage of intraoperative pain distraction. Moreover, we describe our frugal solution to social distancing in psychological support of inpatients.Methods: Between October 2020 and February 2021, five patients underwent acute-care colorectal surgery under locoregional anaesthesia in our department. A 3D mobile theatre (3DMT) was used during the operation to distract the patients from pain. Vital signs, pain intensity, ergonomic comfort/discomfort, sense of presence and distress were intraoperatively monitored. A postoperative “cuddle delivery” service was instituted: video messages from relatives and close friends were delivered daily to the patient through the 3DMT. Emotional effects were investigated through clinical interviews conducted by a psychologist at our hospital.Results: Both intraoperative and postoperative pain were always well controlled. Conversion to general anaesthesia and postoperative intensive support/monitoring were never necessary. The “cuddle delivery” initiative helped patients fill the emotional gap created by the strict containment measures implemented inside the hospital, distracting them from emotional anxiety and physical pain.Conclusions: During the next phase of the COVID-19 pandemic and even after the COVID-19 era, awake laparotomy under locoregional anaesthesia may be a crucial option for delivering acute-care surgery to selected patients when intensive care beds are unavailable and postponing surgery is unacceptable. We also introduce a new modality for the provision of emotional support during postoperative inpatient care as a countermeasure to the restrictions imposed by social distancing measures.

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Section: Awake Laparotomymentioning

confidence: 99%

Pain Distraction During Awake Major Colorectal Surgery: Supporting Patients Beyond the COVID-19 Era. Preliminary Findings

et al. 2021

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“…Loco regional Anesthesia appears as a precious alternative to GA for patients presenting fragile cardiovascular and respiratory reserves and in whom GA would presumably increase morbidity and mortality in such pandemics such as COVID 19. [18][19][20]…”

Section: Snomentioning

confidence: 99%

Locoregional Anesthesia for Major Abdominal Surgeries during COVID-19 Outbreak: An Experience in a Tertiary Care Hospital of Kathmandu, Nepal

et al. 2021

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Introduction: Locoregional Anesthesia (LA) has many benefits over general anaesthesia in major abdominal surgeries with high risks including avoidance of endotracheal intubation thus avoiding aerosol contamination during coronavirus disease 2019 (COVID-19). Methods: A retrospective analysis was performed among patients undergone major abdominal surgery under loco regional anesthesia during April 2019 and March 2020 in 750 bedded tertiary care hospital during COVID- 19 pandemic. In all cases, locoregional anesthesia (spinal, epidural, or combined spinal-epidural anesthesia) was performed. Intraoperative and postoperative complications were monitored and was analyzed. Results: A total of twenty-four cases were included during the study period. Among the cases, majority of cases belonged to Gastrointestinal, n=17(70.83%). The mean operative time was 94 minutes (minimum 55 minutes; maximum 168 minutes). None of the cases required conversion to general anesthesia. Postoperative pain was always well controlled. None of them required postoperative intensive care support. No perioperative major complications (Clavien–Dindo ≥3) occurred. Three cases were found to be infected with COVID -19 infection postoperatively. Conclusion: Our study showed that major abdominal surgeries under loco regional anesthesia resulted feasible, safe, painless, and, in specific cases, was the only viable option. In such a pandemic, it could become a vital strategy to avoid contamination among Health care workers (HCWs) and could limit viral transmission inside theatres.

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COVID-19 and surgery

DEZZANI¹

2022

Chirurgia

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The management of "fragile" and suspected COVID-19 surgical patients during pandemic: an Italian single-center experience

Cited by 4 publications

References 19 publications

Pain Distraction During Awake Major Colorectal Surgery: Supporting Patients Beyond the COVID-19 Era. Preliminary Findings

Pain Distraction During Awake Major Colorectal Surgery: Supporting Patients Beyond the COVID-19 Era. Preliminary Findings

Locoregional Anesthesia for Major Abdominal Surgeries during COVID-19 Outbreak: An Experience in a Tertiary Care Hospital of Kathmandu, Nepal

COVID-19 and surgery

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