Urgent surgery for COVID-19–positive pediatric patient

Abstract

Background We present a case of COVID-19–positive pediatric patient for urgent urological surgery by spinal anesthesia to avoid aerosolizing procedure. Case presentation A 12-year-old, COVID-19–positive boy presented for urgent wound incision and drainage at the circumcision site. Our anesthetic plan consisted of spinal anesthesia with sedation. He was transported from the COVID-19 isolation floor to the negative pressure operating room. He was placed in lateral decubitus position and oxygen was delivered through facemask. Under sedation, spinal anesthesia was achieved at first attempt. The patient maintained spontaneous ventilation without airway intervention. Patient was recovered in the operation room then transported back to the floor. Conclusion Spinal anesthesia is a safe alternative to general endotracheal anesthesia for many pediatric urology procedures. Effective team communication and preparation are keys when caring COVID-19–positive patient in perioperative setting to avoid minimize the risk to healthcare providers.

Surgical outcomes inchildren with perioperative SARS-CoV-2 diagnosis

“…Basnet et al advocated for conservative management of acute appendicitis in infected children as a safer alternative for treatment 17 . A case report described spinal anesthesia as a safe alternative to general tracheal anesthesia in certain contexts of pediatric surgery to avoid the risks of infection to staff and pulmonary injury to patients 18 . However, Matava determined that endotracheal intubation may be performed safely on infected patients with proper precautions 19 .…”

Circumcision - Advances and New Perspectives

“…He was placed in a lateral decubitus position and oxygen was delivered through a facemask. Under sedation, spinal anesthesia was achieved at the first attempt as a safe alternative to general endotracheal anesthesia [65].…”

An evaluation of spinal anesthesia results in pediatric patients undergoing pilonidal sinus surgery: a retrospective study

“…2, 3 However, both anesthesiologists and surgeons have traditionally been reluctant to apply SpA in the pediatric population. 4 A survey study revealed that the unwillingness to apply SpA for routine pediatric surgical procedures is multifactorial in nature. One factor that possibly contributes to such reluctance among surgeons may be the idea that SpA is technically difficult and entails a longer preoperative time.…”