In a crisis, be aware of the danger – but recognize the opportunity. – John F. Kennedy
The coronavirus disease (COVID-19) has posed challenges to healthcare systems globally and will do so for even years. The disease’s risk for both patients and healthcare workers has transformed medical practice. However, anesthesiologists are given the chance to provide the safest type of anesthesia to the patients, simultaneously safeguarding themselves and other OT staff from being susceptible to the virus.
Many studies have shown decreased incidence of intra and postoperative complications in COVID patients undergoing surgery under regional anesthesia and reduced transmission of the disease to the theatre personnel.
The European and American Societies of Regional Anaesthesia have jointly declared COVID-19 recommendations stating that regional anaesthesia should be the best choice compared to general anaesthesia whenever possible. Besides, recommendations for performing regional anaesthesia during the pandemic have been published. The Royal College of Anaesthetists and Association of Anaesthetists also suggest using regional anaesthesia where possible and safe in order to safeguard primary drugs required at the time of critical care of COVID-19 patients.
Routine investigations as per hospital protocol are done. Consent for regional anesthesia and the possibility of conversion to GA should be explained to the patients
COVID-19–infected patients should be offered care in the operating area and in an airborne-infection isolation room for better results. Operation of the patients can be carried out in a positive pressure room provided there are steps to avoid airflow from the operating room.
Regional anaesthesia procedures are not regarded as aerosol-generating, and hence droplet precautionary measures are not generally suggested. But every staff should wear N95 masks equipped with PPE suits if possible. Patients are supposed to wear surgical facemasks to avoid the disease spread.
The delivery mode and oxygen flow rate impact the chances of aerosol generation and its travelling distance; hence, the oxygen flow should be maintained to a minimum to keep saturation, simultaneously decreasing aerosol generation.
Maintain only the necessary equipment, and safeguard the equipment with plastic covers at the time of procedure.
There should be extensive testing for block success so that emergency conversion to general anaesthesia is avoided. Viral filters can be applied to carry out respiratory monitoring.
1) Increased chances of developing DVTin postoperative patients due to decreased mobility
2) COVID-positive patients inherently are at high risk of developing both arterial and venous thrombosis.
As supporters of regional anaesthesia, we encourage the rise in usage of regional anaesthesia at the time of pandemic. Despite the extra advantages to healthcare workers and the hospital, the patient must always stay at the process area. At this time of uncertainty, regional anaesthesia is more favored. Well-defined regional anaesthesia standards and guidance must still be diligently taken into account, and best practices should be given more importance so that nothing is detrimental.
Dr. Mohamed Najibullah Consultant Anesthesiologist Department of Anesthesiology & Pain Management Kauvery Hospital, Chennai
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