GI = gastrointestinal; HMEF = heat and moisture exchanging filter; HSCT = hematopoietic stem cell transplant; ICU = intensive care unit; IL-6 = Interleukin 6; JAKi = Janus kinase inhibitors; LFTs = liver function tests; MERS-CoV = Middle East respiratory syndrome coronavirus; OR = operating rooms; PACU = postanesthesia care unit; PAPR = powered air-purifying respirator; PPE = personal protective equipment; RSV = human respiratory syncytial virus; SARS = severe acute respiratory syndrome; SARS-CoV-2 = severe acute respiratory syndrome coronavirus 2; TIL = tumor-infiltrating lymphocytes; VEGF = vascular endothelial growth factor The novel Coronavirus Disease 2019 (COVID-19) was first reported in China in December 2019. Since then, it has spread across the world to become one of the most serious life-threatening pandemics since the influenza pandemic of 1918. This review article will focus on the specific risks and nuanced considerations of COVID-19 in the cancer patient. Important perioperative management recommendations during this outbreak are emphasized, in addition to discussion of current treatment techniques and strategies available in the battle against COVID-19.

BACKGROUND: We describe the implementation of enhanced recovery after surgery (ERAS) programs designed to minimize postoperative nausea and vomiting (PONV) and pain and reduce opioid use in patients undergoing selected procedures at an ambulatory cancer surgery center. Key components of the ERAS included preoperative patient education regarding the postoperative course, liberal preoperative hydration, standardized PONV prophylaxis, appropriate intraoperative fluid management, and multimodal analgesia at all stages. METHODS: We retrospectively reviewed data on patients who underwent mastectomy with or without immediate reconstruction, minimally invasive hysterectomy, thyroidectomy, or minimally invasive prostatectomy from the opening of our institution on January 2016 to December 2018. Data collected included use of total intravenous anesthesia (TIVA), rate of PONV rescue, time to first oral opioid, and total intraoperative and postoperative opioid consumption. Compliance with ERAS elements was determined for each service. Quality outcomes included time to first ambulation, postoperative length of stay (LOS), rate of reoperation, rate of transfer to acute care hospital, 30-day readmission, and urgent care visits ≤30 days. RESULTS: We analyzed 6781 ambulatory surgery cases (2965 mastectomies, 1099 hysterectomies, 680 thyroidectomies, and 1976 prostatectomies). PONV rescue decreased most appreciably for mastectomy (28% decrease; 95% confidence interval [CI], –36 to –22). TIVA use increased for both mastectomies (28%; 95% CI, 20-40) and hysterectomies (58%; 95% CI, 46-76). Total intraoperative opioid administration decreased over time across all procedures. Time to first oral opioid decreased for all surgeries; decreases ranged from 0.96 hours (95% CI, 2.1-1.4) for thyroidectomies to 3.3 hours (95% CI, 4.5 to –1.7) for hysterectomies. Total postoperative opioid consumption did not change by a clinically meaningful degree for any surgery. Compliance with ERAS measures was generally high but varied among surgeries. CONCLUSIONS: This quality improvement study demonstrates the feasibility of implementing ERAS at an ambulatory surgery center. However, the study did not include either a concurrent or preintervention control so that further studies are needed to assess whether there is an association between implementation of ERAS components and improvements in outcomes. Nevertheless, we provide benchmarking data on postoperative outcomes during the first 3 years of ERAS implementation. Our findings reflect progressive improvement achieved through continuous feedback and education of staff.

Background and Objectives Remifentanil infusion is used as an intraoperative anesthetic for thyroidectomy, but has been associated with acute opioid tolerance and hyperalgesia. A national shortage of remifentanil provided an opportunity to study postoperative pain in patients undergoing thyroidectomy. Methods Retrospective review of prospectively collected data from an outpatient surgery center. Primary analysis compared patients treated before and after remifentanil shortage. Results Median postoperative opioid consumption was 20 morphine milligram equivalents (MMEs) among those treated in the high‐dose period and 15 MMEs in the low‐dose period. Remifentanil/weight received was a significant predictor of requiring a postoperative narcotic (P = .006). Total non‐remifentanil narcotics administered were equivalent but patients in the low dose period received higher amounts of intraoperative long‐acting narcotics. Conclusions Remifentanil infusion for thyroid surgery is associated with higher postoperative pain and postoperative narcotics requirement. While a hyperalgesia state is possible, shifting of longer‐acting narcotics from intraoperative to postoperatively is also supported.

Nurses providing surgical care in nonobstetrical ambulatory surgery centers or specialty hospitals without traditional lactation resources may need to care for patients who are breastfeeding. Nurses in these settings play an important role in supporting and protecting the breastfeeding relationship for nursing mothers separated from their infants during illness or surgical procedures. It is important for care providers to understand how hospitalization and the medications administered before, during, and after a surgical procedure affect mothers who are breastfeeding their infants. This article examines the effects of hospitalization on breastfeeding and focuses on preoperative and postoperative care considerations, including medication use, radiology imaging, interrupting and resuming breastfeeding, breast assessment, and milk storage.