Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan,

TEAS is a safe noninvasive adjunctive intervention for anesthesia management among patients undergoing VATS lobectomy. TEAS at 2/100 Hz can reduce intraoperative opioid dosage and slow the decrease of PaO during one-lung ventilation. It can also effectively reduce pain score, extubation time, and PACU stay immediately after surgery. Further, 100 Hz TEAS can reduce PONV morbidity.

Background: Inadvertent intraoperative hypothermia increases the risk of adverse events, but its related risk factors have not been defined in video-assisted thoracoscopic surgery (VATS). This study aimed at analyzing the prevalence and factors related to inadvertent intraoperative hypothermia in adults undergoing elective VATS under general anesthesia. Methods: This was a retrospective study using data from the Peking University People's Hospital from January through December, 2018. Data were collected on age, sex, height, weight, American Society of Anesthesiologists physical status, the duration of preparation and surgery, timing of surgery, surgery types, anesthesia types, intraoperative core temperature and the length of stay (LOS) in the hospital from the electronic database in our center. Patients were covered with a cotton blanket preoperatively and the surgical draping during the operation. A circulation-water warming mattress set to 38°C were placed under the body of the patients. Inadvertent intraoperative hypothermia was identified as a core temperature monitored in nasopharynx < 36°C. Multivariate logistic regression analysis was used to identify independent risk factors of hypothermia. Results: We found that 72.7% (95% CI 70.5 to 75.0%) of 1467 adult patients who underwent VATS suffered hypothermia during surgery. The factors associated with inadvertent intraoperative hypothermia included age (OR = 1.23, 95% CI 1.11 to 1.36, p < 0.001), BMI (OR = 1.83, 95% CI 1.43 to 2.35, p < 0.001), the duration of preparation (OR = 1.01, 95% CI 1.00 to 1.02, p = 0.014), the duration of surgery (OR = 2.10, 95% CI 1.63 to 2.70, p < 0.001), timing of surgery (OR = 1.64, 95% CI 1.28 to 2.12, p < 0.001), ambient temperature in the operating room (OR = 0.67, 95% CI 0.53 to 0.85, p = 0.001) and general anesthesia combined with paravertebral block after induction of anesthesia (OR = 2.30, 95% CI 1.31 to 4.03, p = 0.004). The average LOS in the hospital in the hypothermia group and the normothemic group was 9 days and 8 days, respectively (p < 0.001). Conclusions: We highlight the high prevalence of inadvertent intraoperative hypothermia during elective VATS and identify key risk factors including age, duration of surgery more than 2 h, surgery in the morning and general anesthesia combined with paravertebral block (PVB) after intubation. We also find that hypothermia did prolong the LOS in the hospital.

The clinical application of lung ultrasound (LUS) in the assessment of coronavirus disease 2019 (COVID-19) pneumonia severity remains limited. Herein, we investigated the role of LUS imaging in COVID-19 pneumonia patients and the relationship between LUS findings and disease severity. This was a retrospective, observational study at Tongji Hospital in Wuhan, on 48 recruited patients with COVID-19 pneumonia, including 32 non-critically ill patients and 16 critically ill patients. LUS was performed and the respiratory rate oxygenation (ROX) index, disease severity, and confusion, urea nitrogen, respiratory rate, blood pressure and age (CURB-65) score were recorded on days 0–7, 8–14, and 15–21 after symptom onset. Lung images were divided into 12 regions, and the LUS score (0–36 points) was calculated. Chest computed tomography (CT) scores (0–20 points) were also recorded on days 0–7. Correlations between the LUS score, ROX index, and CURB-65 scores were examined. LUS detected COVID-19 pneumonia in 38 patients. LUS signs included B line (34/38, 89.5%), consolidation (6/38, 15.8%), and pleural effusion (2/41, 5.3%). Most cases showed more than one lesion (32/38, 84.2%) and involved both lungs (28/38, 73.7%). Compared with non-critically ill patients, the LUS scores of critically ill patients were higher (12 (10–18) vs 2 (0–5), p < 0.001). The LUS score showed significant negative correlations with the ROX index on days 0–7 ( r = –0.85, p < 0.001), days 8–14 ( r = –0.71, p < 0.001), and days 15–21 ( r = –0.76, p < 0.001) after symptom onset. However, the LUS score was positively correlated with the CT score ( r = 0.82, p < 0.001). The number of patients with LUS-detected lesions decreased from 27 cases (81.8%) to 20 cases (46.5%), and the LUS scores significantly decreased from 4 (2–10) to 0 (0–5) ( p < 0.001) from days 0–7 to 17–21. We conclude that LUS can detect lung lesions in COVID-19 pneumonia patients in a portable, real-time, and safe manner. Thus, LUS is helpful in assessing COVID-19 pneumonia severity in critically ill patients.