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Background: The coronavirus disease 2019 (COVID-19) pandemic has become an increasingly challenging problem throughout the world. Because of the numerous potential modes of transmission, surgeons and all procedural staff represent a unique population that requires standardized procedures to protect themselves and their patients. Although several protocols have been implemented during other infectious disease outbreaks, such as Ebola virus, no standardized protocol has been published in regard to the COVID-19 pandemic. Methods: A multidisciplinary team of two surgeons, an anesthesiologist, and an infection preventionist was assembled to create a process with sterile attire adapted from the National Emerging Special Pathogen Training and Education Center (NETEC) donning and doffing process. After editing, a donning procedure and doffing procedure was created and made into checklists. The procedures were simulated in an empty operating room (OR) with simulation of all personnel roles. A ''dofficer'' role was established to ensure real-time adherence to the procedures. Results: The donning and doffing procedures were printed as one-page documents for easy posting in ORs and procedural areas. Pictures from the simulation were also obtained and made into flow chart-style diagrams that were also posted in the ORs. Conclusions: Coronavirus disease 2019 (COVID-19) is a quickly evolving pandemic that has spread all over the globe. With the rapid increase of infections and the increasing number of severely ill individuals, healthcare providers need easy-to-follow guidelines to keep themselves and patients as safe as possible. The processes for donning and doffing personal protective equipment (PPE) presented here provide an added measure of safety to surgeons and support staff to provide quality surgical care to positive and suspected COVID-19-positive patients.

Management of acute perioperative pain in the geriatric patient can be challenging as the physiologic and pharmacokinetic changes associated with aging may predispose older patients to opioid-related side effects. Furthermore, elderly adults are more susceptible to postoperative delirium and postoperative cognitive dysfunction, which may be exacerbated by both poorly controlled postoperative pain and commonly used pain medications. This narrative review summarizes the literature published in the past 10 years for several nonopioid analgesics commonly prescribed to the geriatric patient in the perioperative period. Nonopioid analgesics are broken down as follows: medications prescribed throughout the perioperative period (acetaminophen and nonsteroidal antiinflammatory drugs), medications limited to the acute perioperative setting (N-methyl-D-aspartate receptor antagonists, dexmedetomidine, dexamethasone, and local anesthetics), and medications to be used with caution in the geriatric patient population (gabapentinoids and muscle relaxants). Our search identified 1757 citations, but only 33 specifically focused on geriatric analgesia. Of these, only 21 were randomized clinical trials‚ and 1 was a systematic review. While guidance in tailoring pain regimens that focus on the use of nonopioid medications in the geriatric patient is lacking, we summarize the current literature and highlight that some nonopioid medications may extend benefits to the geriatric patient beyond analgesia. (Anesth Analg 2022;135:290-306) GLOSSARY AChEI = acetylcholinesterase inhibitor; AGS = American Geriatric Society; ALT = alanine aminotransferase; ANS = autonomic nervous system; AV = atrioventricular; CBF = cerebral blood flow; CINAHL = Cumulative Index to Nursing and Allied Health Literature; C max = maximum plasma concentration; CNS = central nervous system; COX = cyclooxygenase; CVA = cerebrovascular accident; ED = effective dose; ER = extended release; FDA = US Food and Drug Administration; GABA = gamma-aminobutyric acid; GFR = glomerular filtration rate; GI = gastrointestinal; ICU = intensive care unit; IM = intramuscular; IR = immediate release; IV = intravenous; LOS = length of stay; MA = meta-analysis; MAOIs = monoamine oxidase inhibitors; MeSH = Medical Subject Heading; MI = myocardial ischemia; NAPQI = N-acetyl-p-benzoquinone imine; NMDA = N-methyl-d-aspartate; NO = nitric oxide; NSAIDs = nonsteroidal anti-inflammatory drugs; PGE2 = prostaglandin E2; POCD = postoperative cognitive dysfunction; POD = postoperative day; PONV = postoperative nausea and vomiting; PPI = proton pump inhibitor; PRISMA = Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RBF = renal blood flow; RCT = randomized controlled trial; SA = sinoatrial; SAH = subarachnoid hemorrhage; SE = side effects; T 1/2 = half-life; TKA = total knee arthroplasty; V d = volume of distribution Chronic Pain Medicine E NArrAtiVe reView Article

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