Corona Virus Disease (COVID 19) is a respiratory infection caused by SARS-CoV-2 or COVID 19 virus which struck the world in November 2019 rapidly spreading and attaining the form of a pandemic by March 2020.The disease was officially named as Coronavirus Disease-2019 (COVID-19) by WHO on February 11, 2020.Spread is predominantly through respiratory droplet and close contacts with infected individuals. Airborne transmission is possible during aerosol generating medical procedures as the virus is abundantly present in nasopharyngeal, salivary secretions and body fluids of affected patients. During the pre-peaking, peak and plateau phase of the epidemic, non-emergency surgeries and invasive procedures took a backseat as all resources of healthcare providers were put to combat the disease. As the pandemic fades away the need of adapting the healthcare facilities and restarting elective surgeries has to be addressed. In this article we try to highlight the various challenges faced by the surgeons, anesthetists and healthcare professionals to restart elective surgical work. The strategies to overcome these hurdles are also discussed.

Background and aims: Middle ear surgeries can be done under local anesthetic infiltration and titrated dose of sedation. Use of supplemental intravenous sedative hypnotic drugs for these surgeries under local anesthesia can enhance patient comfort and increase acceptance of this technique. Our study was aimed to compare Propofol and Midazolam in equipotent doses for conscious sedation in middle ear surgeries Methods and material: After approval from the Institutional Ethics committee, 60 patients from ASA grade 1 and 2 scheduled for middle ear surgery (Tympanoplasty, mastoidectomy) under local anesthesia were randomly allocated into two groups to receive either Propofol (Group I) or Midazolam (Group II) for conscious sedation. Both the groups received premedication and sedation with 1.5 mcg /kg Fentanyl, Group 1 received Inj. Propofol bolus dose of 0.5-1 mg/Kg I.V, followed by infusion at the rate of 1.5-4.5 mg/kg/hour, to attain a sedation score of 3 and additional bolus doses were given as and when required to maintain a sedation score of 3. Group 2 received Inj. Midazolam bolus dose 0.03 to 0.05 mg/kg I.V followed by infusion at the rate of 0.03 to 0.06 mg/kg/hour to attain a sedation score of 3 and additional bolus doses as and when required to maintain a sedation score of 3. All the patients in both the groups received oxygen by nasal prongs at the flow rate of 4L/min from the start of sedation. Heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, oxygen saturation was noted at basal level and at an interval of 2 minutes and later every 5 mins for 30 mins then every 15 mins till end of surgery. Result: The results were analyzed using student’s 't’ test and chi square test wherever appropriate. Results: Pulse rate at 30th minute of sedation was not significantly different from the basal value among both the groups. Mean systolic blood pressure (SBP) in Propofol group was 121.33mmHg and 117.27mmHg among Midazolam group at basal which was comparable and the difference was not significant. Mean diastolic blood pressure was 78.47mmHg in Propofol group and 78.07mmHg among Midazolam group at basal which was comparable and the difference was not significant. Mean respiratory rate (breaths/min) among Propofol and Midazolam group were 16.83 and 16.70 respectively at basal which was comparable and the difference was not significant. Mean arterial oxygen saturation (%) among Propofol and Midazolam group were and 98.0 and 98.07 respectively at basal which was comparable and the difference was not significant. Conclusions: After the start of sedation mean diastolic blood pressure did not show any significant change in both the groups throughout the procedure. After the start of sedation mean respiratory rate and arterial oxygen saturation did not show any significant change in both the groups. Both Propofol and Midazolam are equally safe with respect to hemodynamic effects when used in titrated doses.