Airborne Infections and Emergency Surgery

Abstract

COVID-19 which emerged in Wuhan, China has rapidly spread all over the globe and the World Health Organisation has declared it a pandemic. COVID-19 disease severity shows variation depending on demographic characteristics like age, history of chronic illnesses such as cardio-vascular/renal/respiratory disease; pregnancy; immune-suppression; angiotensin converting enzyme inhibitor medication use; NSAID use etc but the pattern of disease spread is uniform – human to human through contact, droplets and fomites. Up to 3.5% of health care workers treating COVID-19 contact an infection themselves with 14.8% of these infections severe and 0.3% fatal. The situation has spread panic even among health care professionals and the cry for safe patient care practices are resonated world-wide. Surgeons, anesthesiologists and intensivists who very frequently perform endotracheal intubation, tracheostomy, non-invasive ventilation and manual ventilation before intubation are at a higher odds ratio of 6.6, 4.2, 3.1 and 2.8 respectively of contacting an infection themselves. Elective surgery is almost always deferred in fever/infection scenarios. A surgeon and an anesthesiologist can anytime encounter a situation where in a COVID-19 patient requires an emergency surgery. COVID-19 cases requiring surgery predispose anesthesiologists and surgeons to cross-infection threats. This paper discusses, the COVID-19 precautionary outlines which has to be followed in the operating room; personal protective strategies available at present; methods to raise psychological preparedness of medical professionals during a pandemic; conduct of anesthesia in COVID-19 cases/suspect cases; methods of decontamination after conducting a surgery for COVID-19 case in the operating room; and post-exposure prophylaxis for medical professionals.

Effect of Heat and Moisture Exchange Filter on the Dead Space Ventilation in a Pediatric Patient

“…8,9 If we had used only one sampling line, placed at the machine end of the HMEF, as a practice advised and observed during the pandemic times to prevent the sampling line contamination, we would have missed or delayed the diagnosis of CO 2 retention which, in turn, could have dreadful implications in a case of intracranial lesion. 5 Furthermore, identification of the cause of CO 2 retention may have been more difficult and may have necessitated circuit disconnection and AMBU ventilation while checking the circuit patency again. This would have caused OR contamination during the COVID-19 pandemic.…”

“…1 Further, the capnography line is advised to be put on the proximal port of the HMEF, to avoid its contamination. 5 However, the use of HMEF is associated with several issues such as risk of obstruction, increase in airway resistance, increase in the dead space ventilation, etc. Hypercapnia with HMEF use in pediatric patient remains a concern due to the dead space ventilation.…”

Telepain During the COVID-19 Pandemic

“…In January of 2020, whisperings of the mysterious respiratory illness began. By March 20 th the Minnesota Governor declared a state of emergency, banning all elective surgeries (Suresh, 2021). Despite the surgical ban (in Minnesota), our APMT resources and consultations remained available to all hospitalized patients within our health system.…”