Awake Rhinology Surgery in Response to the COVID-19 Pandemic in Europe

Andrews, Peter; Anschuetz, Lukas; Baptista, Peter; Bast, Florian; Beule, Achim G.; Carpentier, J.-P.; Fitzgerald, Deirdre; Furtado, Luis Miguel Pinto Correia; Knox, Barton; Marzetti, Andrea; Perkins, Nora; Randhawa, Premjit S

doi:10.1159/000517155

Cited by 5 publications

(5 citation statements)

References 26 publications

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“…Andrews et al developed recommendations to explain and help clinicians to adopt local anesthesia for rhinology procedures and shorten waiting times and hospital stay during the COVID-19 period (10).…”

Section: Resultsmentioning

confidence: 99%

“…The surgical procedure delay was also associated with a worse surgical outcome. Thus, awake rhinological surgery represents a valid alternative, reducing expenditure, shortening hospitalization, minimizing expense for future treatments, and reducing the use of operating theaters, which aren't required in the setting of an awake procedure (10).…”

Section: Discussionmentioning

confidence: 99%

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Awake Breast Surgery: A Systematic Review

VANNI,

COSTANZO,

PELLICCIARO

et al. 2023

In Vivo

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Background/Aim: Awake surgery has become a valid alternative to general anesthesia in many surgery fields. This technique played a very important role during the COVID-19 period. The growing use of this technique has many advantages. We performed a systematic review to study the potentialities of awake breast surgery. Materials and Methods: We searched Pubmed, Embase, and Cochrane library database and retrieved a total of 109 records. Fortynine of them were excluded as unsuitable. Finally, we selected a total of 12 records concerning different types of studies for topic appropriateness. Three reviewers reviewed independently each record. Results: Five articles analyzing the sustainability of awake surgery during the COVID-19 period were selected. In addition, one article analyzing the impact on the immune system and six articles and eight case reports analyzing anesthetic techniques were also selected. The studies analyzing awake breast surgery during the COVID-19 period showed advantages in terms of sustainability and length of hospitalization. The study analyzing the immune response after awake breast surgery showed lesser lymphocyte response than the general anesthesia group. The studies analyzing anesthetic techniques in awake breast surgery showed that the nerve blocks allow good level of safety and postoperative pain control. Conclusion: The awake breast surgery and fast track implementation shortened hospital stays and reduced costs, without influencing the surgical results. Furthermore, awake breast surgery reduced surgical stress compared to general anesthesia. Among the various anesthetic techniques, nerve blocks are the most advantageous in terms of safety and efficacy compared to epidural anesthesia.Historically, surgery mainly required support with general anesthesia. The practice of surgical interventions on awake patients under local anesthesia, with or without mild sedation, has gained popularity in recent years. Awake surgery is currently proposed for surgical procedures in which the patient was previously expected to be intubated. Surgery with local anesthesia on an awake patient is a valid alternative for different types of surgery such as hand surgery, neurosurgery, spinal surgery, and cardiac surgery. In all these, awake surgery appears to be advantageous in terms of costs, associated symptoms, and recovery after surgery, without increasing the surgical burden on the patient or on the result of the operation (1-4).In neurosurgery, awake strategy can be used in intraoperative brain mapping. In these cases, many techniques such as local 1412

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Awake Breast Surgery: A Systematic Review

VANNI,

COSTANZO,

PELLICCIARO

et al. 2023

In Vivo

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“…The spread of the coronavirus disease 2019 (COVID-19) resulted in significant changes in the management of otorhinolaryngologic cases. In particular, functional surgeries including BDET were often canceled or postponed to allow for sufficient healthcare resources to be attributed to infected patients, as well as emergency and oncological surgeries ( 11 ). Despite the closure of operating theaters and reduction of healthcare resources, in-office procedures remained available.…”

Section: Introductionmentioning

confidence: 99%

In-office Eustachian tube balloon dilation under local anesthesia as a response to operating room restrictions associated with the COVID-19 pandemic

et al. 2023

Self Cite

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ObjectiveTo evaluate the feasibility of local anesthesia for Eustachian tube balloon dilation as an in-office procedure for the treatment of Eustachian tube dilatory dysfunction as a response to the restriction measures of the coronavirus disease 2019 pandemic.MethodPatients with Eustachian tube dilatory dysfunction refractory to nasal steroids undergoing Eustachian tube balloon dilation in local anesthesia were enrolled in a prospective observational cohort between May 2020 and April 2022. The patients were assessed by using the Eustachian tube dysfunction questionnaire (ETDQ-7) score and Eustachian tube mucosal inflammation scale. They underwent clinical examination, tympanometry, and pure tone audiometry. Eustachian tube balloon dilation was performed in-office under local anesthesia. The perioperative experience of the patients was recorded using a 1–10 visual analog scale (VAS).ResultsThirty patients (47 Eustachian tubes) underwent the operation successfully. One attempted dilation was aborded because the patient displayed anxiety. Local anesthesia was performed by using topical lidocaine and nasal packing for all patients. Three patients required an infiltration of the nasal septum and/or tubal nasopharyngeal orifice. The mean time of the operation was 5.7 min per Eustachian tube dilation. The mean level of discomfort during the intervention was 4.7 (on a 1–10 VAS scale). All patients returned home immediately after the intervention. The only reported complication was a self-limiting subcutaneous emphysema.ConclusionEustachian tube balloon dilation can be performed under local anesthesia and is well tolerated by most patients. In the patients reported in this study, no major complications occurred. In order to free operation room capacities, the intervention can be performed in an in-office setting with satisfactory patient feedback.

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“…For example, the cancellation of elective surgeries during the early wave of the pandemic, and potentially from future waves, creates a surgical backlog, of which rhinologic procedures are likely at the tail end. 7 Such delays can negatively impact patients and result in worsened quality of life and outcomes. 3 , 7 Furthermore, rhinologic procedures are often aerosol-generating procedures (AGPs), thereby further increasing the risk for infection among providers and warranting research on effective preventative strategies.…”

Section: Introductionmentioning

confidence: 99%

“… 7 Such delays can negatively impact patients and result in worsened quality of life and outcomes. 3 , 7 Furthermore, rhinologic procedures are often aerosol-generating procedures (AGPs), thereby further increasing the risk for infection among providers and warranting research on effective preventative strategies. In addition, clinical management needs to be considered as sensory disorders resulting from SARS-CoV-2 are also hallmarks of certain rhinologic conditions.…”

Section: Introductionmentioning

confidence: 99%