The Role of Locoregional Anesthesia in the Covid-19 Pandemic

Abstract

<jats:p>Coronavirus disease 2019 (COVID-19) refers to the respiratory tract infection caused by the newly emergent coronavirus SARS-CoV-2. The present pandemic, declared on the 11th of March 2020, was first recognized in Wuhan city, and rapidly spread throughout China and other countries, including Portugal. Regional anesthesia should be considered whenever surgery is planned for a patient with suspected or confirmed COVID-19, as it minimizes not only airway management, the intervention with the highest risk of aerosolization, but also potential personnel contamination and patient recovery time, while maximizing operation room efficiency. Anesthesia techniques should be aimed at preventing airway manipulation such as endotracheal intubation, which is associated with a higher risk of pulmonary complications in infected patients. These recommendations are structured in pre-, intra-, and post-operative management in suspected or confirmed infected patients with SARS-CoV-2, based in local hospital infection committee recommendations and the most recent literature available regarding regional anaesthesia. They are aimed at anesthesiology personnel, with the main goals being both teamand patient safety. The SARS-CoV-2 virus will be not the last novel virus to trigger global pandemics, so having a well-structured regional anesthesia plan to manage this kind of cases will ensure the best outcome possible to both patients and the perioperative team.</jats:p>

Keratinocyte Skin Cancers in General Surgery: The Impact of Anaesthesia, Trainee Supervision, and Choice of Reconstruction

“…is study reports on the achieved surgical margins of excision of keratinocyte cancers across a wide range of locations. e rate of positive margin or incomplete excision was higher than recent publications of both SCC and BCC [4][5][6].…”

“…Preoperative identification of high-risk subtype BCC would potentially substantially reduce the rate of incomplete excision by more accurate preoperative marking and operative planning. In addition, head and neck regions are often challenging to achieve high rates of complete excision with adequate margins [4].…”

Supplemental oxygen in surgical patients with COVID-19

“…Also, some particles are small enough to stay in the air for hours, particularly in operating rooms where negative pressure is not available. Similar to that suggested by Mendes et al [2], we consider that the use of N95 respirators (instead of surgical masks) can be very useful to limit particles spread. The question is, should the N95 respirator be placed on or under the oxygen mask?…”

Coagulation concerns in patients with COVID-19 proposed for regional anesthesia

“…Recently, we published practice recommendations about regional anesthesia in patients with suspected or confirmed COVID-19. 1 Many anesthesiogists have embraced regional anesthetic techniques during the COVID-19 crisis due it presumed physiological benefits as well as possible reductions in transmission risks. There may be some unique characteristics of the coagulation state of patients with COVID-19 that we thought merited a communication.…”

“…2 Therefore, preoperative platelet count and coagulation assays should be considered for all patients scheduled for neuraxial or profound blocks, with postoperative re-testing if a perineural catheter is used in the previous locations. 1 A platelet count above 75,000/mL is an acceptable level for performing neuraxial techniques in obstetric patients. 3 In select circumstances of obstetric anesthesia, platelet count between 50 and 80,000/ mL may still allow neuraxial block.…”