Comparative analysis of the anaesthesia management of gynecological operations between the normal period and COVID-19 pandemic

Year 2021, , 220 - 226, 14.07.2021

Havva Esra Uyar Türkyılmaz , Nihan Aydın Güzey

https://doi.org/10.38053/acmj.928198

Abstract

Aim
In the novel coronavirus (2019-nCoV/SARS-CoV-2) disease 2019 (COVID-19) pandemic period, one of the major objectives of the anaesthesia team was providing quality care for patients whose procedures cannot (or can no longer) be postponed while limiting the risk of contamination of these patients and healthcare professionals. The aim of this study is to analyse and document the changes in anaesthesia management of gynecological operations in accordance with this objective during the pandemic period.
Methods
A retrospective observational study was conducted on patients who had gynecological operation from 01.09.2019 to 31.12.2020. Anaesthetic management of gynecological operations corresponding to the pandemic process (After Pandemic Group) were compared with anaesthetic management of gynecological operations from the before the pandemic process (Before Pandemic Group) . Anaesthesia records of the patients were examined. The following parameters are recorded: Surgery type, indication of the surgery, urgency of the surgery and anaesthesia method performed, airway management of the patients, used medications for the anaesthesia management.

Results
There was an increment in the percentage of operations performed with regional anaesthesia after the start of the pandemic. There was a statistically significant decrement in the percentage of operations performed with laparoscopic technique after the start of the pandemic. There was an increment in the percentage of operations with oncologycal or suspected oncologycal indications after the start of the pandemic; there was no difference in the percentage of urgent surgeries while there was a decrement in the percentage of operations with elective indications.
Conclusion
By taking alterations and fluctations in community prevalence into consideration, decisions about cancellation of surgeries must be made dynamically. Possibility of COVID-19 infection must be considered in every patient. In anaesthesia management, regional anaesthesia methods may be considered in appropriate cases. Proper PPE must be used if airway manipulations are needed.

Keywords

COVID-19, gynecological operations, anaesthesia management

References

• Mahase E. Covid-19: WHO declares pandemic because of “alarming levels” of spread, severity, and inaction. BMJ 2020; 368: 1036.
• Liu Y, Yan LM, Wan L, et al. Viral dynamics in mild and severe cases of COVID-19. Lancet Infect Dis 2020; 6: 656-7.
• Lin Q, Abraham M, Wen D, et al. Management of gynecology patients during the coronavirus disease 2019 pandemic: Chinese expert consensus. Am J Obstet Gynecol 2020; 223: 3-8.
• Wang J, Du G. COVID-19 may transmit through aerosol. Ir J Med Sci 2020; 189: 1143-4.
• Greenland JR, Michelow MD, Wang L, London MJ. COVID-19 infection: implications for perioperative and critical care physicians. Anesthesiology 2020; 132: 1346-61.
• Chang D, Xu H, Rebaza A, Sharma L, Dela Cruz CS. Protecting healthcareworkers from subclinical coronavirus infection. Lancet Respir Med 2020; 8: 13.
• Iacobucci G. Covid-19: all non-urgent elective surgery is suspended for at least three monthsin England. BMJ 2020 Mar 18; 368: m1106.
• Inslee orders halt to elective surgeries and dental services to reserve critical equipment for COVID-19 health care workers. Washington Governor Jay Inslee; 2020. Accessed,https://www.governor.wa.gov/news-media/inslee-ordershalt-elective-surgeries-and-dental-services-reserve-critical-equipment. [Accessed 3 April 2020].
• Fowler AJ, Dobbs TD, Wan YI, Laloo R, Hui S. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg 2021; 108: 97-103.
• Keles E, Akis S, Öztürk UK, Özyürek EŞ, Api M. Gynecological surgeries during the COVID‐19 pandemic in Turkey. Int J Gynecol Obstet 2020; 151: 141–62.
• Xia Y, Jin R, Zhao J, et al. Risk of COVID-19 for cancer patients. Lancet Oncol 2020; 21: 181.
• Thomakos N, Pandraklakis A, Bisch SP, et al. Int J Gynecol Cancer 2020; 30: 728–9.
• The European Network of Gynaecological Cancer Advocacy Groups. ESGO-ENGAG e-survey: perspective of gynecological cancer patients during COVID-19 pandemia, 2020. Available: https://engage.esgo.org/esgo-engage-survey perspectivegynecological-cancer-patients-covid-19-pandemia. [Accessed 26 May 2020].
• ESGE. Recommendations on gynaecological laparoscopic surgery during covid-19 outbreak. https://esge.org/wpcontent/uploads/2020/03/ Covid19 Statement ESGE .pdf; 2020.
• Alhazzani W, Møller MH, Arabi YM, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med 2020; 46: 854-87.
• World Health Organization. Coronavirus disease (COVID-19) technical guidance: infection prevention and control.https://www.who.int/emergencies/ diseases/novel-coronavirus-2019/technical-guidance/infection-prevention-and-control.
• Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS ONE 2012; 7: e35797.
• Lie SA, Wong SW, Wong LT, Wong TGL, Chong SY. Practical considerations forperforming regional anesthesia: lessons learned from the COVID-19 pandemic. Can J Anesth Can Anesth 2020; 67: 885-92.
• Zhong Q, Liu YY, Luo Q, et al. Spinal anaesthesia for patients with coronavirus disease 2019 and possible transmission rates in anaesthetists:retrospective, single-centre, observational cohort study. Br J Anaesth 2020; 124: 670-5.
• Uppal V, Sondekoppam RV, Lobo CA, Kolli S, Kalagara HKP. Practice recommendations on neuraxial anesthesia and peripheral blocks during the COVID-19 pandemic, ASRA/ESRA COVID-19 Guidance for Regional Anesthesia March 31, 2020 www.asra.com/covid-19/radguidance
• Zheng MH, Boni L, Fingerhut A. Minimally invasive surgery and the novel coronavirus outbreak: lessons learned in China and Italy. Ann Surg 2020; 272: 5-6