Perioperative Considerations In Urgent Surgical Care and Operating Room Practice and Guidance During COVID-19 Pandemic; Our Experiences

Ayhan Sahin; Ahmet Gültekin; Gülcan Gücer Şahin; İlker Yıldırım; Cengiz Mordeniz; Cavidan Arar

doi:10.37696/nkmj.771489

Research Article

Perioperative Considerations In Urgent Surgical Care and Operating Room Practice and Guidance During COVID-19 Pandemic; Our Experiences

Year 2020, Volume: 8 Issue: 3, 303 - 313, 20.12.2020

Ayhan Sahin , Ahmet Gültekin , Gülcan Gücer Şahin , İlker Yıldırım , Cengiz Mordeniz Cavidan Arar

https://doi.org/10.37696/nkmj.771489

Abstract

Background: The novel coronavirus SARS-CoV-2 (COVID-19) can infect healthcare workers. We developed an institutional algorithm to protect operating room team members during the COVID-19 pandemic and rationally conserve personal protective equipment (PPE). We aimed to review the latest data on the COVID-19 pandemic and essential information for practice in emergency surgery and the operating room.
Study Design: An interventional platform (operating room, interventional suite, and endoscopy) with our committee formed with our doctors consisting of different branches, we developed our guidelines based on potential patterns of spread, risk of exposure, and conservation of PPE. We aimed to share our experiences with 128 patients who were taken into operation in a 2-month period.
Interventions: Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in Medical Faculty of Namık Kemal University
Results: A decision tree algorithm describing our institutional guidelines for precautions for operating room team members was created. This algorithm is based on the urgency of operation, anticipated viral burden at the surgical site, the opportunity for a procedure to aerosolize virus, and the likelihood a patient could be infected based on symptoms and testing.
Conclusions: Despite COVID-19 being a new threat, we have shown that by developing an easy-to-follow decision algorithm for the interventional platform teams, we can ensure optimal healthcare worker safety.

Keywords

COVID-19, Cross-infection, infection control, operating room, viral pneumonia.

References

1- World Health Organization. Coronavirus disease 2019 (COVID-19) situation reportd81. Available from, https:// www.who.int/docs/default-source/coronaviruse/situation-reports/20200413-sitrep-84-COVID-19.pdf. [Accessed 13 April 2020]
2- Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020. https://doi.org/10.1056/NEJMoa2002032. Advance Access Published February 28
3- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497e506
4- Van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020. [Epub ahead of print].
5- Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145-151. DOI:10.3760/cma.j.issn.0254-6450.2020.02.003
6- Yang W, Cao Q, Qin L, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): a multi-center study in Wenzhou city, Zhejiang, China. J Infect 2020; 80: 388e93
7- Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth 2020. https://doi.org/10.1007/s12630-020-01591-x. Advance Access Published February 12
8. Sorbello M, El- Boghdadly K, Di Giacinto I, Cataldo R, Es- posito C, Falcetta S et al. The Italian coronavirus disease 2019 outbreaks: recommendations from clinical practice. Anaesthesia 2020. Doi: 10.1111/anae.15049.
9. Wong J, Goh QY, Tan Z et al. Preparing for a COVID-19 pandemic: A review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth. 2020;Mar 11. DOI:10.1007/s12630-020-01620-9. [Epub ahead of print]
10. Warren J, Sundaram K, Anis H, et al. Spinal anesthesia is associated with decreased complications after total knee and hip arthroplasty. J Am Acad Orthop Surg. 2020;28:e213- e221. DOI: 10.5435/JAAOS-D- 19-00156.
11. Faculty of Intensive Care Medicine, Intensive Care Society, Association of Anaesthetists, The Royal College of Anaesthetists. Personal protective equipment (PPE) for clinicians. 2020; March 27. Available at: https://icmanaesthesiacovid-19.org/personal
12. American Society of Anesthesiologists. UPDATE: the use of personal protective equipment by anesthesia professionals during the COVID-19 pandemic. 2020; Mar 22. Available at: https://www.asahq.org/about-asa/newsroom/news-releases/2020/03/update the use of personal protective equipment by anesthesia professionals during the COVID-19-pandemic. Accessed March 30, 2020.
13. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease in 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta. 2020;13:145-8. DOI: 10.1016/j.cca.2020.03.022. [Epub ahead of print].
14. Filatov A, Sharma P, Hindi F, Espinosa PS. Neurological complications of coronavirus disease (COVID- 19): encephalopathy. Cureus. 2020;12(3): e7352. DOI:10.7759/cureus.7352.
15. Chen R, Zhang Y, Huang L, Cheng BH, Xia ZY, Meng QT. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing cesarean delivery: a case series of 17 patients. Can J Anaesth. 2020; 2020 Mar 16. DOI: 10.1007/s12630-020-01630-7. [Epub ahead of print]. 16.El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: Current perspectives. Local Reg Anesth. 2018;11:35-44. DOI: 10.2147/LRA.S154512.
17. Meng L, Qiu H, Wan L, et al. Intubation and ventilation amid the COVID-19 outbreak: Wuhan's experience. Anesthesiology. 2020; Mar 26. DOI: 10.1097/ALN.0000000000003296. [Epub ahead of print].
18. Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases [published online ahead of print, 2020 Feb 26]. Radiology. 2020;200642. DOI:10.1148/radiol.2020200642
19. Kokkinakis I, Selby K, Favrat B, Genton B, Cornuz J. Performance du frottis nasopharyngé-PCR pour le diagnostic du Covid-19 - Recommandations pratiques sur la base des premières données scientifiques [Covid-19 diagnosis : clinical recommendations and performance of nasopharyngeal swab-PCR]. Rev Med Suisse. 2020;16(689):699-701.
20. Deng SQ, Peng HJ. Characteristics of and Public Health Responses to the Coronavirus Disease 2019 Outbreak in China. J Clin Med. 2020;9(2):575. Published 2020 Feb 20. DOI:10.3390/jcm9020575

COVID-19 Pandemi Sırasındaki Acil Cerrahi Bakım ve Ameliyathane Uygulamalarında Perioperatif Uygulama ve Rehberlik; Deneyimlerimiz

Year 2020, Volume: 8 Issue: 3, 303 - 313, 20.12.2020

Ayhan Sahin , Ahmet Gültekin , Gülcan Gücer Şahin , İlker Yıldırım , Cengiz Mordeniz Cavidan Arar

https://doi.org/10.37696/nkmj.771489

Abstract

Amaç: Yeni koronavirüs SARS-CoV-2 (COVID-19) sağlık çalışanlarını enfekte edebilir. COVID-19 salgını sırasında ameliyathane ekip üyelerini korumak ve rasyonel olarak kişisel koruyucu ekipman (KKD) korumak için kurumsal bir algoritma geliştirdik. Acil cerrahi ve ameliyathanede COVID-19 salgını ile ilgili en güncel bilgileri gözden geçirmeyi amaçladık.
Metot: Farklı branşlardan oluşan doktorlarımızla oluşturduğumuz komitemiz ile girişimsel bir platform (ameliyathane, girişimsel ve endoskopi), potansiyel yayılma örüntüleri, maruz kalma riski ve KKD'nin korunmasına dayanan kılavuzlarımızı geliştirdik. Deneyimlerimizi 2 aylık bir sürede ameliyat edilen 128 hasta ile paylaşmayı amaçladık.
Girişimler: 2019-nCoV şüphesi olan hastalar için acil durum prosedürleri için anestezi yönetimi ve enfeksiyon kontrol kılavuzları Namık Kemal Üniversitesi Tıp Fakültesi'nde hazırlanmış ve uygulanmıştır.
Bulgular: Ameliyathane ekibi üyelerine yönelik önlemler için kurumsal yönergelerimizi açıklayan bir karar algoritması oluşturuldu. Bu algoritma ameliyatın aciliyetine, cerrahi bölgede beklenen viral yüke, virüsü aerosol haline getirme prosedürü fırsatına ve hastanın semptomlara ve testlere dayanarak enfekte olma olasılığına dayanır.
Sonuçlar: COVID-19'un yeni bir tehdit olmasına rağmen, girişimsel platform ekipleri için izlemesi kolay bir karar algoritması geliştirerek, optimum sağlık çalışanı güvenliğini sağlayabildiğimizi gösterdik.

Keywords

COVID-19, enfeksiyon kontrolü, ameliyathane, bulaş, vral pnömoni

References

1- World Health Organization. Coronavirus disease 2019 (COVID-19) situation reportd81. Available from, https:// www.who.int/docs/default-source/coronaviruse/situation-reports/20200413-sitrep-84-COVID-19.pdf. [Accessed 13 April 2020]
2- Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020. https://doi.org/10.1056/NEJMoa2002032. Advance Access Published February 28
3- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497e506
4- Van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020. [Epub ahead of print].
5- Epidemiology Working Group for NCIP Epidemic Response, Chinese Center for Disease Control and Prevention. Zhonghua Liu Xing Bing Xue Za Zhi. 2020;41(2):145-151. DOI:10.3760/cma.j.issn.0254-6450.2020.02.003
6- Yang W, Cao Q, Qin L, et al. Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19): a multi-center study in Wenzhou city, Zhejiang, China. J Infect 2020; 80: 388e93
7- Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth 2020. https://doi.org/10.1007/s12630-020-01591-x. Advance Access Published February 12
8. Sorbello M, El- Boghdadly K, Di Giacinto I, Cataldo R, Es- posito C, Falcetta S et al. The Italian coronavirus disease 2019 outbreaks: recommendations from clinical practice. Anaesthesia 2020. Doi: 10.1111/anae.15049.
9. Wong J, Goh QY, Tan Z et al. Preparing for a COVID-19 pandemic: A review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth. 2020;Mar 11. DOI:10.1007/s12630-020-01620-9. [Epub ahead of print]
10. Warren J, Sundaram K, Anis H, et al. Spinal anesthesia is associated with decreased complications after total knee and hip arthroplasty. J Am Acad Orthop Surg. 2020;28:e213- e221. DOI: 10.5435/JAAOS-D- 19-00156.
11. Faculty of Intensive Care Medicine, Intensive Care Society, Association of Anaesthetists, The Royal College of Anaesthetists. Personal protective equipment (PPE) for clinicians. 2020; March 27. Available at: https://icmanaesthesiacovid-19.org/personal
12. American Society of Anesthesiologists. UPDATE: the use of personal protective equipment by anesthesia professionals during the COVID-19 pandemic. 2020; Mar 22. Available at: https://www.asahq.org/about-asa/newsroom/news-releases/2020/03/update the use of personal protective equipment by anesthesia professionals during the COVID-19-pandemic. Accessed March 30, 2020.
13. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease in 2019 (COVID-19) infections: A meta-analysis. Clin Chim Acta. 2020;13:145-8. DOI: 10.1016/j.cca.2020.03.022. [Epub ahead of print].
14. Filatov A, Sharma P, Hindi F, Espinosa PS. Neurological complications of coronavirus disease (COVID- 19): encephalopathy. Cureus. 2020;12(3): e7352. DOI:10.7759/cureus.7352.
15. Chen R, Zhang Y, Huang L, Cheng BH, Xia ZY, Meng QT. Safety and efficacy of different anesthetic regimens for parturients with COVID-19 undergoing cesarean delivery: a case series of 17 patients. Can J Anaesth. 2020; 2020 Mar 16. DOI: 10.1007/s12630-020-01630-7. [Epub ahead of print]. 16.El-Boghdadly K, Pawa A, Chin KJ. Local anesthetic systemic toxicity: Current perspectives. Local Reg Anesth. 2018;11:35-44. DOI: 10.2147/LRA.S154512.
17. Meng L, Qiu H, Wan L, et al. Intubation and ventilation amid the COVID-19 outbreak: Wuhan's experience. Anesthesiology. 2020; Mar 26. DOI: 10.1097/ALN.0000000000003296. [Epub ahead of print].
18. Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases [published online ahead of print, 2020 Feb 26]. Radiology. 2020;200642. DOI:10.1148/radiol.2020200642
19. Kokkinakis I, Selby K, Favrat B, Genton B, Cornuz J. Performance du frottis nasopharyngé-PCR pour le diagnostic du Covid-19 - Recommandations pratiques sur la base des premières données scientifiques [Covid-19 diagnosis : clinical recommendations and performance of nasopharyngeal swab-PCR]. Rev Med Suisse. 2020;16(689):699-701.
20. Deng SQ, Peng HJ. Characteristics of and Public Health Responses to the Coronavirus Disease 2019 Outbreak in China. J Clin Med. 2020;9(2):575. Published 2020 Feb 20. DOI:10.3390/jcm9020575

There are 19 citations in total.

Details

Primary Language	English
Subjects	Clinical Sciences
Journal Section	Orginal Article
Authors	Ayhan Sahin 0000-0002-3539-2353 Ahmet Gültekin 0000-0003-4570-8339 Gülcan Gücer Şahin 0000-0002-6587-867X İlker Yıldırım 0000-0002-4245-1163 Cengiz Mordeniz This is me 0000-0001-9427-777X Cavidan Arar 0000-0003-1952-427X
Publication Date	December 20, 2020
Published in Issue	Year 2020 Volume: 8 Issue: 3

Cite

APA	Sahin, A., Gültekin, A., Gücer Şahin, G., Yıldırım, İ., et al. (2020). Perioperative Considerations In Urgent Surgical Care and Operating Room Practice and Guidance During COVID-19 Pandemic; Our Experiences. Namık Kemal Tıp Dergisi, 8(3), 303-313. https://doi.org/10.37696/nkmj.771489
AMA	Sahin A, Gültekin A, Gücer Şahin G, Yıldırım İ, Mordeniz C, Arar C. Perioperative Considerations In Urgent Surgical Care and Operating Room Practice and Guidance During COVID-19 Pandemic; Our Experiences. NKMJ. December 2020;8(3):303-313. doi:10.37696/nkmj.771489
Chicago	Sahin, Ayhan, Ahmet Gültekin, Gülcan Gücer Şahin, İlker Yıldırım, Cengiz Mordeniz, and Cavidan Arar. “Perioperative Considerations In Urgent Surgical Care and Operating Room Practice and Guidance During COVID-19 Pandemic; Our Experiences”. Namık Kemal Tıp Dergisi 8, no. 3 (December 2020): 303-13. https://doi.org/10.37696/nkmj.771489.
EndNote	Sahin A, Gültekin A, Gücer Şahin G, Yıldırım İ, Mordeniz C, Arar C (December 1, 2020) Perioperative Considerations In Urgent Surgical Care and Operating Room Practice and Guidance During COVID-19 Pandemic; Our Experiences. Namık Kemal Tıp Dergisi 8 3 303–313.
IEEE	A. Sahin, A. Gültekin, G. Gücer Şahin, İ. Yıldırım, C. Mordeniz, and C. Arar, “Perioperative Considerations In Urgent Surgical Care and Operating Room Practice and Guidance During COVID-19 Pandemic; Our Experiences”, NKMJ, vol. 8, no. 3, pp. 303–313, 2020, doi: 10.37696/nkmj.771489.
ISNAD	Sahin, Ayhan et al. “Perioperative Considerations In Urgent Surgical Care and Operating Room Practice and Guidance During COVID-19 Pandemic; Our Experiences”. Namık Kemal Tıp Dergisi 8/3 (December 2020), 303-313. https://doi.org/10.37696/nkmj.771489.
JAMA	Sahin A, Gültekin A, Gücer Şahin G, Yıldırım İ, Mordeniz C, Arar C. Perioperative Considerations In Urgent Surgical Care and Operating Room Practice and Guidance During COVID-19 Pandemic; Our Experiences. NKMJ. 2020;8:303–313.
MLA	Sahin, Ayhan et al. “Perioperative Considerations In Urgent Surgical Care and Operating Room Practice and Guidance During COVID-19 Pandemic; Our Experiences”. Namık Kemal Tıp Dergisi, vol. 8, no. 3, 2020, pp. 303-1, doi:10.37696/nkmj.771489.
Vancouver	Sahin A, Gültekin A, Gücer Şahin G, Yıldırım İ, Mordeniz C, Arar C. Perioperative Considerations In Urgent Surgical Care and Operating Room Practice and Guidance During COVID-19 Pandemic; Our Experiences. NKMJ. 2020;8(3):303-1.

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