Impact of SARS-CoV-2 (COVID-19) on emergency abdominal surgery at a tertiary colorectal centre

Résumé fourni par la source

Central neuraxial anaesthesia and sedation (CNA+Sed) for lower limb free-tissue transfer (LLFTT) surgery is an established technique in our unit with excellent patient reported experiences [1] Unplanned conversion to general anaesthesia is undesirable, albeit unavoidable in certain situations, with an unclear incidence in orthopaedic patients Methods We reviewed a single consultant's series of 85 consecutive LLFTT orthoplastic operations performed under CNA+Sed since 2007 to present The cases were analysed prospectively, learning points extracted and technique modified accordingly Results All procedures, but one, were performed for osteomyelitis, the majority of FTTs (69%) being to the contralateral leg Procedures took up to 14 5 h with a mean of 8 8 h All free flaps, but one, were successful All 85 CNAs were performed or supervised by the same anaesthetist Two cases required general anaesthesia in the anaesthetic room (AR): in one, epidural anaesthesia (EA) was abandoned after three bloody taps and replaced by general anaesthesia and nerve blocks;in the other - the patient requested general anaesthesia due to anxiety after the combined spinal-epidural (CSE) was sited Of the remaining 83 cases, there were four (4 8%) unplanned theatre conversions to general anaesthesia Our initial technique was CSE due to perceived benefits of fast onset of CNA In the first stage of the technique evolution (17 CSEs), there were three (17 6%) unplanned general anaesthesia conversions Case 1 developed a cough during microsurgery In cases 2 and 3, EA was insufficient once the spinal had worn off After three conversions, we moved from CSE to EA in 2009, with only one further unplanned theatre conversion in the remaining 66 cases in the studied series (1 5%) Case 4 became hypertensive and bradycardic during microsurgery, complaining of stiffness and back pain;the physiological parameters settled under general anaesthesia Discussion Prolonged orthoplastic procedures can be compared to long haul flights A good bilateral EA is necessary for a smooth flight Unplanned general anaesthesia conversions are particularly undesirable in the current COVID-19 era, while at the same time COVID-19 has highlighted the additional benefits of CNA wherever possible [2] As part of informed consent, patients are warned of the risk of conversion to general anaesthesia for patient, surgeon or anaesthetic reasons This series charts the evolution of our technique of choice Our experience of unplanned conversions has encouraged us to abandon the spinal component of CNA+Sed and use EA+Sed, with demonstrable quality improvement

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