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LETTERS TO EDITOR
Year : 2020  |  Volume : 64  |  Issue : 9  |  Page : 807-809  

Operative procedures performed during SARS-Cov-2 pandemic: Safe for patients and health care workers under appropriate guidelines


Department of Anaesthesia, Symbiosis Medical College for Women, Symbiosis International University, Pune, Maharashtra, India

Date of Submission03-Jun-2020
Date of Decision23-Jun-2020
Date of Acceptance14-Aug-2020
Date of Web Publication01-Sep-2020

Correspondence Address:
Mona S Jadhav
Department of Anaesthesia, Symbiosis Medical College for Women, Symbiosis International University, Pune - 412 115, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_699_20

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How to cite this article:
Jadhav MS. Operative procedures performed during SARS-Cov-2 pandemic: Safe for patients and health care workers under appropriate guidelines. Indian J Anaesth 2020;64:807-9

How to cite this URL:
Jadhav MS. Operative procedures performed during SARS-Cov-2 pandemic: Safe for patients and health care workers under appropriate guidelines. Indian J Anaesth [serial online] 2020 [cited 2020 Dec 1];64:807-9. Available from: https://www.ijaweb.org/text.asp?2020/64/9/807/294079



Sir,

Since the government of India elevated its response to unprecedented severe acute respiratory syndrome (SARS-Cov-2) pandemic, Indian Council of Medical Research (ICMR) has asked to postpone elective surgeries till pandemic is over in order to focus on managing SARS-Cov-2 pandemic. As per ICMR guidelines, emergency procedures should be performed even without SARS-Cov-2 testing.[1]

There is a long list of patients waiting for elective surgeries and we need to consider safety of patients and health care workers (HCW). There are American Society of Anesthesiologists and Anaesthesia Patient Safety Foundation recommendations for assessing all patients for SARS-Cov-2 by reverse transcription polymerase chain reaction preoperatively.[2] These recommendations have been suggested possibly based on current knowledge about SARS-Cov-2.

As per latest guidelines by ICMR, rapid antigen test (Std Q COVID-19 Ag) to be done for asymptomatic patients undergoing aerosol-generating surgical/nonsurgical interventions, which includes elective/emergency surgical procedures like neurosurgery, ear- nose- throat (ENT) surgery, dental procedures; nonsurgical interventions like bronchoscopy, upper gastrointestinal endoscopy, and dialysis.[3]

Few retrospective reports from Wuhan, China and other countries have shown higher morbidity in patients undergoing surgical procedures during incubation period.[4],[5] Due to these initial reports, there was reluctancy in medical fraternity about going ahead with surgical/nonsurgical interventions. As we are going through a rapidly changing situation that has not been experienced before, we need evidence-based data to formulate recommendations and guidelines for the same.

At our institute, we have done a retrospective analysis of all the patients (total no = 84) who came for emergency surgery during the early phase of pandemic between March 22, 2020 and May 13, 2020. Once patient was hospitalised for emergency surgery, history of sign and symptoms suggestive of SARS-Cov-2 was taken. If there was any positive history suggestive of SARS-Cov-2, patient was referred to physician for further evaluation. Throat swab was sent for testing, and emergency procedure was performed as per recommendations for SARS-Cov-2 positive patients. Further these patients were managed as per test report. Patients without any positive history were proceeded for surgery with appropriate personal protective equipments for all HCW. We analysed data for preoperative history of SARS-Cov-2 symptoms, types of emergency procedures, type of anaesthesia given, and perioperative symptoms of SARS-Cov-2 among patients and HCW.

Data was analysed using percentage analysis.

The retrospective analysis of patients' data (total no = 84) who underwent emergency procedures at our institute during SARS-Cov-2 pandemic between March 22 and May 13, 2020 is as follows:

The [Figure 1] shows distribution of types of procedures.
Figure 1: Pie chart showing distribution of types of procedure in percentages

Click here to view


As per available recommendations, anaesthesia was central neuraxial (89.33%) and regional block for majority of patients to reduce aerosol-generating procedures and for remaining patients, general anaesthesia (8.33%) was given. [Table 1] is showing perioperative COVID- 19 incidence. Our observations showed that no patient had symptoms of SARS-Cov-2 in postoperative period. No healthcare worker showed symptoms of SARS-Cov-2.
Table 1: Perioperative incidence of SARS-Cov-2

Click here to view


As initial reports from other countries [4],[5] showed unexpected morbidity and fatalities, our observations do not report any perioperative morbidity or mortality. Retrospective analysis of data suggest that it is safe to operate asymptomatic patients in SARS-Cov-2 pandemic under proper guidelines.[6],[7]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Indian Council of Medical Research Strategy for Covid19 testing in India (version 4, dated 09/04/2020). Available from: https://icmr.nic.in/sites/default/files/upload_documents/Strategey_for_COVID19_Test_v4_09042020.  Back to cited text no. 1
    
2.
American Society of Anesthesiologists (ASA) and Anesthesia. Patient Safety Foundation (APSF) joint statement on perioperative testing for the COVID-19 virus.” Anesthesia Patient Safety Foundation (29 Apr. 2020). Available from: www.apsf.org/news-updates/asa-and-apsf-joint-statement-on-perioperative-testing-for-the-covid-19-virus/. [Last accessed on 2020 Jun 01].  Back to cited text no. 2
    
3.
ICMR recommends use of rapid antigen test kits for diagnosis. Jun 15, 2020-Rapid antigen test kit is a rapid chromatographic immunoassay for qualitative detection of specific antigens to SARS-CoV-2.  Back to cited text no. 3
    
4.
Lei S, Jiang F, Su W, Chen C, Chen J, Mei W, et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine 2020;21:100331.  Back to cited text no. 4
    
5.
Aminian A, Safari S, Razeghian-Jahromi A, Ghorbani M, Delaney CP. COVID-19 outbreak and surgical practice: Unexpected fatality in perioperative period. Ann Surg 2020 ;272 : e27-9.  Back to cited text no. 5
    
6.
Bajwa SJ, Mehdiratta L. Preparedness for emergencies and complications: Proactive planning and multidisciplinary approaches. Indian J Anaesth 2020; 64:366-8.  Back to cited text no. 6
  [Full text]  
7.
Malhotra N, Bajwa SJ, Joshi M, Mehdiratta L, Trikha A. COVID operation theatre- advisory and position statement of Indian Society of Anaesthesiologists (ISA National). Indian J Anaesth 2020; 64:355-62.  Back to cited text no. 7
  [Full text]  


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