scholarly journals Anesthetic Management of Pulmonary Metastatectomy in a Patient Infected with Novel Corona Virus SARS-CoV-2

2021 ◽  
Author(s):  
Mohammed J Al-Naabi ◽  
Madan M Maddali ◽  
Karima RS Al Aliyani ◽  
Ahmed Al-Balushi
Keyword(s):  
Anesthetic Management ◽  
Lung Ventilation ◽  
Pulmonary Metastasectomy ◽  
Protective Equipment ◽  
Chain Reaction ◽  
One Lung Ventilation ◽  
Anesthesia Management ◽  
Aerosol Generation ◽  
Thoracic Surgical Procedures ◽  
Polymerase Chain

Prioritization of individual patients for thoracic surgeries gained importance during the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic to ensure optimal utilization of resources. We report the successful anesthesia management of an urgent pulmonary metastasectomy in an elderly patient despite him testing positive for real-time reverse transcription–polymerase chain reaction [rRT-PCR] on two occasions.  The rationale behind acceptance of the case for surgery and the precautions taken for reducing aerosol generation during the various stages of anesthesia are highlighted. Keywords: COVID-19; SARS-CoV-2; Coronavirus Infections; One-Lung Ventilation; Personal Protective Equipment; Aerosols; Thoracic Surgical Procedures

scholarly journals Detection of Airborne Severe Acute Respiratory Syndrome (SARS) Coronavirus and Environmental Contamination in SARS Outbreak Units

2005 ◽  
Vol 191 (9) ◽  
pp. 1472-1477 ◽  
Author(s):  
Timothy F. Booth ◽  
Bill Kournikakis ◽  
Nathalie Bastien ◽  
Jim Ho ◽  
Darwyn Kobasa ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Environmental Contamination ◽  
Respiratory Protection ◽  
Chain Reaction ◽  
Air Samples ◽  
Aerosol Generation ◽  
Hygiene Practices ◽  
Viral Aerosol ◽  
Polymerase Chain ◽  
Droplet Transmission

Abstract Severe acute respiratory syndrome (SARS) is characterized by a risk of nosocomial transmission; however, the risk of airborne transmission of SARS is unknown. During the Toronto outbreaks of SARS, we investigated environmental contamination in SARS units, by employing novel air sampling and conventional surface swabbing. Two polymerase chain reaction (PCR)–positive air samples were obtained from a room occupied by a patient with SARS, indicating the presence of the virus in the air of the room. In addition, several PCR-positive swab samples were recovered from frequently touched surfaces in rooms occupied by patients with SARS (a bed table and a television remote control) and in a nurses’ station used by staff (a medication refrigerator door). These data provide the first experimental confirmation of viral aerosol generation by a patient with SARS, indicating the possibility of airborne droplet transmission, which emphasizes the need for adequate respiratory protection, as well as for strict surface hygiene practices

scholarly journals Aerosol-generating procedures in thoracic surgery in the COVID-19 era in Malaysia

2020 ◽  
Vol 28 (8) ◽  
pp. 495-499
Author(s):  
Narasimman Sathiamurthy ◽  
Narendran Balasubbiah ◽  
Benedict Dharmaraj
Keyword(s):  
Polymerase Chain Reaction ◽  
Thoracic Surgery ◽  
Reverse Transcriptase ◽  
Personal Protective Equipment ◽  
Healthcare Workers ◽  
Polymerase Chain Reaction Method ◽  
Protective Equipment ◽  
Chain Reaction ◽  
Long Time ◽  
Polymerase Chain

Background The Covid-19 pandemic has caused changes in the surgical treatment of non-Covid patients, especially in thoracic surgery because most procedures are aerosol generating. Hospital Kuala Lumpur, where thoracic procedures are performed, was badly affected. We describe our experience in performing aerosol generating procedures safely in thoracic surgery during the Covid-19 era. Methods Medical records of patients who underwent thoracic surgery from March 18, 2020 to May 17, 2020 were reviewed retrospectively. All patients undergoing thoracic surgery were tested for Covid-19 using the reverse transcriptase polymerase chain reaction method. Patients with malignancy were observed for 10 to 14 days in the ward after testing negative. The healthcare workers donned personal protective equipment for all the cases, and the number of healthcare workers in the operating room was limited to the minimum required. Results A total of 44 procedures were performed in 26 thoracic surgeries. All of these procedures were classified as aerosol generating, and the mean duration of the surgery was 130 ± 43 minutes. None of the healthcare workers involved in the surgery were exposed or infected by Covid-19. Conclusion Covid-19 will be a threat for a long time and thoracic surgeons must continue to provide their services, despite having to deal with aerosol generating procedures, in the new normal. Covid-19 testing of all surgical candidates, using the reverse transcriptase polymerase chain reaction, donning full personal protective equipment for healthcare workers, and carefully planned procedures are among the measures suggested to prevent unnecessary Covid-19 exposure in thoracic surgery.

scholarly journals COVID-19 Autopsies, Oklahoma, USA

2020 ◽  
Vol 153 (6) ◽  
pp. 725-733 ◽  
Author(s):  
Lisa M Barton ◽  
Eric J Duval ◽  
Edana Stroberg ◽  
Subha Ghosh ◽  
Sanjay Mukhopadhyay
Keyword(s):  
Diffuse Alveolar Damage ◽  
Nasopharyngeal Swab ◽  
Protective Equipment ◽  
Chain Reaction ◽  
Polymerase Chain Reaction Testing ◽  
Standard Procedures ◽  
History Of ◽  
Polymerase Chain ◽  
Viral Inclusions ◽  
Postmortem Examinations

Abstract Objectives To report the methods and findings of two complete autopsies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive individuals who died in Oklahoma (United States) in March 2020. Methods Complete postmortem examinations were performed according to standard procedures in a negative-pressure autopsy suite/isolation room using personal protective equipment, including N95 masks, eye protection, and gowns. The diagnosis of coronavirus disease 2019 (COVID-19) was confirmed by real-time reverse transcriptase polymerase chain reaction testing on postmortem swabs. Results A 77-year-old obese man with a history of hypertension, splenectomy, and 6 days of fever and chills died while being transported for medical care. He tested positive for SARS-CoV-2 on postmortem nasopharyngeal and lung parenchymal swabs. Autopsy revealed diffuse alveolar damage and chronic inflammation and edema in the bronchial mucosa. A 42-year-old obese man with a history of myotonic dystrophy developed abdominal pain followed by fever, shortness of breath, and cough. Postmortem nasopharyngeal swab was positive for SARS-CoV-2; lung parenchymal swabs were negative. Autopsy showed acute bronchopneumonia with evidence of aspiration. Neither autopsy revealed viral inclusions, mucus plugging in airways, eosinophils, or myocarditis. Conclusions SARS-CoV-2 testing can be performed at autopsy. Autopsy findings such as diffuse alveolar damage and airway inflammation reflect true virus-related pathology; other findings represent superimposed or unrelated processes.

Congenital Pulmonary Airway Malformation

2018 ◽  
Author(s):  
Alina Lazar
Keyword(s):  
Thoracic Surgery ◽  
Anesthetic Management ◽  
Lung Ventilation ◽  
Cardiovascular Complications ◽  
Positive Pressure ◽  
Clear Understanding ◽  
One Lung Ventilation ◽  
Lung Isolation ◽  
Isolation Techniques ◽  
Lung Abnormalities

Respiratory distress in infants may be caused by perinatal events and physiologic changes (e.g., lung immaturity, meconium aspiration, and persistent pulmonary hypertension); infectious processes; cardiovascular, neurologic, and metabolic abnormalities; as well as congenital lung abnormalities. Some of these may coexist, further complicating the diagnosis, clinical course, and management of the affected infant. Sound anesthetic management of congenital lung abnormalities requires a clear understanding of the pathophysiology of lung lesions and, in particular, the consequences of positive-pressure ventilation in patients with cystic and emphysematous lesions. Also critical is an appreciation for the physiologic differences in children undergoing thoracic surgery, indications for one-lung ventilation, age-appropriate lung isolation techniques, potential respiratory and cardiovascular complications that may occur during pediatric thoracic surgery, and the optimal choices for postoperative analgesia.

Thoracic anaesthesia

2014 ◽  
Author(s):  
Jeremy Prout ◽  
Tanya Jones ◽  
Daniel Martin
Keyword(s):  
Thoracic Surgery ◽  
Surgical Procedures ◽  
Lung Ventilation ◽  
Chest Drain ◽  
One Lung Ventilation ◽  
Double Lumen ◽  
Thoracic Surgical Procedures ◽  
Hypoxic Vasoconstriction ◽  
Thoracic Anaesthesia ◽  
Drain Management

Pre-assessment of patients for thoracic surgery with prediction of postoperative dyspnoea is important and may determine ‘operability’ of malignancy. Anaesthetic conduct for common thoracic surgical procedures such as thoracotomy, video-assisted thorascopic surgery, mediastinal surgery, and bronchoscopic techniques are described. Techniques for providing one-lung ventilation using double-lumen tubes or endobronchial blockers are discussed along with the physiology of one-lung ventilation, hypoxic vasoconstriction, and techniques to improve oxygenation. Thoracic postoperative care such as pain and chest drain management is included

One Lung Ventilation in a Patient with Central Airway Obstruction: Fluoroscopic Guided Bronchial Blocker Placement

2021 ◽  
Author(s):  
Ankit A Gupta
Keyword(s):  
Lymph Nodes ◽  
Airway Obstruction ◽  
Traditional Approach ◽  
Anesthetic Management ◽  
Lung Ventilation ◽  
Bronchial Blocker ◽  
One Lung Ventilation ◽  
Central Airway Obstruction ◽  
Thyroid Mass ◽  
Central Airway

Thyroidectomy is the most common endocrine surgical treatment performed worldwide. Medullary thyroid carcinoma which accounts for less than 1.5 percent of these cases is different from other types of thyroid cancers in a way that it is a neuroendocrine malignancy that originates from the parafollicular C cells of the thyroid gland secreting calcitonin and it frequently spreads to lymph nodes and other organs. Anesthetic management in a case of a large thyroid mass with central airway obstruction is a task cut out for an anesthesiologist and the need to provide one-lung ventilation in these patients for thoracoscopic dissection of mediastinal lymph nodes adds to the challenges. In this case report, we describe fluoroscopic guided bronchial blocker placement as a novel technique for delivering one-lung ventilation in such patients, when the traditional approach of bronchial blocker placement with concomitant use of a fiber optic bronchoscope was not practicable due to the small size of the endotracheal tube in the presence of central airway obstruction.

scholarly journals Effects of Ozone Treatment on Personal Protective Equipment Contaminated with SARS-CoV-2

Antioxidants ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 1222
Author(s):  
Bernardino Clavo ◽  
Elizabeth Córdoba-Lanús ◽  
Francisco Rodríguez-Esparragón ◽  
Sara E. Cazorla-Rivero ◽  
Omar García-Pérez ◽  
...  
Keyword(s):  
Relative Humidity ◽  
Personal Protective Equipment ◽  
Healthcare Professionals ◽  
Ozone Exposure ◽  
Ozone Treatment ◽  
Protective Equipment ◽  
Equipment Management ◽  
Chain Reaction ◽  
Ozone Concentrations ◽  
Polymerase Chain

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is causing profound health, economic, and social problems worldwide. Management of personal protective equipment (PPE) and its potential limited availability have created concerns about the increased risks for healthcare professionals at hospitals and nursing homes. Ozone is a powerful oxidant agent. The objectives of this study were to examine the effects of ozone treatment on PPE contaminated with SARS-CoV-2, and to explore whether relative humidity could modify those effects. Methods: PPE contaminated by heat-inactivated SARS-CoV-2 were treated with different ozone concentrations, exposure times, and relative humidity conditions. SARS-CoV-2 gene amplification was assessed by real-time polymerase chain reaction. Results: There was no amplification of SARS-CoV-2 in PPE after the following ozone exposures: 30 s at 10,000 ppm (20 g/m3), 5 min at 4000 ppm, and 10 min at 2000 ppm. At lower ozone concentrations, 4–12 ppm (0.008–0.024 g/m3), the effects were highly dependent on the relative humidity conditions. Conclusions: Oxidative stress induced by ozone exposure eliminated heat-inactivated SARS-CoV-2 in different PPE components under appropriate exposure times, ozone concentrations, and relative humidity conditions. These findings could have implications in decreasing the risk of contamination associated with personal protective equipment management and in increasing its availability. Further research in the original SARS-CoV-2 strain is guaranteed.

scholarly journals Commentary: COVID in care homes—challenges and dilemmas in healthcare delivery

2020 ◽  
Vol 49 (5) ◽  
pp. 701-705 ◽  
Author(s):  
Adam L Gordon ◽  
Claire Goodman ◽  
Wilco Achterberg ◽  
Robert O Barker ◽  
Eileen Burns ◽  
...  
Keyword(s):  
Social Care ◽  
Care Home ◽  
Healthcare Delivery ◽  
Care Homes ◽  
Protective Equipment ◽  
Healthcare Staff ◽  
Chain Reaction ◽  
Advance Care ◽  
Polymerase Chain ◽  
Low Sensitivity

Abstract The COVID-19 pandemic has disproportionately affected care home residents internationally, with 19–72% of COVID-19 deaths occurring in care homes. COVID-19 presents atypically in care home residents and up to 56% of residents may test positive whilst pre-symptomatic. In this article, we provide a commentary on challenges and dilemmas identified in the response to COVID-19 for care homes and their residents. We highlight the low sensitivity of polymerase chain reaction testing and the difficulties this poses for blanket screening and isolation of residents. We discuss quarantine of residents and the potential harms associated with this. Personal protective equipment supply for care homes during the pandemic has been suboptimal and we suggest that better integration of procurement and supply is required. Advance care planning has been challenged by the pandemic and there is a need to for healthcare staff to provide support to care homes with this. Finally, we discuss measures to implement augmented care in care homes, including treatment with oxygen and subcutaneous fluids, and the frameworks which will be required if these are to be sustainable. All of these challenges must be met by healthcare, social care and government agencies if care home residents and staff are to be physically and psychologically supported during this time of crisis for care homes.

scholarly journals Anesthetic management of a patient with severe aortic regurgitation undergoing reoperation for ascending aorta false aneurysm using hypothermia: prevention of ventricular fibrillation by nifekalant

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Akiko Tomita ◽  
Tomoko Fujimoto ◽  
Shoko Takada ◽  
Yukio Hayashi
Keyword(s):  
Ventricular Fibrillation ◽  
Left Ventricle ◽  
Aortic Regurgitation ◽  
Anesthetic Management ◽  
Myocardial Damage ◽  
Lung Ventilation ◽  
Left Ventricular ◽  
One Lung Ventilation ◽  
Severe Aortic Regurgitation ◽  
Vent Tube

Abstract Background To prevent cardiac collapse and to protect cerebral function, hypothermic cardiopulmonary bypass is established before resternotomy. However, ventricular fibrillation under hypothermia facilitates left ventricular distension, which causes irreversible myocardial damage when the patient has aortic regurgitation. We report a case of successful management in preventing ventricular fibrillation under hypothermia by using nifekalant. Case presentation A 56-year-old male, who had been performed a David operation, was scheduled for a Bentall operation for a pseudo aortic aneurysm with severe aortic regurgitation. After inducing anesthesia, we administered intravenous nifekalant and a vent tube was inserted into the left ventricle under one-lung ventilation. Extracorporeal circulation was established and resternotomy started after cooling to 27 °C. Although severe bradycardia and QT prolongation were observed, ventricular fibrillation did not occur until aortic cross-clamping. Conclusion Combining maintaining cerebral perfusion and avoiding left ventricle distension during hypothermia was successfully managed with nifekalant in our redo cardiac patient with aortic regurgitation.

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