Protocols and safety measurements used in intubation of COVID-19 patients

The COVID-19 pandemic has forced many countries to pose an emergency to contain the contamination and prevent the further spread of the infection. In this context, many societies and research papers were published to optimize guidelines and protocols for patients undergoing surgery and subsequent intubation. Accordingly, infection control is a critical approach to reduce the rate of contamination and risk of catching infections for suspected and confirmed COVID-19 patients. As a result, various guidelines were discussed in the current literature review, including guidelines to the patient, healthcare workers, operating room, anesthesia equipment, and patient transportation. For instance, healthcare workers can protect themselves from catching infections by wearing personal protective equipment and conducting adequate disinfection measures following each operation, in addition to the proper disposal of the contaminated objects. Strictly following these protocols should be done to reduce the risk of contamination in the operating room and enhance the outcomes of the patients and healthcare workers.

The Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study of Anesthetic Equipment Malfunction or Failure: An Analysis of 2206 Incident Reports

Background: Anesthesia equipment problems may contribute to anesthesia mortality and morbidity. The Royal College of Anesthesiologists of Thailand initiated a multicentered incident reporting study namely the Perioperative and Anesthetic Adverse Events in Thailand (PAAd Thai) Study to investigate perioperative complications including equipment malfunction or failure. Materials and Methods: The present report was a descriptive prospective study. After the Institutional Ethical approval with informed consent was waived, the case record form comprising structured and narrative information parts was requested to be filled within 24 hours of occurrence of anesthesia equipment malfunction or failure in 22 large government hospitals across Thailand between January and December 2015. Three senior anesthesiologists reviewed the incident reports. Any discrepancy was discussed to achieve a consensus. Descriptive statistics were used for analysis. Results: Out of 2,206 incident reports, there were 47 (2.1%) equipment malfunction or failure involving anesthetic machine (36.0%), anesthetic circuit (27.6%), laryngoscope (17.0%) and monitoring (12.7%) in operating theatre (97.8%), pediatric anesthesia (19.1%), and emergency condition (21.2%). Diagnoses of incidents was either clinical detection (82.9%) or detection by monitoring equipment (48.9%). Outcomes of incidents were trivial with full recovery. The incidents were considered as results from human factor (38.3%), preventable (46.8%), and might be prevented with surgical safety checklists (34.0%). Conclusion: Equipment malfunction or failure incidents were unusual and did not lead to serious consequence. Common contributing factors were ineffective equipment, non-adherence to surgical checklists, haste, and inexperience of performers. Factors to minimize the incidents were equipment checking, having experience, and comply to surgical checklists. Quality assurance activity, standard and regular equipment maintenance, adherence to surgical checklists, and additional training were suggested as corrective measures. Keywords: Anesthesia, Complications, Equipment malfunction, Equipment failure, Human factors, Surgical checklist

Control of Methicillin-Resistant Staphylococcus aureus Strains Associated With a Hospital Outbreak Involving Contamination From Anesthesia Equipment Using UV-C

Methicillin-resistant Staphylococcus aureus (MRSA) is considered an opportunistic pathogen in humans and is mainly associated with healthcare-associated infections (HCAIs). This bacterium colonizes the skin and mucous membranes of healthy people and causes frequent hospital outbreaks. The aim of this study was to perform molecular typing of the staphylococcal cassette chromosome mec (SCCmec) and agr loci as wells as to establish the pulsotypes and clonal complexes (CCs) for MRSA and methicillin-sensitive S. aureus (MSSA) outbreaks associated with the operating room (OR) at a pediatric hospital. Twenty-five clinical strains of S. aureus (19 MRSA and 6 MSSA strains) were recovered from the outbreak (patients, anesthesia equipment, and nasopharyngeal exudates from external service anesthesia technicians). These clinical S. aureus strains were mainly resistant to benzylpenicillin (100%) and erythromycin (84%) and were susceptible to vancomycin and nitrofurantoin. The SCCmec type II was amplified in 84% of the S. aureus strains, and the most frequent type of the agr locus was agrII, which was amplified in 72% of the strains; however, the agrI and agrIII genes were mainly detected in MSSA strains. A pulsed-field gel electrophoresis (PFGE) analysis grouped the 25 strains into 16 pulsotypes (P), the most frequent of which was P1, including 10 MRSA strains related to the anesthesia equipment, external service anesthesia technicians, and hospitalized patients. Multilocus sequence typing (MLST) identified 15 sequence types (STs) distributed in nine CCs. The most prevalent ST was ST1011, belonging to CC5, which was associated with the SCCmec type II and agrII type. We postulate that the external service anesthesia technicians were MRSA carriers and that these strains were indirectly transmitted from the contaminated anesthesia equipment that was inappropriately disinfected. Finally, the MRSA outbreak was controlled when the anesthesia equipment disinfection was improved and hand hygiene was reinforced.

Regional Anesthesia Equipment

This chapter outlines the conditions, equipment, and documentation necessary for a successful regional anesthesia and acute pain medicine practice. Local Anesthetics and Additives

Microsurgical Training Curriculum for Neurosurgery Residents in Southern Iran

Cerebrovascular diseases comprise a major subspecialty in neurological surgery. Current education curriculums lack the necessary training modalities for teaching the microvascular techniques, to neurosurgery residents. We have included a 1-month micro-lab and animal lab rotation for senior residents, which can be added to their current educational program. Necessary equipment for this rotation includes an operating microscope Zeiss S8, microsurgical instruments, and animal anesthesia equipment are used to perform revascularization techniques on the aorta of a rat model (average-sized Sprague-Dawley weighing 200-250 gram). This rotation was included in previous curriculums as micro-lab. Evaluation of microvascular surgical skills following the addition of animal models to this skill lab is suggested to be considered as a part of OSCE in board certification in future studies. The addition of animal models to micro-lab rotations, provides a better understanding of tissue consistency while dealing with a microvascular surgery procedure, for neurological surgery residents.

2020 AAHA Anesthesia and Monitoring Guidelines for Dogs and Cats*

ABSTRACT Risk for complications and even death is inherent to anesthesia. However, the use of guidelines, checklists, and training can decrease the risk of anesthesia-related adverse events. These tools should be used not only during the time the patient is unconscious but also before and after this phase. The framework for safe anesthesia delivered as a continuum of care from home to hospital and back to home is presented in these guidelines. The critical importance of client communication and staff training have been highlighted. The role of perioperative analgesia, anxiolytics, and proper handling of fractious/fearful/aggressive patients as components of anesthetic safety are stressed. Anesthesia equipment selection and care is detailed. The objective of these guidelines is to make the anesthesia period as safe as possible for dogs and cats while providing a practical framework for delivering anesthesia care. To meet this goal, tables, algorithms, figures, and “tip” boxes with critical information are included in the manuscript and an in-depth online resource center is available at aaha.org/anesthesia.