Anaesthetic Management of Suspect COVID-19 Patient during a COVID-19 Pandemic Presenting for Emergency Limb Saving Surgery

Anand Subramaniam,B Balamurugan

doi:10.9734/jpri/2022/v34i10a35517

Abstract

Covid-19 pandemic is an unprecedented crisis and has changed dynamics of health care by severely straining the resources for patients coming for both elective and emergency surgeries. Ultrasound guided nerve block has been a life saver in most covid-19 positive patients coming for emergency surgical procedures as they reduce the risk of general anaesthesia in a patient with already compromised lung physiology and also minimizes risk of aerosol contamination of the operation theatre and health care personnel. We describe the anaesthetic management of a 67year old male patient with uncontrolled diabetes mellitus and sepsis for diabetic foot wound fasciotomy and wound debridement. The patient was operated under ultrasound guided popliteal sciatic and Saphenous nerve block of the right lower limb with all precautions taken to prevent covid spread as the patient had a high index of suspicion for covid-19. The patient was reported positive for RT-PCR in the postoperative period.

Highlights

COVID-19 patients coming for emergency surgery pose a challenge to the Anaesthesiologists
On the other hand, anesthetizing Patient whose respiratory and cardiac reserves are severely compromised at the same time minimizing the spread of infection within the operation theatre and to the health care personnel involved in the patient care was an arduous task
General anaesthesia involves invasive airway manipulation both during intubation and extubation leading to aerosol generation and high risk of transmission of respiratory infection to the health care personnel involved [1]

Summary

INTRODUCTION

COVID-19 patients coming for emergency surgery pose a challenge to the Anaesthesiologists. General anaesthesia involves invasive airway manipulation both during intubation and extubation leading to aerosol generation and high risk of transmission of respiratory infection to the health care personnel involved [1]. Retrospective analysis of SARS reports and research identified pooled analysis of risk for a variety of Aerosal Generating Procedures, with intubation and noninvasive manual ventilation creating a 6.6- and 3.3-fold increased risk of infection respectively in Health Care Workers [2]. The operation theatre should be a negative pressure room to minimize the risk of transmission of virus during aerosol generating manoeuvres [3] but most of the operation theatre in India are positive pressure system. We report the anaesthetic management and precautions taken in a suspect covid patient coming for emergency surgery

CASE REPORT

DISCUSSION

CONCLUSION

Evaluation of droplet dispersion during