Operating Theatre Research Articles

Preparing cardiovascular patients for the operative theatre.

Preparing cardiovascular patients for the operative theatre.

Analyzing interprofessional teamwork in the operating room: An exploratory observational study using conventional and alternative approaches

ABSTRACT Intraoperative teamwork is vital for patient safety. Conventional tools for studying intraoperative teamwork typically rely on behaviorally anchored rating scales applied at the individual or team level, while others capture narrative information across several units of analysis. This prospective observational study characterizes teamwork using two conventional tools (Operating Theatre Team Non-Technical Skills Assessment Tool [NOTECHS]; Team Emergency Assessment Measure [TEAM]), and one alternative approach (modified-Systems Engineering Initiative for Patient Safety [SEIPS] model). We aimed to explore the advantages and disadvantages of each for providing feedback to improve teamwork practice. Fifty consecutive surgical cases at a Canadian academic hospital were recorded with the OR Black Box®, analyzed by trained raters, and summarized descriptively. Teamwork performance was consistently high within and across cases rated with NOTECHS and TEAMS. For cases analyzed with the modified-SEIPS tool, both optimal and suboptimal teamwork behaviors were identified, and team resilience was frequently observed. NOTECHS and TEAM provided summative assessments and overall pattern descriptions, while SEIPS facilitated a deeper understanding of teamwork processes. As healthcare organizations continue to prioritize teamwork improvement, SEIPS may provide valuable insights regarding teamwork behavior and the broader context influencing performance. This may ultimately enhance the development and effectiveness of multi-level teamwork interventions.

Posteromedial Buttress Plate for Schatzker 6 Fractures as Double Column Fixation

Objective: Treatment of Schatzker Type 6 fractures is to use a posteromedial buttress plate as part of a double-column fixation technique. Materials & Methods: The design of this study was a cross sectional study design and this study was conducted in DHQ Teaching Hospital Gujranwala. patients with posterior medial fracture of Schatzker type 6 and having associated damage of some soft tissue present within the joint underwent surgery at our institutional operation theatre. In this Study setting we included total 20 patients (14 male [70%] and 6 females [30%]) who came with Bicondylar fractures having Comminuted Posteromedial Fragments of tibia. Results: Of the Patients, 12 (60%) had excellent results, 5(25%) had good results , and 3 (15%) had fair results. In total, 17 patients (85%) achieved cheering results. Walking, Stability, and motion were good or excellent in all cases. Practical Implication: One of the main advantages of the posteromedial buttress plate fixation technique is that it provides support to the medial column of the tibia, which is an important weight-bearing structure in the lower extremity. By restoring the structural integrity of the medial column, the technique can help promote early weight-bearing and facilitate early rehabilitation. All displaced posteromedial tibial plateau fractures should be surgically stabilized and buttressed using plate to restore joint congruity and prevent late subluxation and early arthritis. The aim is to study the role of posteromedial plating in the management of complex tibial plateau fractures with a posteromedial fragment Conclusion: Use of a posteromedial buttress plate as part of a double-column fixation technique can be an effective approach for treating Schatzker Type 6 fractures. Keywords: Fixation of Posterior Column, Buttress plate, Schatzker 6 fracture

The Efficacy of Wide-Awake Local Anesthesia No Tourniquet (WALANT) in Common Plastic Surgery Operations Performed on the Upper Limbs: A Case-Control Study.

The wide-awake local anesthesia no tourniquet (WALANT) technique is commonly used in elective hand surgery, whereas its application in plastic surgery is still limited. The aim of the study is to evaluate the feasibility and efficacy of WALANT in common plastic surgery operations performed on the upper limbs. Patients who underwent those operations under WALANT were matched and compared with patients who had general or regional anesthesia without infiltration of a local anesthetic solution. All operations were performed by the same surgeon. Data from 98 operations were collected and analyzed for the total operation time, operation theatre time and complication and patient satisfaction rates. All operations under WALANT, mainly skin tumor excision and flap repair or skin grafting and burn escharectomy with or without skin grafting, were completed successfully. No statistical difference in total operation time and complication rates was revealed. Statistical significance favoring WALANT was identified regarding the mean operation theatre time and patient satisfaction. WALANT is an effective method for common plastic surgery operations performed on the upper limbs that is associated with better operation theatre occupancy and high patient satisfaction rates.

Feasibility Study of the Grid-Connected Hybrid Energy System for Supplying Electricity to Support the Health and Education Sector in the Metropolitan Area

One of the biggest issues impeding a country’s progress is the lack of power. To overcome this issue, hybrid renewable energy systems (HRES) play an important role. Due to rising consumption and diminishing resources globally, sustainability has recently attracted more attention. Bangladesh has access to renewable energy sources, including solar, micro-hydro, biomass, wind, and others. The objective of this research is to minimize the net present cost (NPC), cost of energy (COE), and CO2 emissions of the suggested electricity network using the Hybrid Optimization Model for Multiple Energy Resources (HOMER) Pro Software. This investigation explores the possible use of a hybridized energy system (i.e., solar, wind, and diesel) with battery storage in Bangladesh’s northern area. Utilizing HOMER Pro software, an optimal grid-connected system is chosen after evaluating the techno-economic viability of several configuration options. For the Rangpur metropolitan region, seven distinct grid-connected solutions with stationary renewable sources are simulated. The HRES is designed to meet demands for hospital, diagnostic, school, and operation theatre loads of 3250.00 kWh, 250.00 kW maximum requirement, and 570.00 kWh, 71.25 kW maximum electricity demand, respectively. Multivariate linear regression (MLR) is used to assess the suggested optimal combination in terms of system size, cost, technical performance, and environmental stability. The findings show that the metric real-time rate (annual) has emerged as the most advantageous option since economic criteria like total NPC and COE are preferred above others.

Robust Motion Planning in Robot-Assisted Surgery for Nonlinear Incision Trajectory

In the era of digital OTs (operating theatres), the developments in robot-assisted surgery (RAS) can greatly benefit the medical field. RAS is a method of technological advancement that uses robotic articulations to assist in complicated surgeries. Its implementation improves the ability of the specialized doctor to perform surgery to a great extent. The paper addresses the dynamics and control of the highly non-linear 3DOF surgical robot manipulator in the event of external disturbances and uncertainties. The integration of non-linear robust SMC (sliding mode control) with a smoothing mechanism, a FOPID (fractional-order proportional integral derivative) controller, and a fuzzy controller provides a high degree of robustness and minimal chatter. The addition of fuzzy logic to the controller, named intelligent fuzzy-SFOSMC (smoothing fractional order sliding mode controller) improves the system’s performance by ruling out the disturbances and uncertainties. The prototype model is developed in a laboratory and its outcomes are validated on OP5600, a real-time digital simulator. Simulation and experimental results of the proposed fuzzy-SFOSMC are compared with conventional controllers, which illustrates the efficacy and superiority of the proposed controller’s performance during the typical surgical situations. The proposed fuzzy-SFOSMC outperforms conventional controllers by providing greater precision and robustness to time-varying nonlinear multi-incision trajectories.

NEUTRAL HYPOCHLOROUS ACID SOLUTION AS AN ORTHOPAEDIC STERILIZATION AGENT

Hypochlorous acid (HOCl) is a potent anti-bacterial agent which could reduce periprosthetic joint infection. Early infection complications in joint replacements are often considered to be due to local contamination at the time of surgery and result in a significant socioeconomic cost. Current theatre cleaning procedures produce “clean” operating theatres which still contain bacteria (colony forming units, CFU). Reducing this bacterial load may reduce local contamination at the time of surgery. HOCl is produced naturally in the human neutrophil and has been implicated as the primary agent involved in bacterial killing during this process. In vitro research confirms its efficacy against essentially all clinically relevant bacteria. The recent advent of commercial production of HOCl, delivered as a fog, has resulted in extensive use in the food industry. Reported lack of corrosion and high anti-bacterial potency are seen as two key factors for the use of HOCl in the orthopaedic environment. Prior work by the authors comparing human cell toxicity of HOCl, chlorhexidine and iodine solutions shows favourable results.This study evaluates use of neutral HOCl applied as a dry room fog to decrease bacteria in the operating theatre environment. Using an animal operating theatre as the test site, bacterial swabs were taken from ten 100cm2 sample areas before standard cleaning with detergent, after standard cleaning, and again after 60 minutes exposure to HOCl fog.After standard cleaning, 6 of 10 sample sites recorded significant bacterial growth (>10 CFU/100cm2). After exposure to HOCl fog, growth in all 10 sites was below detection limits (<10 CFU/100cm2). This was repeated with specific exposure to Staphylococcus aureus and Escherichia coli.We can conclude that HOCl is effective when used as a fogging agent to reduce bacterial loading within an operating theatre environment and as such has significant potential to reduce intraoperative contamination and periprosthetic infection.

Norman Dott's dome-shaped neurosurgical operating theatres in Edinburgh (1960-2020) - End of an era.

When the new twin operating theatres at the Edinburgh Department of Surgical Neurology opened for the first time on 1 July 1960, they revealed a revolutionary space-pod design. The new department had been designed to firmly establish the specialty in Scotland and the UK, setting the stage for a period of real progress. The most distinctive feature of the two operating theatres was their egg shape, including domed ceilings pierced with operating lights, general lighting, ventilation grilles and viewing ports for visitors. Norman Dott (1897-1973) and his colleagues set the foundation for prosperity and success that lasted decades. However, 60 years after their opening, the DCN theatres at Western General Hospital shut forever, as the department moved to the new Department of Clinical Neurosciences, at the new Royal Infirmary Edinburgh. Echoes of the old theatres will live on in the new; the boldness of the design of the original theatres reflected the close cooperation between clinician-teachers, architects and administrators for the public good. This tradition of tangible confidence and optimism will hopefully carry into a new era, in the new hospital.

Intelligent Fractional Order Sliding Mode Based Control for Surgical Robot Manipulator

In the era of digital OT (Operating Theatre), the developments in Robot-Assisted Surgery (RAS) can greatly benefit the medical field. RAS is a method of technological advancement that uses surgical robots to assist complicated surgeries. Its implementation improves the ability of the specialised doctors to perform surgery to a great extent. This paper addresses the dynamics and control of the highly non-linear 3DOF surgical robot manipulator in the occurrence of external disturbances and uncertainties. The integration of non-linear robust SMC (Sliding Mode Control) with smoothing mechanism, FOPID (Fractional-Order Proportional Integral Derivative) controller and fuzzy controller provides a high degree of robustness and minimal chatter. The addition of type-2 fuzzy logic to the controller, named intelligent T2F-SFOSMC (Type-2 Fuzzy-Smoothing Fractional Order Sliding Mode Controller), improves the system’s performance by ruling out the disturbances and uncertainties. The prototype model is developed in a laboratory and its outcomes are validated on OP5600: a real-time digital simulator. The simulation results and experimental results of the proposed T2F-SFOSMC are compared with conventional controllers, which illustrates the efficacy and superiority of the proposed controller’s performance during the typical situation of surgery. The proposed T2F-SFOSMC outperforms conventional controllers by providing greater precision, stability and robustness to time-varying nonlinear multi-incision trajectory.

PROTOCOL FOR EXAMINING TRANSFER VALIDITY OF A SUPRACONDYLAR HUMERAL FRACTURE PINNING AUGMENTED REALITY SIMULATOR

Augmented reality simulators offer opportunities for practice of orthopaedic procedures outside of theatre environments. We developed an augmented reality simulator that allows trainees to practice pinning of paediatric supracondylar humeral fractures (SCHF) in a radiation-free environment at no extra risk to patients. The simulator is composed of a tangible child's elbow model, and simulated fluoroscopy on a tablet device. The treatment of these fractures is likely one of the first procedures involving X-ray guided wire insertion that trainee orthopaedic surgeons will encounter. This study aims to examine the extent of improvement simulator training provides to real-world operating theatre performance.This multi-centre study will involve four cohorts of New Zealand orthopaedic trainees in their SET1 year. Trainees with no simulator exposure in 2019 - 2021 will form the comparator cohort. Trainees in 2022 will receive additional, regular simulator training as the intervention cohort. The comparator cohort's performance in paediatric SCHF surgery will be retrospectively audited using routinely collected operative outcomes and parameters over a six-month period. The performance of the intervention cohorts will be collected in the same way over a comparable period. The data collected for both groups will be used to examine whether additional training with an augmented reality simulator shows improved real-world surgical outcomes compared to traditional surgical training. This protocol has been approved by the University of Otago Health Ethics committee, and the study is due for completion in 2024.This study is the first nation-wide transfer validity study of a surgical simulator in New Zealand. As of September 2022, all trainees in the intervention cohort have been recruited along with eight retrospective trainees via email. We present this protocol to maintain transparency of the prespecified research plans and ensure robust scientific methods. This protocol may also assist other researchers conducting similar studies within small populations.

COMPARATIVE STUDY BETWEEN DELAYED UMBILICAL CORD CLAMPING AND MILKING OF UMBILICAL CORD IN REGARD OF HEMATOCRIT LEVELAND NEURODEVELOPMENTAL OUTCOME AMONG PRETERM/LOW BIRTH WEIGHT BABIES IN A TERTIARY CARE HOSPITAL OF WEST BENGAL

Introduction: It is well established that Delayed cord clamping, in which cord is clamped only after a short delay (30 to 180 sec) after birth, improves iron status, reduce anemia and need for blood transfusion in later life, and also provides higher amount of placental stem cells to the infant without causing signicant harm to the mother and baby. Aims: To Compare Haematocrit level after 48 hours of age in preterm and low birth weight babies between the delayed umbilical cord clamping and umbilical cord milking and to compare neurodevelopmental outcome at third and six completed months of age in preterm and low birth weight babies between the delayed umbilical cord clamping and umbilical cord milking. Materials and Methods:The present study was a Hospital based Interventional study. This study was conducted from January 2021 – June 2022at Labour Room and operation theatre of College of Medicine & Sagore Dutta Hospital, Kolkata-700058, a tertiary centre in West Bengal.80 patients were included in this study. Result:In our study, higher number of patients had Neck Holding(6 months) [29 (72.5%)]in Milking of Umbilical Cord compared to Delayed Umbilical Cord Clamping [27 (67.5%)] but this was not statistically signicant (p=0.6255) And higher number of patients had Roll Over(6 months) [29(72.5%)]in Milking of Umbilical Cord compared to Delayed Umbilical Cord Clamping [27 (67.5%)] though it was not statistically signicant (p=0.1432). Conclusion: It was found that, the mean Birth Weight (gm.) was not signicantly lower in Milking of Umbilical Cord compared to Delayed Umbilical Cord Clamping. And the mean Haemoglobin at 48 hours was signicantly lower in Milking of Umbilical Cord compared to Delayed Umbilical Cord Clamping.

Efficacy of Intrathecal Bupivacaine with Dexmedetomidine and Bupivacaine Alone in Lower Segment Caesarian Section Patients

Objective: This research aims to compare the effectiveness of intrathecal bupivacaine combined with dexmedetomidine to bupivacaine alone in patients having caesarian procedures. Methods: This randomized, controlled study was conducted at in operation theatre in Liaquat national hospital, with the agreement of the hospital's institutional review board. There were 272 patients total, and they were split evenly in two groups of 136 using non-probability consecutive sampling technique. Group A: Patients received subarachnoid block (2 ml of 0.5 % hyperbaric bupivacaine and 10 micrograms of normal saline). Group B: Patients received subarachnoid block (2 ml of 0.5 % hyperbaric bupivacaine and 10 micrograms of dexmedetomidine at L3-L4 or L4-L5 inter-vertebral space). Before the induction of anaesthesia, the patient's systolic blood pressure (BP), diastolic blood pressure (BP), mean arterial pressure (MAP), heart rate (HR), and peripheral capillary oxygen saturation (SPO2) will be monitored Results: The mean age of the participants in both study groups were 27.14±5.3 and 25.9±3.65 years. A significant difference in the mean systolic blood pressure of the participants in both groups as observed at 15-, 45- and 60-minutes interval (p=0.000). The mean time interval from blocks to shivering occurrence in the participants in both study groups were 57.08±3.8 and 81.03±2.8minutes. A significant difference (P=0.000) in the mean time interval from blocks to shivering occurrence in the participants in both study groups was observed. 49% participants in the groups experienced shivering while 24% in group B. Conclusion: From our findings, we infer that adding 10µg of dexmedetomidine to strong bupivacaine in SA may reduce the frequency and severity of shivering without causing any serious side effects.

An Audit of the Gynecological Emergencies requiring Emergency Laparotomy in a Tertiary Care Hospital: Timeline of Events from Arrival to Emergency to Arrival to Operation Theater

An Audit of the Gynecological Emergencies requiring Emergency Laparotomy in a Tertiary Care Hospital: Timeline of Events from Arrival to Emergency to Arrival to Operation Theater

A Case Report of A Mid-Front Head Injury Using Starry Sky Surgical Approach of the Face

A 20-year-old male was referred to the Department of oral and maxillofacial surgery, Trinity Hospital, Aizawl-Mizoram on July 4th,2022 with a history of Road traffic accident (RTA). The patient was unconscious and was taken to the operation theatre and had multiple facial injuries. A frontal bone fracture with frontal sinus injury was noticed and a starry sky approach was used under GA. Overall, the starry sky approach shows very less scars and very less complications and proves to be the right approach in frontal bone fracture involving the midline.

A quantitative evaluation of aerosol generation during awake tracheal intubation.

Aerosol-generating procedures are medical interventions considered high risk for transmission of airborne pathogens. Tracheal intubation of anaesthetised patients is not high risk for aerosol generation; however, patients often perform respiratory manoeuvres during awake tracheal intubation which may generate aerosol. To assess the risk, we undertook aerosol monitoring during a series of awake tracheal intubations and nasendoscopies in healthy participants. Sampling was undertaken within an ultraclean operating theatre. Procedures were performed and received by 12 anaesthetic trainees. The upper airway was topically anaesthetised with lidocaine and participants were not sedated. An optical particle sizer continuously sampled aerosol. Passage of the bronchoscope through the vocal cords generated similar peak median (IQR [range]) aerosol concentrations to coughing, 1020 (645-1245 [120-48,948]) vs. 1460 (390-2506 [40-12,280]) particles.l-1 respectively, p=0.266. Coughs evoked when lidocaine was sprayed on the vocal cords generated 91,700 (41,907-166,774 [390-557,817]) particles.l-1 which was significantly greater than volitional coughs(p < 0.001). For 38 nasendoscopies in 12 participants, the aerosol concentrations were relatively low, 180 (120-525 [0-9552]) particles.l-1 , however, five nasendoscopies generated peak aerosol concentrations greater than a volitional cough. Awake tracheal intubation and nasendoscopy can generate high concentrations of respiratory aerosol. Specific risks are associated with lidocaine spray of the larynx, instrumentation of the vocal cords, procedural coughing and deep breaths. Given the proximity of practitioners to patient-generated aerosol, airborne infection control precautions are appropriate when undertaking awake upper airway endoscopy (including awake tracheal intubation, nasendoscopy and bronchoscopy) if respirable pathogens cannot be confidently excluded.

Commissioning new operation theatres by microbiological air sampling

Introduction: Ensuring air quality in operation theatres is of paramount importance to prevent surgical site infections. Microbiological commissioning number of new surgical theatres in our hospital, has been a challenging, yet also a rewarding experience to our staff. Methodology: A total of 19 new operation theatres including orthopaedic, neurosurgical, and cardiac theatres and associated sterile site areas were evaluated. Air sampling was followed by high level cleaning and running ventilation systems for 25 air changes per hour. Five samples were collected from each operation theatre. A sample of 1000L of air was aspirated on to 5% Horse Blood agar over 10 minutes. Colonies were enumerated following aerobic incubation at 37◦C for 24 and 48 hours. Results: During the first round of sampling 73% of samples yielded satisfactory (≤10 CFU/m3) results. A second round of samples following deep cleaning was required to certify remaining theatres. Conclusion: Microbiological testing and commissioning of our new operation theatres enabled us to certify our new operation theatres locally.

Assessment of the awareness of radiation protection and related concepts among nursing staff mainly working in diagnostic imaging units, cath-labs and operation theatres in Sri Lanka: A survey-based study

IntroductionThis study was carried out to evaluate the awareness of radiation protection, radiation types, medical imaging equipment and radiation effects among nurses for the first time in Sri Lanka. Since nurses are involved as direct caregivers in diagnostic and therapeutic radiography and radiation treatment procedures, they need to have a good understanding of the areas mentioned above. MethodsA self-administered questionnaire was used to collect data from 391 nurses working in hospitals, clinics, and other healthcare settings. Forwarded questions gathered the participants' demographic details and assessed their awareness of radiation protection, medical imaging equipment, radiation type and radiation effects. The average score per awareness area for each demographic characteristic was calculated based on the responses. Additionally, the percentage of participants who scored above 50 and 75 was calculated for each awareness area. ResultsThe majority were female participants (81.1%) and possessed a diploma in nursing (66.0%) with 10.8 years of average work experience. 92.3%, 74.7%, 69.8% and 22.3% of the participants scored more than 50 marks for the questions related to radiation protection, medical imaging equipment, radiation type and radiation effects, respectively. The level of nursing education and prior training in radiation protection significantly influenced all awareness areas, whereas participants with a graduate qualification in nursing and with prior radiation protection training scored the highest average marks. ConclusionBased on the scores obtained, the Sri Lankan nurses have satisfactory awareness of the essential concepts related to radiation types, medical imaging equipment and radiation protection. However, there is a significant lacking of awareness of radiation effects. This can be attributed to the fact that most participants did not have any formal training in radiation protection. The results implicate that proper training in radiation protection can significantly influence awareness of radiation protection and related concepts. Therefore, it is a timely requirement to initiate short awareness programs and continuing education programs on radiation protection for nurses working in specialised radiation units. Implications for practiceThe study suggests the necessity of initiating continuous education programs for nursing staff radiation protection to overcome the awareness gaps.

Does Arterial Blood Gas (ABG) Provide a Safety Net for Extubation in Surgical Patients?

Background Extubation has always been a critical aspect of anaesthesia. Guidelines and recommendations are in place for achieving successful extubation, but the risk of failure always persists. Through this study, we assess whether arterial blood gas (ABG) values taken intraoperatively help predict extubation success in the operation theatre. Materials and methods This was a prospective observational study for one year of extubated patients whose blood gas values were not within the normal range. The patients of age 18 years and above undergoing high-risk elective and emergency surgeries where at least one intraoperative arterial blood sample was taken for blood gas analysis were included. Apart from parameters of ABG demographic data, urgency and duration of surgery, blood loss, urine output, use of intraoperative fluid(s), and blood product(s) were also observed. Results Of 578 patients enrolled, 116 patients were extubated based on the predefined extubation criteria. Of these, 24 patients were reintubated within 24 hours. ABG parameters such as partial pressure of arterial oxygen (PaO2) and serum HCO3-levels were significantly lower in the reintubated patients compared to non-reintubated patients (p-values of 0.045 and 0.003, respectively). Conclusion This study showed that the PaO2 <100 mm Hg or ratio of arterial oxygen partial pressure to fractional inspired oxygen (P/F ratio) of less than 200 and an HCO3- value of less than 18 are plausible ABG parameters to decide extubation in post-surgery patients in OT. PaCO2, base deficit, and lactate were less reliable parameters for planning extubation.

Nurses' Perceptions of Patient Safety on Patient Safety Climate

PurposeThe purpose of this study was to determine the relationship between nurses' perception of patient safety and the safety climate. DesignDescriptive study. MethodsThe sample consisted of 262 surgical nurses. Data were collected with an online questionnaire system using the Leiden Operating Theatre and Intensive Care Safety (LOTICS) Scale and Patient Safety Climate (PSC) Scale. FindingsIntensive care unit (ICU) nurses were found to have higher perceptions of patient safety (106.0 ± 15.2 vs 102.6 ± 17.0) and safety climate (59.2 ± 20.9 vs 50.9 ± 24.3) than Operating Room (OR) nurses.According to ICU nurses, OR nurses stated that teamwork was weak, they did not feel like a part of the team, and teamwork was incompatible. They stated that there was no preliminary information about the operation, that they could not get enough information during the operation, that sufficient materials were not available in the OR in case of need, and that the worn-out materials were not replaced and repaired in a timely manner. ConclusionsAs nurses' perception of patient safety increases; patient safety climate perceptions also increased. Providing both professional and in-service trainings to raise awareness of patient safety, developing strategies that prevent team conflicts, providing preliminary information about the surgery, and eliminating material deficiencies can increase nurses' perception of PSC.

Anesthetic implications for transurethral resection of prostate in a COVID-19 survivor with Stanford-A aortic dissection with acute urinary retention due to metastatic carcinoma prostate: a case report

BackgroundAortic dissection is a new addition to the long COVID-19 complication catalog. We report this rare and novel complication, which can be missed without a high index of suspicion in the ever-burgeoning population of COVID-survivors presenting for un-related surgery. We emphasize the importance of recording blood pressure in both the upper limbs in COVID-survivors during pre-anesthetic checkup, especially in patients with a dilated aorta on the chest radiograph to identify any interarm blood pressure discrepancy characteristic of aortic dissection. Discontinuation of antihypertensive based on low/normal blood pressure in left upper limb can precipitate concealed and catastrophic rise in blood pressure in the right upper-limb propagating the dissection of aorta to a fatal conclusion. The cardinal anesthetic consideration is to mitigate the effect of hemodynamic perturbations on the dissected aorta.Case presentationWe report the successful management of the case of a 76-year-old male prostatic cancer patient with COVID-induced aortic-dissection and acute urinary retention, posted for transurethral resection of prostate. CT angiography revealed an intimal flap in the ascending aortic lumen and aortic arch till the origin of left subclavian artery resulting in a double-barreled aorta. An arterial line was secured in right radial artery and non-invasive blood pressure recorded in left arm simultaneously (202/60 mmHg in right upper-limb and 92/70 mmHg in the left upper-limb on wheeling into the operation theatre). He underwent transurethral prostatic resection and bilateral orchidectomy under low-dose subarachnoid block with prophylactic use of labetalol infusion.ConclusionsThe importance of recording blood pressure in both the upper limbs in COVID survivors maintaining a high index of suspicion for aortic dissection cannot be overemphasized. Transurethral prostatic resection surgery under low-dose subarachnoid block is possible under the umbrella of judicious selection and optimal use of cardiac medication with an interventional cardiologist as standby in patients with aortic dissection.