key: cord-1010370-zk781b0i
authors: Mahendru, Kiran; Kumar, Abhishek; Bhargava, Tanvi
title: Patient positioning under anesthesia during COVID-19 pandemic –Foresight risks to prepare, plan and execute
date: 2020-10-07
journal: nan
DOI: 10.1016/j.tacc.2020.10.001
sha: 0217011f53e7700fc7f6b0f3a1cf4e80cb7d6a93
doc_id: 1010370
cord_uid: zk781b0i

nan

The outbreak of COVID-19 began in December 2019 in Wuhan, Hubei province, China with a few cases of viral pneumonia. [1] With the declaration of a pandemic by the World Health Organization in March 2020, [2] the disease has been a constant threat to physical, mental health as well as the world economy. It has also paralyzed the care of patients in need of medical supervision for indications other than COVID pneumonia. Anesthesiologists are leading this battle as they are well acquainted with the knowledge and skills needed to combat COVID-19.

The unprecedented healthcare crisis has brought about a change in the paradigm of every aspect of anesthesia practice. The protection of both health care workers and patients is important apart from the accustomed standard of care. Therefore, routine practices need to be conceptualized afresh for successful management.

Positioning under anesthesia is associated with potential risks to the patient because of the inhibition of various protective mechanisms. [3] Each position is associated with changes in the cardiac and respiratory physiology as well as the risk of nerve injuries and pressure sores. [4] [5] [6] [7] The combination of position-specific physiological changes and risk of COVID-19 transmission place both the patient as well as the anesthesiologist in peril. Therefore, careful planning and coordination between the anesthesiologist, surgeon, and operating room (OR) staff is needed for successful positioning with minimum risk of COVID -19 transmission.

The goal of the OR team will be to minimize the aerosol generation and achieve successful positioning in the first attempt. Positioning under regional anesthesia alone will be associated with the lowest risk as compared to general anesthesia with or without regional due to a. Summarize and debrief between the teammates to enhance the process of learning b. It will also facilitate better patient management in the future All the above steps to be practiced while repositioning of the patient before extubation.

Lateral decubitus and prone position are associated with excessive drooling of secretions which can be a source of infection for OR staff. Hence appropriate measures like antisialagogue to be used preoperatively. Accidental dislodgement of the tube can occur while positioning, thus the tube should be adequately taped to prevent accidental extubation.

Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia

COVID-19) Situation Reports [Internet], report, World Health Organization. World Health Organization

Patient positioning in anaesthesia

Haemodynamic effects from aortocaval compression at different angles of lateral tilt in non-labouring term pregnant women

Peripheral nerve injuries associated with anaesthesia

Well leg compartment syndrome after pelvic and perineal surgery in the lithotomy position

Calf compartment pressures in the Lloyd-Davies position: a cause for concern?

Centers for disease control and prevention, coronavirus disease 2019, using personal protective equipment