The Greek e-journal of Perioperative Medicine

1

Authors: Papagiannopoulou P, Mouloudi E.

Editorial

5-12

Authors: Rashid A, Nazir S, Junaid S, Mir I, Zaieem M

COVID-19 has officially been declared as a pandemic. Although the ultimate course and impact of COVID-19 is yet to be seen, the disease has already overwhelmed health care infrastructure. Operation theaters are high-risk areas for transmission of respiratory infections given the involvement of multiple staff, and the need for high transmission-risk aerosol generating activities. The current study aims to establish a guide for establishing optimum protection conditions that should be done before, during and after surgical intervention. A clear plan has to be developed to only provide essential surgical care during the pandemic. All the elective and non-essential procedures need to be deferred. Whenever close contact is mandated with the suspected patients, the staff should wear proper personal protective equipment. There should be proper training in the appropriate use and application of PPE. The most important thing in the chain is hand hygiene and 70% alcohol solutions should be placed strategically. Universal pre-operative testing of patients is discouraged. Minimum possible staff should be used to transfer the patient to and from the operating theater. The path of the patient should be kept clear. Consider designating a specific operating theater for all suspected COVID-19 cases. Though general anaesthesia is not contra-indicated in suspected or confirmed COVID-19 cases, regional anesthesia with IV sedation, if feasible, should be preferred. Bag mask ventilation should be avoided for as long as possible. The most skilled provider should do intubation. The risk of aerosol exposure and the resultant transmission of infection to the operative team during a laparoscopic procedure is a likely issue and have led people to advocate open surgery in suspected COVID-19 patients. Laparoscopic surgery in COVID-19 positive patients should be performed in a negative pressure room and smoke evacuation systems should be used. The patient should be extubated in the operating room itself and should be shifted only once they have recovered fully. Appropriate disinfection of atmosphere and OT walls and floors should be done. Patients should be shifted to an area earmarked for COVID patients. Negative airflow should be used preferably in areas that are reserved for suspected COVID-19 patients. It is essential that every center develops its own protocols bearing in mind the local factors, but the protocols developed should be followed stringently in order to break the transmission of COVID-19 and protect health-care workers and the patients alike.

21-31

Authors: Apostolidis K, Aslanidis Th, Nikolaidou O, Charitidou S, Syrmou E, Allios D, Tsioupa A, Iliadis K, Karabelidou Ch.

COVID-19 pandemic has created an unprecedented citation for the healthcare system; such that its effects are now started to become obvious. The main aim of this report is to describe the time trends of utilization of prehospital emergency medical system in a region of northern Greece from first confirmed case of the COVID-19 in the country, at 26/02/2020, till the first order for loosing lockdown at 04/05/2020. Use of data retrospectively collected for PEMS usage, in the regional unit of Thessaloniki, Northern Greece 26/02/2020, till the first order for loosing lockdown at 04/05/2020. The area of interest represents a little more than 10% of the total population of Greece. Daily cases of selected categories (suicides, assaults, animal bites, cardiac arrests, and car accidents) were recorded. Comparison with the daily cases in the previous 2 years (2019,2018), for the same period was performed. Comparison of suicides reveals larger daily case for 2020 in regard to both 2019 (p=0.049) and to 2018 (p=0.000438); while this was not the case in assaults (p=0.09 and 0.103 respectively) and animal bites cases (p = 0.38 and 0.101 respectively). Yet, for the later, the net number of animal bites cases was larger during the lockdown. Cardiac arrests were more in comparison with the previous 2 years (2019:p=1.88 x 10-5, 2018:p=7.12 x10-5); and, as expected, the opposite was valid for card accidents : they were more in 2018 that the same period of 2019 (p=1.03×10-6) and 2020 (p= 2.53 x10-12). It seems that lockdown has affected daily cases of suicides, cardiac arrests more than the other categories under research. Net number of animal bites cases were also increased. Assaults cases seem to be unaffected during the lockdown period, although more careful interpretation is needed. Finally, car accidents, due to travel limitations, were fewer in the same period. However, larger studies are needed -especially from highly affected from the pandemic areas- to reach certain conclusions.