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In the Extraordinary Times of Coronavirus Disease 2019: Clinical Strategies for Performing Spinal Surgery

Asian Spine Journal 2020년 14권 5호 p.721 ~ 729
Barry Tan Wei Loong, Jeanette Tan Sze Lyn Jasmin, Ashokka Balakrishnan, Lopez Keith Gerard, Thambiah Joseph, Kumar Naresh,
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 ( Barry Tan Wei Loong ) - National University Health System Department of Orthopaedic Surgery
 ( Jeanette Tan Sze Lyn Jasmin ) - National University Health System Department of Anaesthesia
 ( Ashokka Balakrishnan ) - National University Health System Department of Anaesthesia
 ( Lopez Keith Gerard ) - National University Health System Department of Orthopaedic Surgery
 ( Thambiah Joseph ) - National University Health System Department of Orthopaedic Surgery
 ( Kumar Naresh ) - National University Health System Department of Orthopaedic Surgery

Abstract


The coronavirus disease 2019 (COVID-19) pandemic has caused pronounced strain on global healthcare systems, forcing the streamlining of clinical activities and conservation of health resources. There is a pressing need for institutions to present discipline-specific strategies for the management of COVID-19 patients. We present the comprehensive considerations at the National University Hospital, Singapore from the surgeon’s and anesthetist’s perspectives in the performance of spinal surgery in COVID-19 patients. These are based on national guidelines and overarching principles of protection for the healthcare workers (HCWs) and efficiency in surgical planning. The workflow begins with the emergency department screening that has been adapted to the local epidemiology of COVID-19 in order to identify suspected/confirmed cases. If patient history cannot be obtained, demographic, clinical, and imaging data are used. Designated orthopedic “contaminated teams” are available 24/7 with an activation time of <30 minutes for review. In cases where sub-specialty spine surgeons were required, these professionals were inducted into the “contaminated team” and quarantined until cleared to return to work. Indications for emergency spine surgery were determined pre-emptively. Preoperative surgical considerations included the minimization of manpower, limited dissection, reduced operative time, and judicious use of equipment, leading to reduced aerosolization. Anesthesia considerations include preoperative screening for COVID-19?related concerns that influence surgery, operating room process planning and induction, intraoperative, reversal, recovery, and resuscitation considerations. Focused multi-disciplinary preoperative briefing facilitates familiarization. Surgical, anesthetic, and postoperative workflows were designed to reduce the risk of transmission and protect HCWs while effectively performing spinal surgery. The COVID-19 pandemic has necessitated paradigm shifts in healthcare planning, hospital workflows, and operative protocols. The viral burden does not discriminate between surgeons and physicians, and it is crucial that we, as medical professionals, adapt practices to be malleable and fluid to address the ever-changing developments.

키워드

COVID-19; Spine surgery; Operative surgical procedures; Perioperative procedures; Anesthesia methods; Hospital planning; Personal protective equipment

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