COVID-19 Pandemi Sırasındaki Acil Cerrahi Bakım ve Ameliyathane Uygulamalarında Perioperatif Uygulama ve Rehberlik; Deneyimlerimiz

Aim: The novel coronavirus SARS-CoV-2 (COVID-19) can infect healthcare workers. We developed an institutional algorithm to protect operating room team members during the COVID-19 pandemic and rationally conserve personal protective equipment (PPE). We aimed to review the latest data on the COVID-19 pandemic and essential information for practice in emergency surgery and the operating room.Materials and Methods: An interventional platform (operating room, interventional suite, and endoscopy) with our committee formed with our doctors consisting of different branches, we developed our guidelines based on potential patterns of spread, risk of exposure, and conservation of PPE. We aimed to share our experiences with 128 patients who were taken into operation in a 2-month period.Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in Medical Faculty of Namık Kemal University.Results: A decision tree algorithm describing our institutional guidelines for precautions for operating room team members was created. This algorithm is based on the urgency of operation, anticipated viral burden at the surgical site, the opportunity for a procedure to aerosolize virus, and the likelihood a patient could be infected based on symptoms and testing.Conclusion: Despite COVID-19 being a new threat, we have shown that by developing an easy-to-follow decision algorithm for the interventional platform teams, we can ensure optimal healthcare worker safety.Amaç: Yeni koronavirüs SARS-CoV-2 (COVID-19) sağlık çalışanlarını enfekte edebilir. COVID-19 salgını sırasında ameliyathane ekip üyelerini korumak ve rasyonel olarak kişisel koruyucu ekipman (KKE) için kurumsal bir algoritma geliştirdik. Acil cerrahi ve ameliyathanede COVID-19 salgını ile ilgili en güncel bilgileri gözden geçirmeyi amaçladık. Materyal ve Metot: Farklı branşlardan oluşan doktorlarımızla oluşturduğumuz komitemiz ile girişimsel bir platform (ameliyathane, girişimsel ve endoskopi), potansiyel yayılma örüntüleri, maruz kalma riski ve KKE'nin korunmasına dayanan kılavuzlarımızı geliştirdik. Deneyimlerimizi 2 aylık bir sürede ameliyat edilen 128 hasta ile paylaşmayı amaçladık. 2019-nCoV şüphesi olan hastalar için acil durum prosedürleri için anestezi yönetimi ve enfeksiyon kontrol kılavuzları Namık Kemal Üniversitesi Tıp Fakültesi'nde hazırlanmış ve uygulanmıştır. Bulgular: Ameliyathane ekibi üyelerine yönelik önlemler için kurumsal yönergelerimizi açıklayan bir karar algoritması oluşturuldu. Bu algoritma ameliyatın aciliyetine, cerrahi bölgede beklenen viral yüke, virüsü aerosol haline getirme prosedürü fırsatına ve hastanın semptomlara ve testlere dayanarak enfekte olma olasılığına dayanır. Sonuç: COVID-19'un yeni bir tehdit olmasına rağmen, girişimsel platform ekipleri için izlemesi kolay bir karar algoritması geliştirerek, optimum sağlık çalışanı güvenliğini sağlayabildiğimizi gösterdik

Combined spinal-epidural anesthesia or local anesthesia + Sedoanalgesia in abdominal aortic Aneurism Repair?

Objective: Anesthesia for the repair of abdominal aortic aneurism can be performed with different modalities of anesthesia or their combinations. The risk level for the morbidity and mortality of the patients, is increased in geriatric patients with the existence of accompanying pathology. To compare two different anesthesia methods (local anesthesia and sedation vs combined spinal and epidural anesthesia) for the repair of endovascular aneurism in a geriatric patient. Material and Methods: 16 high risk geriatric patients were included in the study. The parameters of 16 high risk patients who underwent elective or emergency treatment for endovascular aneurism were included. Group-I (n:8) was given local anesthesia and sedation, Group-II (n:8) was given combined spinal and epidural anesthesia. Intraoperative and postoperative hemodynamic parameters were reviewed and analyzed. The demographic data of the two groups ressembled each other. Results: The complication rate was calculated at an average of 6.25%, which was considered insignifcant (p>0.05). There was no signifcant difference between the duration of hospital and intensive care unit stay for the two groups (p>0.05). Conclusion: Combined spinal and epidural anesthesia requires much more experience, but it is safer than local anesthesia and sedation for endovascular aneurism patients