University of Iowa, United States of America.
Department of Anesthesia and Critical Care Medicine, Royal Hobart Hospital, Hobart, Tasmania, Australia.
J Clin Anesth. 2020 Sep;64:109854. doi: 10.1016/j.jclinane.2020.109854. Epub 2020 Apr 29.
We performed a narrative review to explore the economics of daily operating room management decisions for ambulatory surgery centers following resolution of the acute phase of the Coronavirus Disease 2019 (COVID-19) pandemic. It is anticipated that there will be a substantive fraction of patients who will be contagious, but asymptomatic at the time of surgery. Use multimodal perioperative infection control practices (e.g., including patient decontamination) and monitor performance (e.g., . transmission from patient to the environment). The consequence of COVID-19 is that such processes are more important than ever to follow because infection affects not only patients but the surgery center staff and surgeons. Dedicate most operating rooms to procedures that are not airway aerosol producing and can be performed without general anesthesia. Increase throughput by performing nerve blocks before patients enter the operating rooms. Bypass the phase I post-anesthesia care unit whenever possible by appropriate choices of anesthetic approach and drugs. Plan long-duration workdays (e.g., 12-h). For cases where the surgical procedure does not cause aerosol production, but general anesthesia will be used, have initial (phase I) post-anesthesia recovery in the operating room where the surgery was done. Use anesthetic practices that achieve fast initial recovery of the brief ambulatory cases. When the surgical procedure causes aerosol production (e.g., bronchoscopy), conduct phase I recovery in the operating room and use multimodal environmental decontamination after each case. Use statistical methods to plan for the resulting long turnover times. Whenever possible, have the anesthesia and nursing teams stagger cases in more than one room so that they are doing one surgical case while the other room is being cleaned. In conclusion, this review shows that while COVID-19 is prevalent, it will markedly affect daily ambulatory workflow for patients undergoing general anesthesia, with potentially substantial economic impact for some surgical specialties.
我们进行了叙述性综述，以探讨在 2019 年冠状病毒病（COVID-19）急性阶段解决后，日间手术中心的日常手术室管理决策的经济学。预计将有相当一部分患者在手术时具有传染性，但无症状。使用多模式围手术期感染控制措施（例如，包括患者去污）并监测性能（例如，从患者向环境传播）。COVID-19 的后果是，这些过程比以往任何时候都更加重要，因为感染不仅影响患者，还影响手术中心的工作人员和外科医生。将大多数手术室用于不会产生气道气溶胶且可以在不使用全身麻醉的情况下进行的程序。通过在患者进入手术室之前进行神经阻滞来增加吞吐量。尽可能通过适当选择麻醉方法和药物绕过第一阶段的麻醉后护理病房。计划长时间的工作日（例如，12 小时）。对于手术过程不会产生气溶胶，但将使用全身麻醉的情况，在进行手术的手术室中进行初始（第一阶段）麻醉后恢复。使用能够快速实现短暂日间病例初始恢复的麻醉实践。当手术过程产生气溶胶（例如支气管镜检查）时，在手术室进行第一阶段恢复，并在每次手术后使用多模式环境去污。使用统计方法来计划由此产生的长周转时间。只要有可能，让麻醉和护理团队在多个房间中交错病例，以便他们在一个手术房间中进行手术，而另一个房间正在进行清洁。总之，本综述表明，在 COVID-19 流行期间，它将显著影响接受全身麻醉的患者的日常日间手术流程，对某些外科专业产生潜在的重大经济影响。
