Wade Stuart, Nair Ganeshkrishna, Ayeni Hafis A, Pawa Amit
Anaesthesia, Guy's and St Thomas' NHS Foundation Trust, London, GBR.
Cureus. 2020 Jun 23;12(6):e8781. doi: 10.7759/cureus.8781.
Study objective Analysis of emergency cases performed during initial coronavirus disease 2019 (COVID-19) pandemic and the proportion completed under regional anesthesia (RA). Design Cohort study comparing surgical caseload during initial seven-week COVID-19 pandemic in 2020. Comparison was made with pre-COVID-19 caseload over the corresponding seven-week timeframe in 2019. Setting The setting of the study was emergency surgery theaters at Guy's and St Thomas' NHS Foundation Trust, London, UK. Patients All patients requiring emergency surgery over the defined study period were reviewed with the exception of obstetric and pediatric populations. Interventions Surgical caseload for 2020 and 2019 cohorts established using the Galaxy IT system used to log all operations. All relevant anesthetic charts for the 2020 cohort were subsequently reviewed to ascertain perioperative use of RA. Measurements The type of block, mode of approach, experience of the operator, personal protective equipment (PPE) worn, block complications, type of sedation and complications were entered into database. Main results A total of 338 emergency surgical cases were performed during the COVID-19 pandemic in 2020, compared to 603 cases over the corresponding period in 2019. This showed a 44% decrease in emergency surgical workload. There was a marked disparity in reduction of surgical caseload by surgical subspecialty. Trauma (137 vs 66 cases), a 52% decrease, and general surgery (193 vs 64 cases), a 66% decrease, were the most pronounced, and explanations for this are explored. RA was performed in 34% (26% as primary technique) of cases during the COVID-19 pandemic. The use of RA as the primary anesthesia technique was noticeably higher than previous UK data (11%), and was prominent in specialties such as general surgery, gynecology and urology, not traditionally completed under RA. Conclusions Surgical RA (and general anesthesia avoidance) has a significant role in the future to ensure high-quality perioperative care for patients whilst minimizing exposure to staff and utilization of scarce resources (PPE).
分析2019冠状病毒病（COVID-19）大流行初期进行的急诊病例以及在区域麻醉（RA）下完成的比例。
队列研究，比较2020年COVID-19大流行初期七周内的手术病例数。与2019年相应七周时间范围内COVID-19之前的病例数进行比较。
英国伦敦盖伊和圣托马斯国民保健服务基金会信托医院的急诊手术室。
除产科和儿科人群外，对在规定研究期间需要急诊手术的所有患者进行了评估。
使用用于记录所有手术的Galaxy IT系统确定2020年和2019年队列的手术病例数。随后对2020年队列的所有相关麻醉记录进行审查，以确定围手术期RA的使用情况。
将阻滞类型、入路方式、操作者经验、所佩戴的个人防护装备（PPE）、阻滞并发症、镇静类型和并发症录入数据库。
2020年COVID-19大流行期间共进行了338例急诊手术病例，而2019年同期为603例。这表明急诊手术工作量减少了44%。各外科亚专业的手术病例数减少存在明显差异。创伤（137例对66例）减少了52%，普通外科（193例对64例）减少了66%最为明显，并对此进行了原因探讨。在COVID-19大流行期间，34%的病例采用了RA（26%作为主要技术）。RA作为主要麻醉技术的使用明显高于英国以前的数据（11%），并且在普通外科、妇科和泌尿外科等传统上不在RA下完成手术的专科中很突出。
手术RA（以及避免全身麻醉）在未来具有重要作用，可确保为患者提供高质量的围手术期护理，同时尽量减少工作人员的暴露以及稀缺资源（PPE）的使用。
