Caring for patients with pain during the COVID-19 pandemic: consensus recommendations from an international expert panel.
chronic pain; COVID-19; COVID-19; epidural steroid injections; immune; management; opioid therapy; opioids; population; prevalence; prevention; quality-of-life; recommendations; risk; steroids; united-states
Chronic pain causes significant suffering, limitation of daily activities and reduced quality of life. Infection from COVID-19 is responsible for an ongoing pandemic that causes severe acute respiratory syndrome, leading to systemic complications and death. Led by the World Health Organization, healthcare systems across the world are engaged in limiting the spread of infection. As a result, all elective surgical procedures, outpatient procedures and patient visits, including pain management services, have been postponed or cancelled. This has affected the care of chronic pain patients. Most are elderly with multiple comorbidities, which puts them at risk of COVID-19 infection. Important considerations that need to be recognised during this pandemic for chronic pain patients include: ensuring continuity of care and pain medications, especially opioids; use of telemedicine; maintaining biopsychosocial management; use of anti-inflammatory drugs; use of steroids; and prioritising necessary procedural visits. There are no guidelines to inform physicians and healthcare providers engaged in caring for patients with pain during this period of crisis. We assembled an expert panel of pain physicians, psychologists and researchers from North America and Europe to formulate recommendations to guide practice. As the
Shanthanna H; Strand N H; Provenzano D A; Lobo C A; Eldabe S; Bhatia A; Wegener J; Curtis K; Cohen S P; Narouze S
Anaesthesia
2020
2020-04-07
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1111/anae.15076" target="_blank" rel="noreferrer noopener">10.1111/anae.15076</a>
Complications of anesthesia for children with malignant infantile osteopetrosis before and after hematopoietic stem cell transplantation
diagnosis; Pediatrics; intubation; osteopetrosis; management; morbidity; Anesthesiology; complication; autosomal recessive osteopetrosis; anaesthesia
P>Objectives and aims: The primary aim was to determine the frequency of anesthetic-related complications for patients with malignant infantile osteopetrosis (MIOP) before and after hematopoietic stem cell transplant (HSCT). The secondary aims were to describe the types of complications that occurred, to determine whether the risk of anesthetic complications was altered by HSCT, and to determine the frequency of difficult intubation. Background: Patients with MIOP undergo HSCT, often in infancy, and anesthesia is frequently required for investigations and procedures associated with transplantation. Although MIOP has adverse implications for anesthetic management, the literature describing the anesthetic management of MIOP patients is limited. Methods: A retrospective review of medical and anesthetic records was undertaken between November 2000 and March 2008. Results: Eleven patients underwent 127 anesthetics. The overall complication rate was 11%. Before HSCT, there were 12 complications in 62 anesthetics (19.3%). After HSCT, there were two complications in 65 anesthetics (3.2%). This difference was not statistically significant. All of the complications were airway or respiratory events. Of the 26 intubations associated with anesthesia, 23 (88.5%) were easy, 1 (3.8%) was moderately difficult, and 2 (7.7%) were difficult. Conclusion: Complications associated with anesthesia for infants and children with MIOP having HSCT are fairly common and are usually airway or respiratory related. Difficult endotracheal intubation is also common.
Burgoyne L L; Kaur A; Billups C A; Parish M E; Kaddoum R N; Bikhazi G B; Pereiras L A
Pediatric Anesthesia
2010
2010-11
Journal Article or Conference Abstract Publication
<a href="http://doi.org/10.1111/j.1460-9592.2010.03425.x" target="_blank" rel="noreferrer noopener">10.1111/j.1460-9592.2010.03425.x</a>
Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations.
acute respiratory syndrome; anaesthesia; cesarean delivery; coronavirus; COVID-19; COVID-19; dispersion; exhaled air; hypotension; management
Coronavirus disease 2019 (COVID-19) has had a significant impact on global healthcare services. In an attempt to limit the spread of infection and to preserve healthcare resources, one commonly used strategy has been to postpone elective surgery, whilst maintaining the provision of anaesthetic care for urgent and emergency surgery. General anaesthesia with airway intervention leads to aerosol generation, which increases the risk of COVID-19 contamination in operating rooms and significantly exposes the healthcare teams to COVID-19 infection during both tracheal intubation and extubation. Therefore, the provision of regional anaesthesia may be key during this pandemic, as it may reduce the need for general anaesthesia and the associated risk from aerosol-generating procedures. However, guidelines on the safe performance of regional anaesthesia in light of the COVID-19 pandemic are limited. The goal of this review is to provide up-to-date, evidence-based recommendations or expert opinion when evidence is limited, for performing regional anaesthesia procedures in patients with suspected or confirmed COVID-19 infection. These recommendations focus on seven specific domains including: planning of resources and staffing; modifying the clinical environment; preparing equipment, supplies and drugs; selecting appropriate personal protective equipment; providing adequate oxygen therapy; assessing for and safely performing regional anaesthesia procedures; and monitoring during the conduct of anaesthesia and post-anaesthetic care. Implicit in these recommendations is preserving patient safety whilst protecting healthcare providers from possible exposure.
Uppal V; Sondekoppam R V; Landau R; El-Boghdadly K; Narouze S; Kalagara H K P
Anaesthesia
2020
2020-04-28
Article information provided for research and reference use only. All rights are retained by the journal listed under publisher and/or the creator(s).
journalArticle
<a href="http://doi.org/10.1111/anae.15105" target="_blank" rel="noreferrer noopener">10.1111/anae.15105</a>