# ent

id: cord-257729-s0vo7dlk
type: EVENT
entity:
  Delivery COVID 19 Considerations Center for Disease Control and Prevention Interim Infection Prevention and Control Recommendations for Patients with Suspected


id: cord-327388-26ot3cuy
type: WORK_OF_ART
entity:
  Addressing Equity in Telemedicine for Chronic Disease Management During the Covid 19 Pandemic Catalyst


id: cord-318519-8sny5uq1
type: CHEMICAL
entity:
  virus 3 4 3 the procedure requires the gastroenterologist technologist and at times anesthesia provider to stand in close proximity


id: cord-265233-v5sq5epy
type: WORK_OF_ART
entity:
  Implementing Filtering Facepiece Respirator FFR Reuse Including Reuse after Decontamination When There Are Known Shortages


id: cord-265233-v5sq5epy
type: ORG
entity:
  New Document Shows Inadequate Distribution of Personal Protective Equipment and Critical Medical Supplies


id: cord-289806-6ihptx6n
type: ORG
entity:
  Institute of Medicine US Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations Guidance for Establishing Crisis Standards of Care for Use in Disaster Situations A Letter Report OPERATIONAL IMPLEMENTATION


id: cord-291137-09a3tblt
type: GGP
entity:
  bradykinin 1 2 3 4 5 ACE indicates angiotensin converting enzyme Ang 1 angiotensin I Ang 2 angiotensin II AT 1 angiotensin type 1


id: cord-291137-09a3tblt
type: GGP
entity:
  angiotensinconverting enzyme Ang 1 7 angiotensin 1 7 Ang 1 9 angiotensin 1 9 Ang 1 angiotensin I Ang 2 angiotensin II


id: cord-324388-onc441uw
type: ORG
entity:
  Universities Australia Clinical Trials Regulation Informed Consent and Information to Patients European Patients Forum Guidelines


# bib

id: cord-011656-zln7zmn9
title: Medical Ethics Versus Healthcare Workers’ Rights: Fight-or-Flee Response
author: Subedi, Asish
date: 2020-06-16
txt: ./txt/cord-011656-zln7zmn9.txt
cache: ./cache/cord-011656-zln7zmn9.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7302076/
doi: 10.1213/ane.0000000000005060
abstract: nan
summary:
  To the Editor I read with great interest an article by Bong 1 on coronavirus disease 2019 (COVID-19) impact on low-and middle-income countries (LMICs). This article deals with the several health care problems faced in LMICs, and the authors have provided solutions to overcome it. 2 This report highlights the importance of psychological well-being of health care workers involved during the COVID-19 tsunami. To overcome the mental stress, the government should provide social securities and incentives to health care workers, and moral support to reassure how important we are to the country and the sacrifices we are doing at this crisis. 1 While, at this moment, when the rich countries are struggling to get the PPEs for their own health care workers, we will only have a handful of these PPEs by the time it reaches our place. Intensive care units in the context of COVID-19 in Nepal: current status and need of the hour


id: cord-012459-tge08va0
title: Airway Alert Bracelets: Enhancing Safety in the Coronavirus Disease 2019 Era
author: Matthews, Laura J.
date: 2020-08-18
txt: ./txt/cord-012459-tge08va0.txt
cache: ./cache/cord-012459-tge08va0.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7437420/
doi: 10.1213/ane.0000000000005165
abstract: nan
summary:
  We have designed a medical alert bracelet, similar to a hospital name band, that is placed on any patient where nonstandard equipment (anything other than iView video laryngoscope [Intersurgical, Wokingham, England] plus bougie) was needed to secure the airway or where the person intubating experienced difficulty. They then remain on the patient''s wrist for the duration of their ICU stay and provide a visual alert of their difficult airway, regardless of the bed space or even hospital if they are transferred for ongoing care (Figure) . The presence of this bracelet on a patient prompts a review of the electronic intubation notes before undertaking any procedure where the airway could be "at risk," and appropriate measures to be put in place-for example, a senior anesthetist with the relevant equipment present when airway alert patients are proned or deproned. Airway Alert Bracelets: Enhancing Safety in the Coronavirus Disease 2019 Era Figure.


id: cord-253281-95ubt4k1
title: Return to Normal: Prioritizing Elective Surgeries With Low Resource Utilization
author: Wilson, Lauren A.
date: 2020-05-04
txt: ./txt/cord-253281-95ubt4k1.txt
cache: ./cache/cord-253281-95ubt4k1.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004930
doi: 10.1213/ane.0000000000004930
abstract: Supplemental Digital Content is available in the text.
summary:
  We therefore evaluated intensive care unit (ICU) utilization and mechanical ventilation following common elective surgical procedures to (1) determine which procedures are the least resource intensive and (2) which patient populations are less likely to require postoperative ICU admission or ventilation. Multivariable logistic regression models measured the association between patient age/comorbidity burden as measured by Charlson-Deyo index, 3 and the outcomes of ICU admission and ventilation, to validate the perception that younger and healthier patients are less likely to require these resources. Of the 15 elective surgeries evaluated, cardiac procedures were the most resource intensive with 83.9% of patients admitted to the ICU and 27.9% requiring ventilation, followed by abdominal procedures that had an average ICU admission rate of 20.3%. In almost all procedure cohorts, younger patients with a low comorbidity burden were less likely to require ICU admission and/or ventilation.


id: cord-254266-6ca2d79d
author: Loftus, Randy W.
date: 2020-04-20
txt: ./txt/cord-254266-6ca2d79d.txt
cache: ./cache/cord-254266-6ca2d79d.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004854
doi: 10.1213/ane.0000000000004854
abstract: nan
summary:
  [3] [4] [5] We evaluated the impact of an evidence-based, multifaceted approach on perioperative Staphylococcus aureus transmission and surgical-site infections (SSIs) in a randomized clinical trial. 7 Povidone-iodine has rapid and effective virucidal activity against the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and Modified Vaccinia Virus Ankara (MVA) with at least a 4 log 10 (99.99%) inactivation of both pathogens within 15 seconds. While chlorhexidine gluconate is less effective than povidone-iodine, 8 it has activity against enveloped viruses on skin and in the oral cavity (0.12%) with viral inactivation in as little as 30 seconds. 7, 8, 11, 12, 15 In conclusion, the evidence shows a favorable risk/benefit profile for our recommendation of patient decolonization with nasal povidone and oral chlorhexidine rinse to help mitigate the perioperative spread of COVID-19.

title:
  In Response: "Perioperative COVID-19 Defense: An Evidence-Based Approach for Optimization of Infection Control and Operating Room Management"


id: cord-254861-lpzx878m
title: An Interim Solution to the Decreased Availability of Respirators Against COVID-19
author: Saggese, Nicholas P.
date: 2020-04-22
txt: ./txt/cord-254861-lpzx878m.txt
cache: ./cache/cord-254861-lpzx878m.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33035018/
doi: 10.1213/ane.0000000000004879
abstract: nan
summary:
  To the Editor W e read the recent article titled, "Utility of Substandard Facemask Options for Health Care Workers during the COVID-19 Pandemic" by Abd-Elsayed and Karru 1 with great interest. The respirator is comprised of an anesthesia mask, inline ventilator filter, or high-efficiency particulate air (HEPA) filter and elastic straps ( Figure A) . 3 Also, a case report from Singapore demonstrated 41 health care workers (HCWs) who came in contact with COVID-19 patients during aerosolizing procedures. Alternatively, the authors of this letter used 2 tourniquets fashioned together instead of rubber bands to create a better seal ( Figure C) . After using this technique and performing a user seal An Interim Solution to the Decreased Availability of Respirators Against COVID-19 Figure. Solutions to the shortage of N95 respirators are crucial for protecting health care workers from contracting the virus and becoming a vector of transmission to others. Utility of substandard face mask options for health care workers during the COVID-19 pandemic


id: cord-257729-s0vo7dlk
title: Obstetric Anesthesia During the Coronavirus Disease 2019 Pandemic
author: Bauer, Melissa
date: 2020-04-20
txt: ./txt/cord-257729-s0vo7dlk.txt
cache: ./cache/cord-257729-s0vo7dlk.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004856
doi: 10.1213/ane.0000000000004856
summary:
  T he management of obstetric patients infected with Coronavirus Disease 2019 (COVID19) due to human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) requires quite unique considerations-from caring for critically ill pregnant and postpartum women to protecting health care workers from exposure during the delivery hospitalization (health care providers, personnel, family members, and beyond). 4 An additional manifestation noted among patients with COVID-19 infection is the sudden loss (or reduction) of the sense of smell and taste, which is currently recommended by the American Academy of Otolaryngology-Head With increasing numbers of Coronavirus Disease 2019 (COVID 19) cases due to efficient human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States, preparation for the unpredictable setting of labor and delivery is paramount.

abstract:
  With increasing numbers of Coronavirus Disease 2019 (COVID19) cases due to efficient human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States, preparation for the unpredictable setting of labor and delivery is paramount. The priorities are 2-fold in the management of obstetric patients with COVID-19 infection or persons under investigation (PUI): (1) caring for the range of asymptomatic to critically ill pregnant and postpartum women; (2) protecting health care workers and beyond from exposure during the delivery hospitalization (health care providers, personnel, family members). The goal of this review is to provide evidence-based recommendations or, when evidence is limited, expert opinion for anesthesiologists caring for pregnant women during the COVID19 pandemic with a focus on preparedness and best clinical obstetric anesthesia practice.


id: cord-258071-amkfz940
title: Barrier System for Airway Management of COVID-19 Patients
author: Brown, Sarah
date: 2020-04-22
txt: ./txt/cord-258071-amkfz940.txt
cache: ./cache/cord-258071-amkfz940.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33035017/
doi: 10.1213/ane.0000000000004876
abstract: nan
summary:
  To the Editor A irway management of patients with Coronavirus Disease 2019 (COVID-19) poses significant risk to involved staff because of the aerosolizing nature of airway interventions. When selecting such a barrier device, one should consider the importance of access to the airway, containment of aerosolization, time required to set up the device for patient use, and patient tolerance of the device. Some barrier devices, while superior at containing aerosolization, unfortunately restrict the laryngoscopist''s hand movements and would require abandoning a laryngoscopy attempt to remove the barrier if it proved too cumbersome. After intubation is performed and endotracheal tube secured, the clear plastic drape can be tucked into the drawstring bag, which now contains the contaminated airway space for the duration of the case. The patient could be later extubated under the clear drape, and the drape can then be removed and placed in the drawstring bag along with disposable airway equipment such as the suction catheter and stylet.


id: cord-263087-fhn4m2zc
title: Adaptation to the Plastic Barrier Sheet to Facilitate Intubation During the COVID-19 Pandemic
author: Yang, Yao-Lin
date: 2020-05-04
txt: ./txt/cord-263087-fhn4m2zc.txt
cache: ./cache/cord-263087-fhn4m2zc.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32345856/
doi: 10.1213/ane.0000000000004923
abstract: nan
summary:
  To the Editor W e read with interest the recent article by Brown et al, 1 titled "Barrier System for Airway Management of COVID-19 Patients" which described the use of a plastic drape attached to a plastic bag as a protective measure during endotracheal intubation and extubation. A transparent dressing should not be utilized with videolaryngoscopy as the film''s adhesive nature may interfere with the maneuvering of laryngoscope or endotracheal tube, but a dressing can be placed Adaptation to the Plastic Barrier Sheet to Facilitate Intubation During the COVID-19 Pandemic Figure. Although we have been carefully removing the drape after successful intubation, we feel that Brown et al 1 and other authors make an excellent point that the sheet can be left in place for the duration of surgery, and the patient can be subsequently extubated under the drape, shielding anesthesia providers and other operating room personnel when the endotracheal tube is removed.


id: cord-265233-v5sq5epy
title: Decontamination and Reuse of N95 Filtering Facepiece Respirators: Where Do We Stand?
author: Cassorla, Lydia
date: 2020-10-15
txt: ./txt/cord-265233-v5sq5epy.txt
cache: ./cache/cord-265233-v5sq5epy.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000005254
doi: 10.1213/ane.0000000000005254
summary:
  P ersistent shortages of filtering facepiece respirators (FFR) to protect health care workers (HCW) 1 during the current coronavirus disease 2019 (COVID-19) pandemic 2,3 has driven interest in decontamination and reuse. 8 While FFR are not superior to surgical masks for protection of HCW from seasonal flu, [9] [10] [11] [12] [13] [14] retrospective studies showed increased protection from severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1). [28] [29] [30] [31] [32] [33] [34] In 2006, the Institute of Medicine, now the National Academy of Medicine, convened a "Committee on the Development of Reusable Facemasks for Use during an Influenza Pandemic." Highlighting unpreparedness, 2 reports recommended "expeditious research and policy action" to develop personal protective equipment (PPE) designed to withstand decontamination, evidence-based performance standards, and improved coordination among regulatory agencies. Best available evidence supports moist heat, low T autoclave, MWGS, and HP-based decontamination as effective methods for SARS-CoV-2 without causing significant damage to FFR for 2-5 cycles.

abstract:
  The coronavirus disease 2019(COVID-19) pandemic created an extraordinary demand for N95 and similarly rated filtering facepiece respirators (FFR) that remain unmet due to limited stock, production constraints, and logistics. Interest in decontamination and reuse of FFR, a product class designed for single use in health care settings, has undergone a parallel surge due to shortages. A worthwhile decontamination method must provide effective inactivation of the targeted pathogen(s), and preserve particle filtration, mask fit, and safety for a subsequent user. This discussion reviews the background of the current shortage, classification, structure, and functional aspects of FFR, and potentially effective decontamination methods along with reference websites for those seeking updated information and guidance. The most promising techniques utilize heat, hydrogen peroxide, microwave-generated steam, or ultraviolet light. Many require special or repurposed equipment and a detailed operational roadmap specific to each setting. While limited, research is growing. There is significant variation between models with regard to the ability to withstand decontamination yet remain protective. The number of times an individual respirator can be reused is often limited by its ability to maintain a tight fit after multiple uses rather than by the decontamination method itself. There is no single solution for all settings; each individual or institution must choose according to their need, capability, and available resources. As the current pandemic is expected to continue for months to years, and the possibility of future airborne biologic threats persists, the need for plentiful, effective respiratory protection is stimulating research and innovation.


id: cord-273737-t6j3leec
author: Poeran, Jashvant
date: 2020-06-30
txt: ./txt/cord-273737-t6j3leec.txt
cache: ./cache/cord-273737-t6j3leec.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000005083
doi: 10.1213/ane.0000000000005083
summary:
  BACKGROUND: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions) and by geographic location (New York metropolitan region versus the rest of New York State). In NYC, 221,970 patients required an ICU stay with mechanical ventilation (Table 3) ; 12,726 of those patients were admitted after elective surgery (12,726/221,970 = 5.7%), versus emergent/urgent/trauma surgery (n = 75,334) and medical reasons (n=133,910). While suspending elective surgeries clearly increases hospital (non-ICU) bed capacity, our analysis suggests a limited impact on ICU resource allocation, especially in the context of the much larger share of ICU admissions due to emergent/urgent/trauma surgery and medical etiologies.

title:
  Cancellation of Elective Surgery and Intensive Care Unit Capacity in New York State: A Retrospective Cohort Analysis

abstract:
  BACKGROUND: In response to the coronavirus disease 2019 (COVID-19) pandemic, New York State ordered the suspension of all elective surgeries to increase intensive care unit (ICU) bed capacity. Yet the potential impact of suspending elective surgery on ICU bed capacity is unclear. METHODS: We retrospectively reviewed 5 years of New York State data on ICU usage. Descriptions of ICU utilization and mechanical ventilation were stratified by admission type (elective surgery, emergent/urgent/trauma surgery, and medical admissions) and by geographic location (New York metropolitan region versus the rest of New York State). Data are presented as absolute numbers and percentages and all adult and pediatric ICU patients were included. RESULTS: Overall, ICU admissions in New York State were seen in 10.1% of all hospitalizations (n = 1,232,986/n = 12,251,617) and remained stable over a 5-year period from 2011 to 2015. Among n = 1,232,986 ICU stays, sources of ICU admission included elective surgery (13.4%, n = 165,365), emergent/urgent admissions/trauma surgery (28.0%, n = 345,094), and medical admissions (58.6%, n = 722,527). Ventilator utilization was seen in 26.3% (n = 323,789/n = 1232,986) of all ICU patients of which 6.4% (n = 20,652), 32.8% (n = 106,186), and 60.8% (n = 196,951) was for patients from elective, emergent, and medical admissions, respectively. New York City holds the majority of ICU bed capacity (70.0%; n = 2496/n = 3566) in New York State. CONCLUSIONS: Patients undergoing elective surgery comprised a small fraction of ICU bed and mechanical ventilation use in New York State. Suspension of elective surgeries in response to the COVID-19 pandemic may thus have a minor impact on ICU capacity when compared to other sources of ICU admission such as emergent/urgent admissions/trauma surgery and medical admissions. More study is needed to better understand how best to maximize ICU capacity for pandemics requiring heavy use of critical care resources.


id: cord-273884-dm73zgt8
title: Cardiopulmonary Resuscitation in the Prone Position: A Good Option for Patients With COVID-19
author: Ludwin, Kobi
date: 2020-06-16
txt: ./txt/cord-273884-dm73zgt8.txt
cache: ./cache/cord-273884-dm73zgt8.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32516166/
doi: 10.1213/ane.0000000000005049
abstract: Supplemental Digital Content is available in the text.
summary:
  To the Editor P rone positioning of intubated patients suffering from pneumonia improves ventilation-perfusion matching, recruits collapsed alveoli, provides a more uniform distribution of tidal volume through improved chest wall mechanics, and may decrease mortality in more severely hypoxemic patients. 2 Immediate initiation of cardiopulmonary resuscitation (CPR), including chest compressions, are crucial but challenging when the patient is prone. Performance of CPR in the prone position is uncommon, but there are several reports of CPR in patients in the prone position having spine surgery (Supplemental Digital Content, Table 1 , http://links. A reasonable question is whether a prone patient with cardiac arrest be turned supine before initiating CPR or remain in the prone position. Kwon et al 3 reported that the largest left ventricular cross-sectional area is 0-2 vertebral segments below the inferior angle of the scapula in at least 86% of patients in patients positioned prone. Prone positioning improves oxygenation in spontaneously breathing nonintubated patients with hypoxemic acute respiratory failure: a retrospective study


id: cord-274819-xp5q9f0r
author: Lai, Yu Yung
date: 2020-04-20
txt: ./txt/cord-274819-xp5q9f0r.txt
cache: ./cache/cord-274819-xp5q9f0r.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32282387/
doi: 10.1213/ane.0000000000004869
abstract: nan
summary:
  title: A Carton-Made Protective Shield for Suspicious/Confirmed COVID-19 Intubation and Extubation During Surgery A barrier enclosure has recently been proven to effectively minimize the spread of patients'' droplets and aerosols during intubation. 2 However, in the scenario of suspicious/confirmed COVID-19 patients who need to undergo emergency surgery, extubation and emergence cough after general anesthesia are another potential source of transmission, and might contaminate the operating room. Here we proposed a simple, carton-made, protective shield that provides an effective reduction of transmission of droplets and aerosols during both intubation and extubation. After the A Carton-Made Protective Shield for Suspicious/Confirmed COVID-19 Intubation and Extubation During Surgery shield interrupts operation, it should be discarded and a new one prepared for extubation. When extubation of suspicious/confirmed COVID-19 after general anesthesia is needed, the adjunct protective shield may help minimize droplet and aerosol transmission and reduce operating room contamination.

title:
  A Carton-Made Protective Shield for Suspicious/Confirmed COVID-19 Intubation and Extubation During Surgery


id: cord-280794-k591vqji
title: Neuraxial Procedures in COVID-19–Positive Parturients: A Review of Current Reports
author: Bauer, Melissa E.
date: 2020-04-20
txt: ./txt/cord-280794-k591vqji.txt
cache: ./cache/cord-280794-k591vqji.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32221171/
doi: 10.1213/ane.0000000000004831
abstract: nan
summary:
  Because anesthesiologists must take into account the risk of meningitis or encephalitis associated with neuraxial procedures in the setting of untreated viremia, we reviewed publications reporting outcomes in COVID-19-positive pregnant women in the current pandemic in an attempt to address this concern. In general, the risk of causing meningitis or encephalitis is extremely low with neuraxial procedures, even in infected patients. Before performing a neuraxial procedure in these patients, it would be advisable to review a recent platelet count given that one-third of patients with COVID-19 infection have been reported to have thrombocytopenia compared with 7%-12% of patients during pregnancy alone. 7 In pregnant women, a platelet count of 70,000 × 10 6 /L has a low risk for spinal epidural hematoma, and lower levels should be considered in cases such as these with a high risk for respiratory compromise with general anesthesia.


id: cord-282026-839jc5wp
title: Coronavirus Disease 2019: Epidemiological Factors During Aerosol-Generating Medical Procedures
author: Tsui, Ban C. H.
date: 2020-06-16
txt: ./txt/cord-282026-839jc5wp.txt
cache: ./cache/cord-282026-839jc5wp.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000005063
doi: 10.1213/ane.0000000000005063
abstract: nan
summary:
  3 During AGMPs, PPE (including N95 respirators, powered air purifying respirators [PAPRs], face shields, gowns, and gloves) remains the major environment-host IF protecting HCWs. For AGMPs, such as intubation, video laryngoscopy provides slightly more distance between the infected patient and the HCW when compared to direct laryngoscopy, but the HCW still remains at high exposure risk. In fact, the Anesthesia Patient Safety Foundation (APSF) and the American Society of Anesthesiologists (ASA) recommend decontamination of the OR after care of COVID patients and "entry should be delayed until sufficient time has elapsed for enough air changes to remove aerosolized infectious particles." 3 Safety practices used by other occupations exposed to hazardous particulates provide a great resource for alternative agent-environment IFs for HCWs performing AGMPs. Local exhaust ventilation hoods near the contamination source provide effective control of dust and fumes generated in industries utilizing woodworking and soldering.


id: cord-287553-yev5i6hu
title: Additional Barrier to Protect Healthcare Workers During Intubation
author: Babazade, Rovnat
date: 2020-04-27
txt: ./txt/cord-287553-yev5i6hu.txt
cache: ./cache/cord-287553-yev5i6hu.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32332297/
doi: 10.1213/ane.0000000000004904
abstract: nan
summary:
  We describe a novel barrier method made from an easily accessible, cheap, and disposable transparent plastic sheet (120 × 100 cm; Figure A) with a crosscut that is marked with a red sticker on the transparent sheet (1.5 × 1.5 cm; Figure A) that is positioned at the mouth. In our simulation, the anesthesiologist covered the head of an airway mannequin with this sheet before preoxygenation with a facemask that is connected to the artificial manual breathing unit through crosscut ( Figure B ). After induction of anesthesia, vocal cords are visualized either by a direct or video laryngoscope under the sheet ( Figure C) , and the endotracheal tube is passed through a marked crosscut in the sheet ( Figure D) . A novel barrier method: "aerosol cover." A, Disposable transparent plastic sheet (120 × 100 cm) with a crosscut (1.5 × 1.5 cm). D, Endotracheal tube is passed through a marked crosscut.


id: cord-288569-sitxa2ul
title: Role of Mask/Respirator Protection Against SARS-CoV-2
author: Smereka, Jacek
date: 2020-04-20
txt: ./txt/cord-288569-sitxa2ul.txt
cache: ./cache/cord-288569-sitxa2ul.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004873
doi: 10.1213/ane.0000000000004873
abstract: nan
summary:
  1 There are currently many types of masks/respirators available, ranging from simple surgical masks designed to protect wearers from microorganism transmission and fit loosely to the user''s face, through N95 masks used to prevent users from inhaling small airborne particles. Surgical masks are designed to protect against droplets or particles with a diameter of >100 μm, whereas severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus is essentially spherical, albeit slightly pleomorphic, with a diameter of 60-140 nm and 100 times smaller than the pore diameter. Long et al 5 conclude in their meta-analysis that the use of N95 respirators compared with surgical masks is not associated with a lower risk of laboratory-confirmed influenza. Wang et al 1 indicated that 10 of 213 medical professionals with no mask were infected by COVID-19 as compared with 0 of 278 wearing N95 respirators. 6 To conclude, the use of protective masks can and should be the first protection against SARS-CoV-2 transmission to medical personnel.


id: cord-289806-6ihptx6n
author: Martinez, Rebecca
date: 2020-10-07
txt: ./txt/cord-289806-6ihptx6n.txt
cache: ./cache/cord-289806-6ihptx6n.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33002930/
doi: 10.1213/ane.0000000000005253
abstract: Supplemental Digital Content is available in the text.
summary:
  The pandemic brought near-complete cessation of nonurgent hospital activities with the rapid expansion of critical care services, with the notable exception of the labor and delivery unit (LDU), which continued to have a full complement of patients presenting for obstetric care. By the time the obstetric ICU (OBICU) was fully operational (end of March), the volume demand was mildly curtailed by some patients electing to leave NYC; however, interinstitutional transfers for maternal or fetal indications provided steady demands for care, with fluctuations occurring week by week. However, a key difference is that the critical care attendings (ICU oversight) are not ultimately responsible for patient care decisions and provide ad hoc consultations if deemed needed by the obstetric anesthesia attending. Daily online lectures by the Internal Medicine or Anesthesia departments review critical care topics that are both general in nature and specific to SARS-CoV-2 infection; these lectures while targeted at residents were available to all members of the OBICU team.

title:
  Critical Obstetric Patients During the Coronavirus Disease 2019 Pandemic: Operationalizing an Obstetric Intensive Care Unit


id: cord-291137-09a3tblt
title: Angiotensin II for the Treatment of COVID-19–Related Vasodilatory Shock
author: Chow, Jonathan H.
date: 2020-04-20
txt: ./txt/cord-291137-09a3tblt.txt
cache: ./cache/cord-291137-09a3tblt.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32209811/
doi: 10.1213/ane.0000000000004825
abstract: nan
summary:
  ; Ang-1 = angiotensin I; Ang-2 = angiotensin II; APACHE = Acute Physiology and Chronic Health Evaluation; ARDS = acute respiratory distress syndrome; AT 1 = angiotensin type 1; AT 2 = angiotensin type 2; ATHOS-3 = Angiotensin II for the Treatment of High Output Shock; CI = confidence interval; COVID-19 = coronavirus disease 2019; ECMO = extracorporeal membrane oxygenation; EDHF = endotheliumderived hyperpolarizing factor; ICU = intensive care unit; MAS = mitochondrial assembly protein; NO = nitric oxide; RAAS = renin-angiotensin-aldosterone system; RRT = renal replacement therapy; SARS = severe acute respiratory syndrome C oronavirus disease 2019 (COVID-19) first appeared in Wuhan, China, in early December 2019. 1 In the subgroup of patients admitted to the intensive care unit (ICU), required mechanical ventilation, or died from the disease, 11.9% required continuous renal replacement therapy (RRT), 13.4% developed septic shock, and 40.3% developed acute respiratory distress syndrome (ARDS).


id: cord-293473-32jx8j5g
title: Falsely Low Fibrinogen Levels in COVID-19 Patients on Direct Thrombin Inhibitors
author: Maier, Cheryl L.
date: 2020-05-12
txt: ./txt/cord-293473-32jx8j5g.txt
cache: ./cache/cord-293473-32jx8j5g.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32371744/
doi: 10.1213/ane.0000000000004949
abstract: nan
summary:
  When present in the patient sample, DTIs inhibit the thrombin in the Clauss reagent, prolonging the time to clot formation, and thus underestimating the fibrinogen concentration. Viscoelastic testing represents an alternative to the Clauss method for following fibrinogen levels in the setting of DTIs. The platelet-fibrinogen interactions assessed by maximum amplitude on thromboelastography (TEG) (Haemonetics, Boston, MA) or maximum clot formation on rotational thromboelastometry (ROTEM) (Instrumentation Laboratories) are relatively unaffected by the presence of DTIs. 6 In the example provided in the Figure, a ROTEM was obtained following the reported severe drop in fibrinogen on day 4 and resulted in the following notable parameters: EXTEM clotting time of 477 seconds (normal range 43-82 seconds) and FIBTEM maximum clot firmness of 39 mm (normal range 7-24 mm). The graph demonstrates an example of the magnitude of which an argatroban infusion can have upon the measurement of fibrinogen levels determined by the Clauss assay.


id: cord-295495-leyasj3d
title: Supraglottic Airway–Guided Intubation During the COVID-19 Pandemic: A Closed Technique
author: Wong, Patrick
date: 2020-05-12
txt: ./txt/cord-295495-leyasj3d.txt
cache: ./cache/cord-295495-leyasj3d.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32371746/
doi: 10.1213/ane.0000000000004951
abstract: nan
summary:
  2, 3 We propose a potential "closed set up" version of SAGFBI, which uses an ultrasound probe cover, to form a closed system to minimize aerosol contamination. Approximately 10 cm proximal to the distal end of the probe cover, a small slit is created and the patient-end of a filter is inserted. The distal end of the probe cover is pulled over the entrance of the Auragain ventilation port and taped to form an airtight seal (Figure, panel B) . Second, intubation remains "closed" throughout, that is, from insertion of the bronchoscope into the SGA and the patient''s airway until attachment of the anesthetic circuit to the tracheal tube, unlike other intubation techniques. Airtight seals are made by taping the proximal end of the probe cover and plait and taping the filter inserted near the distal end.


id: cord-296186-ltdhgtdl
author: Verdiner, Ricardo E.
date: 2020-05-12
txt: ./txt/cord-296186-ltdhgtdl.txt
cache: ./cache/cord-296186-ltdhgtdl.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32398432/
doi: 10.1213/ane.0000000000004957
summary:
  In response to the rapidly evolving Coronavirus Disease 2019 (COVID-19) pandemic and the potential need for physicians to provide critical care services, the American Society of Anesthesiologists (ASA) has collaborated with the Society of Critical Care Anesthesiologists (SOCCA), the Society of Critical Care Medicine (SCCM), and the Anesthesia Patient Safety Foundation (APSF) to develop the COVID-Activated Emergency Scaling of Anesthesiology Responsibilities (CAESAR) Intensive Care Unit (ICU) workgroup. The Coronavirus Disease-Activated Emergency Scaling of Anesthesiology Responsibilities in the Intensive Care Unit (CAESAR-ICU) program is a joint initiative of American Society of Anesthesiologists (ASA), Society of Critical Care Medicine (SCCM), Anesthesia Patient Safety Foundation (APSF), and Society of Critical Care Anesthesiologists (SOCCA) and is intended to create a "survival" guide for the practicing anesthesiologist who may be called on to provide early management and stabilization of COVID-19 patients. Poor survival with extracorporeal membrane oxygenation in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19): pooled analysis of early reports

title:
  Coronavirus Disease–Activated Emergency Scaling of Anesthesiology Responsibilities Intensive Care Unit

abstract:
  In response to the rapidly evolving Coronavirus Disease 2019 (COVID-19) pandemic and the potential need for physicians to provide critical care services, the American Society of Anesthesiologists (ASA) has collaborated with the Society of Critical Care Anesthesiologists (SOCCA), the Society of Critical Care Medicine (SCCM), and the Anesthesia Patient Safety Foundation (APSF) to develop the COVID-Activated Emergency Scaling of Anesthesiology Responsibilities (CAESAR) Intensive Care Unit (ICU) workgroup. CAESAR-ICU is designed and written for the practicing general anesthesiologist and should serve as a primer to enable an anesthesiologist to provide limited bedside critical care services.


id: cord-296725-ecy0rie9
title: Lessons Learned From First COVID-19 Cases in the United States
author: Landau, Ruth
date: 2020-04-20
txt: ./txt/cord-296725-ecy0rie9.txt
cache: ./cache/cord-296725-ecy0rie9.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004840
doi: 10.1213/ane.0000000000004840
abstract: nan
summary:
  The simultaneous surge of cases compounded by a critical shortage of protective personnel equipment (PPE), including N95 masks and high-efficiency particulate air (HEPA) filters to avoid contaminating anesthesia machines, has added to the challenge that anesthesiologists are facing today on labor and delivery units across the United States. Current recommendations include airborne protection for all aerosolizing procedures such as endotracheal intubation during general anesthesia. As per current recommendations, for this patient who was neither tested nor symptomatic for COVID-19, the anesthesia team did not use any PPE (besides surgical masks and gloves) nor was a HEPA filter placed between the endotracheal tube and the anesthesia machine. Our case emphasizes that in labor and delivery units managing parturients from communities with a high prevalence of COVID-19 infection, in the absence of universal testing before cesarean delivery, all patients, even those initially asymptomatic on admission, should be treated as PUI when inducing general anesthesia.


id: cord-302112-l74s05s0
author: Laosuwan, Prok
date: 2020-05-12
txt: ./txt/cord-302112-l74s05s0.txt
cache: ./cache/cord-302112-l74s05s0.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33031684/
doi: 10.1213/ane.0000000000004937
abstract: nan
summary:
  title: Acrylic Box Versus Plastic Sheet Covering on Droplet Dispersal During Extubation in COVID-19 Patients 1 There are some suggestions from around the world proposing the placement of large transparent plastic sheets over patients'' faces to limit the contamination area. 2, 3 Therefore, we compared the effectiveness and spreading patterns of acrylic boxes and plastic sheets as protective barriers compared to noncoverage technique under fluorescent condition. We demonstrated the differences of overall droplet dispersion between 3 acrylic box models (3.3%-19.0%), plastic sheet (2.8%), and noncoverage technique (26.3%) during tracheal extubation. The plastic sheet caused contamination both on the chest and abdomen of anesthesia personnel. The height of the box might take part in the contamination area as the droplet dispersion may rebound to the surroundings after striking the top. The droplet spreading patterns of panels (A), (B), (C), transparent plastic sheet (D), and noncoverage technique (E).

title:
  Acrylic Box Versus Plastic Sheet Covering on Droplet Dispersal During Extubation in COVID-19 Patients


id: cord-305066-g042y51w
title: Utility of Substandard Face Mask Options for Health Care Workers During the COVID-19 Pandemic
author: Abd-Elsayed, Alaa
date: 2020-04-20
txt: ./txt/cord-305066-g042y51w.txt
cache: ./cache/cord-305066-g042y51w.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004841
doi: 10.1213/ane.0000000000004841
abstract: nan
summary:
  [4] [5] [6] The US Centers for Disease Control and Prevention (CDC) has suggested that the use of substandard optionsincluding surgical masks, cloth masks, and extended use or reuse of respirators-can be considered, with exercised caution. In this commentary, we attempt to characterize the utility of and provide considerations for the use of these substandard face mask options by HCWs during the COVID-19 pandemic. MacIntyre et al 12 previously reported that the adherent use of surgical face masks or respirators was superior to not using either form of protection in preventing adults from contracting influenza in affected households. Such findings collectively suggest that the adherent use of even suboptimal face masks, along with recommended hand washing practices, may provide meaningful decrement in the risk of contracting respiratory viral illnesses. HCWs, especially those in more impoverished areas of the world, are faced with using substandard options such as surgical face masks, cloth masks, and even extended use or reuse of respirators.


id: cord-310104-1c7q9m06
author: Sasangohar, Farzan
date: 2020-04-20
txt: ./txt/cord-310104-1c7q9m06.txt
cache: ./cache/cord-310104-1c7q9m06.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004866
doi: 10.1213/ane.0000000000004866
abstract: nan
summary:
  T he novel Coronavirus Disease 2019 (COVID19) pandemic has resulted in an overall surge in new cases of depression and anxiety and an exacerbation of existing mental health issues, with a particular emotional and physical toll on health care workers. In this article, we share the lessons learned collectively by an interdisciplinary team of ICU leadership and collaborating scientists at the Center for Outcomes Research at HMH about the experience of occupational fatigue and burnout of intensive care personnel as a result of responding to the COVID-19 pandemic. Several factors may have exacerbated occupational fatigue and burnout in ICUs. Given our overarching roles across various facets of the health care system and our first-hand experiences with the response, the "lessons learned" documented here provide a holistic overview of major system-level problems exposed by the pandemic.

title:
  Provider Burnout and Fatigue During the COVID-19 Pandemic: Lessons Learned From a High-Volume Intensive Care Unit


id: cord-311372-g34gquid
author: Zmijewski, Jaroslaw W.
date: 2020-07-20
txt: ./txt/cord-311372-g34gquid.txt
cache: ./cache/cord-311372-g34gquid.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32701539/
doi: 10.1213/ane.0000000000005140
abstract: nan
summary:
  D espite remarkable progress in understanding the immune response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2), optimal management of immune function during severe viral infections remains a major issue among critically ill patients. Since the first description of role of HLA-DR in immunosuppression, 5 HLA-DR expression on monocytes has been subsequently proven to be a reliable marker for evaluating immune dysfunction and risk of secondary bacterial infections in sepsis and trauma patients. 10 Subsequent studies have recently confirmed that immune dysregulation in COVID-19 patients with respiratory failure is associated with a significant downregulation of monocyte HLA-DR. [13] [14] [15] Such inflammatory mechanisms can be relevant in the development of immunosuppression in sepsis survivors, consistent with reduced Human Leukocyte Antigen-DR Deficiency and Immunosuppression-Related End-Organ Failure in Severe Acute Respiratory Syndrome Coronavirus 2 Infection HLA-DR expression on monocytes after an initial activation of immune cells during sepsis syndrome.

title:
  Human Leukocyte Antigen-DR Deficiency and Immunosuppression-Related End-Organ Failure in Severe Acute Respiratory Syndrome Coronavirus 2 Infection


id: cord-317602-ftcs7fvq
author: O’Reilly-Shah, Vikas N.
date: 2020-05-12
txt: ./txt/cord-317602-ftcs7fvq.txt
cache: ./cache/cord-317602-ftcs7fvq.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004945
doi: 10.1213/ane.0000000000004945
abstract: nan
summary:
  Although it appears that there is general consensus on the use of the Substitutable Medical Apps, Reusable Technologies on Fast Healthcare Interoperability Resources (SMART on FHIR) standard developed by the nonprofit Health Level Seven International (HL7) for the interchange of data, the standard is not specific enough to ensure, and regulators have failed to require, that different vendors implement the specification in compatible ways. To briefly recap, if hospitals across the country were able to observe and interpret data being gathered at other institutions in real time and to contribute their own data to the shared repository, the health care system could be learning about and improving its care of COVID-19 patients continuously and collaboratively, based on the sum total of available information rather than incrementally in silos. The public has a pressing interest in ensuring that data standards (eg, OMOP, FHIR) are rapidly developed, adopted by appropriate international standards organizations (eg, HL7), and implemented by EHR vendors in a manner that facilitates interoperability for individual patient care, public health, and research purposes.

title:
  The COVID-19 Pandemic Highlights Shortcomings in US Health Care Informatics Infrastructure: A Call to Action


id: cord-318519-8sny5uq1
title: To the Editor
author: Hagan, Katherine B.
date: 2020-05-12
txt: ./txt/cord-318519-8sny5uq1.txt
cache: ./cache/cord-318519-8sny5uq1.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32398429/
doi: 10.1213/ane.0000000000004962
abstract: nan
summary:
  To the Editor W e thank Drs Rah and Platovsky 1 for bringing attention to special considerations for gastrointestinal (GI) endoscopic procedures in an ambulatory care setting during the coronavirus disease of 2019 (COVID-19) pandemic. As institutions endeavor to ensure safe endoscopic practices for emergent, urgent, and elective cases, distribution of personal protective equipment (PPE) and access to reliable SARS-CoV-2 (COVID-19) testing remain key issues. Therefore, we strongly recommend PPE use per Center for Disease Control (CDC) guidelines for AGPs 6 and for all procedures in the GI endoscopy suite during the COVID-19 pandemic. We must remember that procedural areas such as endoscopy are not only associated with high patient volumes areas but also associated with prolonged AGP interventions. Determining urgent/emergent status of gastrointestinal (GI) endoscopic procedures in an ambulatory care setting during the coronavirus disease of 2019 (COVID-19) pandemic: additional Factors that need to be considered


id: cord-322784-eqfjrceq
author: Li, Yunping
date: 2020-10-15
txt: ./txt/cord-322784-eqfjrceq.txt
cache: ./cache/cord-322784-eqfjrceq.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33002928/
doi: 10.1213/ane.0000000000005256
summary:
  Care of the pregnant patient during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic presents many challenges, including creating parallel workflows for infected and noninfected patients, minimizing waste of materials, and ensuring that clinicians can seamlessly transition between types of anesthesia. We used a cyclical improvement system and the plus/delta debriefing method to rapidly develop workflows consisting of sequential checklists and procedure-specific packs. Thus, the impact of SARS-CoV-2 in obstetric anesthesia required the creation of parallel workflows to simultaneously deliver high-level care to pregnant patients with and without COVID-19 for labor analgesia, cesarean anesthesia, and other procedures. • Provide full and simultaneous services for both infected and noninfected patients • Rapidly adapt to new workflows • Maximize safety for staff and patients through standard practices • Minimize risk of contamination during procedures • Optimize supplies and materials Debriefings following neuraxial labor analgesia procedures with COVID-19 patients were performed with the director of obstetric anesthesia and frontline clinicians.

title:
  Adaptation of an Obstetric Anesthesia Service for the Severe Acute Respiratory Syndrome Coronavirus-2 Pandemic: Description of Checklists, Workflows, and Development Tools

abstract:
  Care of the pregnant patient during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic presents many challenges, including creating parallel workflows for infected and noninfected patients, minimizing waste of materials, and ensuring that clinicians can seamlessly transition between types of anesthesia. The exponential community spread of disease limited the time for development and training. METHODS: The goals of our workflow and process development were to maximize safety for staff and patients, minimize therisk of contamination, and reduce the waste of unused supplies and materials. We used a cyclical improvement system and the plus/delta debriefing method to rapidly develop workflows consisting of sequential checklists and procedure-specific packs. RESULTS: We designed independent workflows for labor analgesia, neuraxial anesthesia for cesarean delivery, conversion of labor analgesia to cesarean anesthesia, and general anesthesia. In addition, we created procedure-specific material packs to optimize supplies and prevent wastage. Finally, we generated sequential checklists to allow staff to perform standard operating procedures without extensive training. CONCLUSIONS: Collectively, these workflows and tools allowed our staff to urgently care for patients in high-risk situations without prior experience. Over time, we refined the workflows using a cyclical improvement system. We present our checklists and workflows as well as the system we used for their development, so that others may use them to their benefit.


id: cord-324388-onc441uw
title: Same-Day Consent for Regional Anesthesia Clinical Research Trials: It’s About Time
author: Siddiqui, Urooj
date: 2020-08-12
txt: ./txt/cord-324388-onc441uw.txt
cache: ./cache/cord-324388-onc441uw.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000005196
doi: 10.1213/ane.0000000000005196
abstract: nan
summary:
  Notwithstanding the low-risk nature of participation in most regional anesthesia clinical trials, subject recruitment on the same day as surgery is often prohibited by local research ethics boards (REB) due to their concerns regarding patient autonomy and perceptions of patient vulnerability immediately before surgery that could impact the voluntary nature and the rigor of the informed consent process.


id: cord-327388-26ot3cuy
title: The Tipping Point of Medical Technology: Implications for the Postpandemic Era
author: Lu, Amy
date: 2020-06-16
txt: ./txt/cord-327388-26ot3cuy.txt
cache: ./cache/cord-327388-26ot3cuy.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32511105/
doi: 10.1213/ane.0000000000005040
abstract: nan
summary:
  Whereas classic infectioncontrol and public health measures were used during the severe acute respiratory syndrome (SARS) epidemic in 2003, COVID-19 provides the opportunity to explore the potential of new digital technologies, including big data analytics, artificial intelligence, blockchain technology, and the Internet of Things. 1 Among the many available digital technologies, O''Reilly-Shah et al 2 in this issue of Anesthesia & Analgesia address not only the potential benefits but also the barriers to adopting health informatics for patient care during the COVID-19 pandemic. This includes expanding our roles in telehealth platforms and remote monitoring and surveillance in the inpatient and outpatient settings, thereby adding significant value to the continuum of care through perioperative medicine. In the inevitable post-COVID pandemic era, what is the anesthesiologist''s role in technology as our health care systems and other major stakeholders define the "new normal?" Is this our opportunity to take a legitimate seat at the table of state and national discussions on value-based care and population health management strategies using our understanding of the continuum of care from the preoperative phase through the postdischarge phase?


id: cord-336423-rs4bma9b
author: Endersby, Ryan Vincent William
date: 2020-05-12
txt: ./txt/cord-336423-rs4bma9b.txt
cache: ./cache/cord-336423-rs4bma9b.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33031686/
doi: 10.1213/ane.0000000000004953
abstract: nan
summary:
  4 These articles describe barrier devices for potentially reducing aerosol and droplet transmission in Coronavirus Disease 2019 (COVID-19) patients. Brown et al 1 and Babazade et al 4 describe the use of plastic drapes, whereas Lai and Chang 2 and Tsai 3 describe rigid box designs. 2, 3 In addition, the rigid design forces assistants to stand far off to the side of the patient, which limits help with airway management and does not offer them the same protection provided to the laryngoscopist. Without the hood, Glo-Germ could be identified on the laryngoscopist''s hands, entire arms, gown, neck, face, eye protection, mask, and more extended spread around the operating room. We believe our hood maintains the advantages of the barrier design with it offering adequate space around a patient''s head and neck for both the laryngoscopist and assistant to provide effective airway management from preoxygenation to extubation.

title:
  Barrier Devices for Reducing Aerosol and Droplet Transmission in Coronavirus Disease 2019 Patients: Advantages, Disadvantages, and Alternative Solutions


id: cord-336973-z8mwzmf6
title: In Response
author: Rubulotta, Francesca
date: 2020-07-14
txt: ./txt/cord-336973-z8mwzmf6.txt
cache: ./cache/cord-336973-z8mwzmf6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000005121
doi: 10.1213/ane.0000000000005121
abstract: nan
summary:
  In Response W e thank esteemed colleagues Drs Brull and Kopman, 1 both well-known experts in the field of neuromuscular monitoring and blockade for their interest in our article and their comments. 2 The creation of dedicated anesthesia intubation teams during the COVID-19 crisis as well as the increasing engagement of anesthesiologists in the ICU setting led us to believe that presenting basic principles of neuromuscular monitoring could be of interest for all readers. NMB monitoring is not standard of care in the ICU, despite the infusion of NMBAs is common for adult with severe ARDS or during proning maneuvers. The COVID-19 pandemic peak has significantly increased the workload in most ICUs and the frequency of TOF monitoring has been compromised at times. We do not recommend the corrugator supercilii as the monitoring site of choice but wanted to point out that it best reflects NMB or neuromuscular transmission at the diaphragm or larynx, anatomic areas of particular interest for ICU physicians.


id: cord-337572-kx5hihnr
title: Coronaviruses and SARS-CoV-2: A Brief Overview
author: Ludwig, Stephan
date: 2020-04-20
txt: ./txt/cord-337572-kx5hihnr.txt
cache: ./cache/cord-337572-kx5hihnr.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004845
doi: 10.1213/ane.0000000000004845
summary:
  The virus was later denominated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and defined as the causal agent of Coronavirus Disease 2019 . Here we provide a short background on coronaviruses and their origin, and we describe in more detail the novel SARS-CoV-2 and the efforts thus far to identify effective therapies against COVID-19. The virus was later denominated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and defined as the causal agent of Coronavirus Disease 2019 (COVID-19). The virus was later denominated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and defined as the causal agent of Coronavirus Disease 2019 (COVID-19). 19 SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 At the end of December 2019, China reported the increasing occurrence of pneumonia in the city of Wuhan, Hubei province. Identification of a novel coronavirus in patients with severe acute respiratory syndrome

abstract:
  In late December 2019, several cases of pneumonia of unknown origin were reported from China, which in early January 2020 were announced to be caused by a novel coronavirus. The virus was later denominated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and defined as the causal agent of Coronavirus Disease 2019 (COVID-19). Despite massive attempts to contain the disease in China, the virus has spread globally, and COVID-19 was declared a pandemic by the World Health Organization (WHO) in March 2020. Here we provide a short background on coronaviruses, and describe in more detail the novel SARS-CoV-2 and attempts to identify effective therapies against COVID-19.


id: cord-342642-qzoowc97
title: Anesthesiologists and the High Risk of Exposure to COVID-19
author: García-Méndez, Nayely
date: 2020-05-04
txt: ./txt/cord-342642-qzoowc97.txt
cache: ./cache/cord-342642-qzoowc97.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004919
doi: 10.1213/ane.0000000000004919
abstract: nan
summary:
  key: cord-342642-qzoowc97 title: Anesthesiologists and the High Risk of Exposure to COVID-19 cord_uid: qzoowc97 (1) PPE are all the set of elements and devices, that are specifically designed to protect the HCP against accidents and illnesses that could be caused by agents during the performance of their daily basis activities as well as in the emergency care; and (2) the occupational risk related to the exposure of the HCP must be identified and analyzed. The JCI has been calling for action at all government levels to address the shortage and protect those who work heroically to care for infected patients with COVID-19. We can confirm that in Mexico, there have been "hospital outbreaks" with 329 HCPs who have been infected with COVID-19 throughout the country. Prevención y control de infección en enfermedades respiratorias agudas con tendencia epidémica y pandémica durante la atención sanitaria Pautas. Available at: www.paho.org/es/documentos/ prevencion-control-infeccion-enfermedades-respiratoriasagudas-con-tendencia-epidemica Anesthesiologists and the High Risk of Exposure to COVID-19


id: cord-343865-wbd0hqqc
author: Singh, Ajay
date: 2020-05-12
txt: ./txt/cord-343865-wbd0hqqc.txt
cache: ./cache/cord-343865-wbd0hqqc.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32366767/
doi: 10.1213/ane.0000000000004940
abstract: nan
summary:
  Worldwide a significant number of health care workers (HCWs) have been infected till to date with Asia-Pacific region reporting 35 deaths and over 4000 quarantined cases, as on April 3, 2020. Effective use of PPE by HCWs is an integral part of COVID-19 prevention in the health care setting. Two-way audio-visual communication system with closed circuit television (CCTV) cameras in the doffing area has the potential to ensure HCW safety from the offsite location through a trained observer, qualified to guide round the clock (Figure) . He will communicate, visually inspect, protect, and guide HCWs through the protocols of doffing PPE. Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19): interim guidance Use of personal protective equipment among health care personnel: results of clinical observations and simulations Alternative doffing strategies of personal protective equipment to prevent self-contamination in the health care setting

title:
  Real-Time Remote Surveillance of Doffing During COVID-19 Pandemic: Enhancing Safety of Health Care Workers


id: cord-343904-fjtt3f2e
title: Clarifications on Technologies to Optimize Care of Severe COVID-19 Patients
author: Brull, Sorin J.
date: 2020-07-14
txt: ./txt/cord-343904-fjtt3f2e.txt
cache: ./cache/cord-343904-fjtt3f2e.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000005120
doi: 10.1213/ane.0000000000005120
abstract: nan
summary:
  To the Editor W e read with great interest the article by Dr Rubulotta et al 1 and we congratulate the authors for their timely information with regard to strategies and technologies designed to optimize care of patients with severe coronavirus disease (COVID-19). The problem with this statement is that the authors argue that if intubation fails, then neuromuscular block can be reversed quickly by administering sugammadex 16 mg/kg. The authors also suggest, in the event of an anaphylactic reaction to rocuronium, that sugammadex may abort or reverse this process. 2 It also has been shown that subjective (tactile) evaluation of the TOF count is vastly different based on the muscle assessed: qualitative (subjective) evaluation of TOF responses at the eye muscles, for instance, resulted in a >5-fold higher risk of residual paralysis than those patients in whom the hand (adductor pollicis) muscles were assessed subjectively.


id: cord-345136-zcd00lcw
title: The Use of Analgesia and Sedation in Mechanically Ventilated Patients With COVID-19 ARDS
author: Kapp, Christopher M.
date: 2020-07-14
txt: ./txt/cord-345136-zcd00lcw.txt
cache: ./cache/cord-345136-zcd00lcw.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000005131
doi: 10.1213/ane.0000000000005131
abstract: nan
summary:
  From day 2 to 7, when most patients remained intubated, the median daily dose of oral morphine equivalents was 775 mg (interquartile range [IQR], 648.4-899.7 mg) and for oral midazolam equivalents was 270.9 mg (IQR, 201.3-304.4 mg). Of the patients who underwent neuromuscular blockade, the median daily dose of opiates (in oral morphine equivalents) and benzodiazepines (in oral midazolam equivalents) was 937.2 mg (IQR, 667.7-1683 mg) and 224.7 mg (IQR, 56.56-610 mg), respectively. For patients who did not receive neuromuscular blockade, the median daily dosage of opiates (in oral morphine equivalents) and benzodiazepines (in oral midazolam equivalents) was 623.8 mg (IQR, 176.3-726.9 mg) and 135 mg (IQR, 40.63-203.8 mg), respectively. The median and interquartile range of daily opiate (mg oral morphine equivalents) and benzodiazepine use (mg oral midazolam equivalents) is shown per day of mechanical ventilation at JHH.


id: cord-345610-rx1zmajl
title: Calculate the COVID-19 Equation With the People’s Energy as Key Variable
author: Boggs, Steven D.
date: 2020-04-22
txt: ./txt/cord-345610-rx1zmajl.txt
cache: ./cache/cord-345610-rx1zmajl.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32304464/
doi: 10.1213/ane.0000000000004892
abstract: nan
summary:
  title: Calculate the COVID-19 Equation With the People''s Energy as Key Variable Besides "joint efforts from people all around the world," 2 it appears to be absolute key that leaders attend to the psychological and emotional well-being of our clinicians in addition to the physical well-being of our staffs "to protect health care workers better, to save more lives." 2 Necessary protective measures interfere with the camaraderie that each of us tries to create at work. While literally getting-in-touch is a caring physician''s "first language," 3 the interactions with our patients now through masks and with PPE create barriers which are new to them and to us. 6 We must calculate the COVID-19 equation with the people''s energy as key variable in mind! Staffing with disease-based epidemiologic indices may reduce shortage of intensive care unit staff during the COVID-19 pandemic


id: cord-347500-sigm6tos
title: The Response of the Anesthesia & Analgesia Community to Coronavirus Disease 2019
author: Vetter, Thomas R.
date: 2020-04-27
txt: ./txt/cord-347500-sigm6tos.txt
cache: ./cache/cord-347500-sigm6tos.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004905
doi: 10.1213/ane.0000000000004905
abstract: nan
summary:
  In February 2020, SARS-CoV-2 was subsequently defined by the World Health Organization (WHO) as the causative agent of the emerging zoonotic coronavirus disease 2019 (COVID-19). As presciently described in 3 articles in the July/ August 2005 issue of the journal Foreign Affairs, the recent emergence of a novel viral strain like SARS-CoV-2 and the ensuing COVID-19 global pandemic were by all accounts biologically, historically, culturally, and politically inevitable. 2-4 COVID-19 is only the most recent of a litany of so-called "emerging infectious diseases" that have opportunistically infected humans for centuries and likely for millennia. For severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), applying an R 0 value of 2.5, this equates to a herd immunity threshold of 60%. Emerging infectious diseases and pandemic potential: status quo and reducing risk of global spread


id: cord-350521-jfd5gd2p
title: The COVID-19 Pandemic: Effects on Low- and Middle-Income Countries
author: Bong, Choon-Looi
date: 2020-04-20
txt: ./txt/cord-350521-jfd5gd2p.txt
cache: ./cache/cord-350521-jfd5gd2p.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1213/ane.0000000000004846
doi: 10.1213/ane.0000000000004846
summary:
  Coronavirus Disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers, health systems, and economies. -William Butler Yeats, The Second Coming A s news of a novel viral illness in China emerged in January 2020 1 and until the day when the Director General of the World Health Organization (WHO) declared a pandemic, 2 those who live and work in low-and middle-income countries (LMICs) held their collective breath. 6 Countries have closed their borders, enforced strict social isolation and quarantine procedures, and increased testing Coronavirus Disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers, health systems, and economies. This will further reduce resources available for health care, not just in managing COVID-19 patients, but also for those with many other major medical conditions.

abstract:
  Coronavirus Disease 2019 (COVID-19) is spreading rapidly around the world with devastating consequences on patients, health care workers, health systems, and economies. As it reaches low- and middle-income countries, its effects could be even more dire, because it will be difficult for them to respond aggressively to the pandemic. There is a great shortage of all health care providers, who will be at risk due to a lack of personal protection equipment. Social distancing will be almost impossible. The necessary resources to treat patients will be in short supply. The end result could be a catastrophic loss of life. A global effort will be required to support faltering economies and health care systems.


