Surgical Considerations for an Awake Tracheotomy During the COVID-19 Pandemic

Patients' caring experience during procedures under regional anesthesia in Mainland China: A phenomenology study

Background

Although regional anesthesia is common, the procedure results in feelings of uncertainty and anxiety in some patients. Increased care is needed for these patients under general anesthesia. Few studies have focused on the intraoperative caring experience of patients during regional anesthesia. This study focused on the caring experience of patients during procedures involving regional anesthesia.

Methods

The descriptive phenomenology method of Husserl was employed. Semi-structured interviews were conducted with a purposive sample in five Grade III-A hospitals in Zhengzhou City, Henan Province. The seven-step analysis method of Colaizzi was applied for the analysis, summation, and theme refinement of the interview data.

Results

A total of 14 patients from five hospitals participated in the interviews. Four domains and 16 themes emerged during analysis: be informed (about the operation site, progression of the operation, informed in advance, receive explanation for abnormal experience); take care of my body (painless, gentle movements, special care); be protected (work seriously, favorable atmosphere, skilled, authority); and treated as an individual (pay attention, accompany, ask for opinions, encourage patient expression, humorous).

Conclusion

Patients during procedure under regional anesthesia had specific caring experiences relative to other patients. Medical staff should recognize the importance of regional anesthesia patients' intraoperative caring experience. Hospital administrators should offer support to allow healthcare staff to provide targeted caring for patients during procedure under regional anesthesia.

[The first year of the SARS-CoV-2 pandemic-impact on otorhinolaryngology]

BACKGROUND

The first year of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has already affected our public health care system to an enormous extent and will continue to do so in the future. Otorhinolaryngologists (ORLs) are suspected to be at high risk of infection, due to the high viral load in the mucosa of the upper airways. The current review evaluates the impact of the pandemic on ORLs' activities and assesses the risk infection.

METHODS

A selective literature research was conducted using relevant English and German terms for ORL, SARS-CoV‑2, risk, and infection at PubMed, medRxiv, and bioRxiv, as well as in the Deutsches Ärzteblatt and on the websites of the Robert Koch Institute and the Johns Hopkins University.

RESULTS

Protection recommendations for ORL include general hygiene measures and wearing KN95 masks for routine professional activities. When in contact with coronavirus disease 2019 (COVID-19) patients, it is recommended to extend the personal protective equipment by eye protection, gloves, cap, and gown. International otorhinolaryngology societies have released guidelines for procedures (e.g., tracheostomy, sinus surgery), propagating personal protection for the surgical team and reduction of aerosols. Testing for SARS-CoV‑2 in patients and medical staff can contribute to reducing the risk of infection. Vaccination would provide some additional protection for ORLs and other health care professionals with increased exposure to aerosols. There is increasing evidence that ORLs are at a high risk of contracting SARS-CoV‑2.

CONCLUSION

Consequent personal protection, frequent testing of patients and health care professionals, and the promised SARS-CoV‑2 vaccinations may provide adequate protection for highly exposed persons.

Results of a national web-based survey on the SARS-CoV-2 infectious state of otorhinolaryngologists in Germany

PURPOSE

SARS-CoV-2 is detected on the mucosa of the upper airways to a high degree. In the course of the COVID-19 pandemic, otorhinolaryngologists (ORL) are assumed to be at high risk due to close contact with the mucosa of the upper airways. No data are yet available providing evidence that ORLs have an increased risk of infection.

METHODS

German ORLs were invited via e-mail through the German Society of ORL, Head and Neck Surgery and the German ENT Association to participate in a web-based survey about infection with SARS-CoV-2 and development of COVID-19. Data of infections and concomitant parameters in German ORLs were collected and compared to the total number of infections in Germany.

RESULTS

Out of 6383 German ORLs, 970 (15%) participated. 54 ORLs reported testing positive for SARS-CoV-2. Compared to the total population of Germany, ORLs have a relative risk of 3.67 (95% CI 2.82; 4.79) of contracting SARS-CoV-2. Domestic quarantine was conducted in 96.3% of cases. Two individuals were admitted to hospital without intensive care. No casualties were reported. In 31 cases, the source of infection was not identifiable whereas 23 had a clear medical aetiology: infected patients: n = 5, 9.26%; medical staff: n = 13, 14.1%. 9.26% (n = 5) of the identified cases were related to contact to infected family members (n = 3), closer neighbourhood (n = 1) or general public (n = 1). There was no identified increased risk of infection due to performing surgery.

CONCLUSION

German ORLs have an almost 3.7-fold risk of contracting SARS-CoV-2 compared to the population baseline level. Appropriate protection appears to be necessary for this occupational group.

The Impact of the COVID-19 Pandemic on Follow-Ups for Vertigo/Dizziness Outpatients

OBJECTIVES

In the present report, we aimed to investigate the impact of the coronavirus disease (COVID-19) pandemic on vertigo/dizziness outpatient cancellations in Japan.

METHODS

We examined 265 vertigo/dizziness outpatients at the ear, nose, and throat department of the Nara Medical University between March 01, 2020, and May 31, 2020, during the COVID-19 pandemic in Japan. We also focused on 478 vertigo/dizziness outpatients between March 01, 2019, and May 31, 2019, before the COVID-19 pandemic, to compare the number of cancellations between these 2 periods. The reasons for cancellation and noncancellation were investigated using telephone multiple-choice questionnaires (telMCQs), particularly for patients with benign paroxysmal positional vertigo (BPPV) and Meniere's disease (MD).

RESULTS

There were many cancellations for medical examinations during the 2020 study period. The total number of vertigo/dizziness outpatients decreased by 44.6% in the 2020 period compared to the same period in 2019. The percent reduction in clinic attendance from 2019 to 2020 (ie, [2019-2020]/2019) for patients with BPPV was higher than that for patients with MD. Compared to the other vertigo-associated conditions, patients with MD exhibited a lower percent reduction in clinic attendance. According to the results of the telMCQs, 75.0% of BPPV cases and 88.2% of MD cases cancelled their appointment and gave up visiting hospitals due to fear of COVID-19 infection, even if they had moderate to severe symptoms. On the contrary, 25.0% and 80.0% patients with BPPV and MD, respectively, did not cancel their appointment; they should not have visited the hospital but stayed at home because they had slight symptoms.

CONCLUSIONS

These findings suggest that advanced forms should be prepared for medical care, such as remote medicine. These forms should not only be for the disease itself but also for the mental distress caused by persistent symptoms.

Head and Neck Practice in the COVID-19 Pandemics Today: A Rapid Systematic Review

Introduction  Head and neck specialists and otorhinolaryngologists are greatly exposed to coronavirus disease 2019 (COVID-19) transmission in their everyday praxis. Many articles are being published regarding medical staff protection and patient management during the pandemic. Objective  To provide an easy access to and a trustful review of the main aspects that have changed in the head and neck surgery and otorhinolaryngology practice due to the COVID-19 pandemic. Data Synthesis  The search terms used were: ( head and neck or otorhinolaryngology or ORL or thyroid ) AND ( severe acute respiratory syndrome coronavirus 2 [ SARS-COV-2] or COVID-19 or CORONAVIRUS ). The results were limited to the year of 2020. Articles were read in English, Portuguese, French, German, and Spanish or translated from Chinese. All included articles were read by at least two authors. Thirty-five articles were included. Most articles suggest postponing elective surgeries, with exception to cancer surgeries, which should be evaluated separately. Twenty-five articles recommended some kind of screening prior to surgery, using polymerase chain reaction (PCR) tests and epidemiological data. Extra precautions, such as use of personal protective equipment (PPE), are suggested for both tracheostomies and endoscopies. Fifteen articles give recommendation on how to use telemedicine. Conclusion  The use of PPE (N95 or powered air-purifying respirator [PAPR]) during procedures should be mandatory. Patients should be evaluated about their COVID-19 status before hospital admission. Cancer should be treated. Tracheostomy tube cuff should be inflated inside the tracheal incision. All COVID-19 precautions should be kept until there is a validated antiviral treatment or an available vaccine.

Personal protective equipment for surgeons during COVID-19 pandemic: systematic review of availability, usage and rationing

BACKGROUND

Surgeons need guidance regarding appropriate personal protective equipment (PPE) during the COVID-19 pandemic based on scientific evidence rather than availability. The aim of this article is to inform surgeons of appropriate PPE requirements, and to discuss usage, availability, rationing and future solutions.

METHODS

A systematic review was undertaken in accordance with PRISMA guidelines using MEDLINE, Embase and WHO COVID-19 databases. Newspaper and internet article sources were identified using Nexis. The search was complemented by bibliographic secondary linkage. The findings were analysed alongside guidelines from the WHO, Public Health England, the Royal College of Surgeons and specialty associations.

RESULTS

Of a total 1329 articles identified, 95 studies met the inclusion criteria. Recommendations made by the WHO regarding the use of PPE in the COVID-19 pandemic have evolved alongside emerging evidence. Medical resources including PPE have been rapidly overwhelmed. There has been a global effort to overcome this by combining the most effective use of existing PPE with innovative strategies to produce more. Practical advice on all aspects of PPE is detailed in this systematic review.

CONCLUSION

Although there is a need to balance limited supplies with staff and patient safety, this should not leave surgeons treating patients with inadequate PPE.

The impact of preoperative screening system on head and neck cancer surgery during the COVID-19 pandemic: Recommendations from the nationwide survey in Japan

Objective

the pandemic of coronavirus disease 2019 (COVID-19), hospitals worldwide are at risk of nosocomial infection. Preoperative identification of COVID-19 in patients who are scheduled to be admitted to the hospital is essential to preventing the collapse of medical facility. In Japan, the preoperative observation and screening tests with the RT-PCR testing for the new coronavirus (SARS-CoV-2) and chest CT scan are recommended for head and neck cancer surgery during the COVID-19 pandemic.

Method

We conducted surveys of the current situation in Japan through the internet.

Results

Chest CT scan was fully performed (90%), but the RT-PCR testing was not adequately performed (51%).

Conclusion

Although the current screening system can be considered effective to a certain extent, we recommend further widespread use of pre-admission RT-PCR testing not only for patients with head and neck cancer surgery but also for all the hospitalized patients, in order to promote safer treatments, during the COVID-19 pandemic.