COVID-19 pandemi öncesi ve pandemi dönemlerindeki acil ameliyatlarýnýn ve acil cerrahi anestezi yöntemlerinin deðerlendirilmesi

AMAÇ: Koronavirüs hastalýðý 2019 (COVID-19) pandemisini takiben eðitime ara verilmesi, sosyal izolasyon ve sokaða çýkma kýsýtlamalarý gibi bulaþ riskini azaltmaya yönelik alýnan önlemler sonucunda toplumda aktif rol alan insan sayýsýnda azalma olmuþtur. Bunun sonucu olarak acil cerrahi etiyolojisinde bir deðiþiklik olacaðý düþünülebilir. Bu çalýþmada, COVID-19 pandemi öncesi ve pandemi dönemlerinde hastanemizde yapýlan acil ameliyatlarý ve acil cerrahi anestezi yöntemlerini deðerlendirmeyi ve þüpheli COVID-19 enfeksiyonu olan hastalarýn acil anestezi yönetimini sunmayý amaçladýk.
GEREÇ VE YÖNTEM: 22 Ocak–29 Nisan 2020 tarihleri arasýnda hastanemizde acil ameliyat olan hastalar geriye dönük olarak incelendi. Hastalar, 11 Mart 2020 tarihi öncesinde ameliyat olanlar (Grup 1) ve sonrasýnda ameliyat olanlar (Grup 2) olarak iki gruba ayrýldý. Ýki grup verileri karþýlaþtýrýldý. Grup 1’deki tüm hastalara ve Grup 2’de COVID-19 þüphesi olmayanlara rutin acil anestezi ve cerrahi yaklaþým uygulandý. Grup 2’de COVID-19 þüphesi olan hastalar, resmî kurumlarýn ve bilimsel derneklerin kýlavuzlarýna uygun olarak oluþturulan algoritma ile tedavi edildi.
BULGULAR: Yaþ, cinsiyet, kronik hastalýklar, ASA sýnýflamasý, Mallampati skoru, cerrahi branþ, cerrahi prosedürler, cerrahi etiyolojisi, ameliyat süresi ve hastanede yatýþ süresi her iki grupta benzerdi. Genel anestezi ve spinal anestezi uygulanan hasta sayýsý Grup 1 için sýrasýyla 198 (%82.5) ve 42 (%17.5), Grup 2 için sýrasýyla 161 (%73.9) ve 57 (%26.1) idi (p=0.025).
TARTIÞMA: Pandemi döneminde ki acil hastalarýn klinik verileri ve cerrahi iliþkili özellikleri pandemi öncesi acil hastalar ile benzerdir ancak pandemi döneminde daha fazla spinal anestezi uygulanmýþtýr. Acil anestezi uygulamalarý sonucu anestezi ekibinde çapraz enfeksiyon gözlenmemesi için kiþisel koruyucu ekipman kurallarýna uyulmalýdýr. T.C. Saðlýk Bakanlýðý’nýn düzenli olarak güncellenen tavsiyelerine ve kýlavuz önerilerine uyularak ameliyathanede gerekli acil müdahalelerin güvenli bir þekilde yapýlabileceðini ve COVID-19 nozokomiyal enfeksiyonunun önlenebileceðini düþünüyoruz.

Evaluation of emergency operations and anesthesia procedures used in surgical emergencies before and during the COVID-19 pandemic

BACKGROUND: The number of people actively participating in society has decreased following the coronavirus disease 2019 (COVID-19) pandemic as a result of the measures taken to reduce the risk of transmission, such as interruption to education, social isolation, and curfews. Accordingly, change in the etiology of emergency surgery and characteristics of patients may be expected. The current study aimed to compare emergency surgery between the COVID-19 pre-pandemic and pandemic periods and to present the data and emergency anesthesia management of patients with suspected COVID-19.
METHODS: Patients who underwent emergency surgery in our hospital between January 22 and April 29, 2020, were examined retrospectively. The patients were divided into two groups: Those operated before March 11, 2020 (Group 1) and those operated from this date April 29, 2020 (Group 2). The data of the two groups were compared. Routine emergency anesthesia and surgical approach were applied to all patients in Group 1 and those without suspected COVID-19 in Group 2. Patients with suspected COVID-19 in Group 2 were treated with an algorithm created in accordance with the guidelines of official institutions and scientific associations.
RESULTS: Age, gender, chronic medical diseases, ASA classification, Mallampati score, surgical department, surgical procedures, surgical etiology, duration of surgery, and length of hospital stay were similar in both groups. The number of patients undergoing general anesthesia and spinal anesthesia was 198 (82.5%) and 42 (17.5%) for Group 1 while it was 161 (73.9%) and 57 (26.1%), respectively, for Group 2 (p=0.025).
CONCLUSION: The clinical data and surgical features of emergency patients during the pandemic were similar to those before the pandemic; however, the rate of spinal anesthesia was higher in the former. Personal protective equipment standards should be followed to prevent cross-infection among the anesthesiology team during anesthesia procedures for emergency operations. We consider that necessary emergency interventions can be safely performed and COVID-19 nosocomial infection can be prevented in the operating room by following the Ministry of Health recommendations and guidelines that are updated regularly.