Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic
Identifieur interne : 000141 ( Pmc/Corpus ); précédent : 000140; suivant : 000142Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic
Auteurs : Sui An Lie ; Sook Wai Wong ; Loong Tat Wong ; Theodore Gar Ling Wong ; Shin Yuet ChongSource :
- Canadian Journal of Anaesthesia [ 0832-610X ] ; 2020.
Abstract
Coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization on 11 March 2020 because of its rapid worldwide spread. In the operating room, as part of hospital outbreak response measures, anesthesiologists are required to have heightened precautions and tailor anesthetic practices to individual patients. In particular, by minimizing the many aerosol-generating procedures performed during general anesthesia, anesthesiologists can reduce exposure to patients’ respiratory secretions and the risk of perioperative viral transmission to healthcare workers and other patients. To avoid any airway manipulation, regional anesthesia should be considered whenever surgery is planned for a suspect or confirmed COVID-19 patient or any patient who poses an infection risk. Regional anesthesia has benefits of preservation of respiratory function, avoidance of aerosolization and hence viral transmission. This article explores the practical considerations and recommended measures for performing regional anesthesia in this group of patients, focusing on control measures geared towards ensuring patient and staff safety, equipment protection, and infection prevention. By doing so, we hope to address an issue that may have downstream implications in the way we practice infection control in anesthesia, with particular relevance to this new era of emerging infectious diseases and novel pathogens. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not the first, and certainly will not be the last novel virus that will lead to worldwide outbreaks. Having a well thought out regional anesthesia plan to manage these patients in this new normal will ensure the best possible outcome for both the patient and the perioperative management team.
Url:
DOI: 10.1007/s12630-020-01637-0
PubMed: 32212103
PubMed Central: 7095295
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PMC:7095295Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic</title><author><name sortKey="Lie, Sui An" sort="Lie, Sui An" uniqKey="Lie S" first="Sui An" last="Lie">Sui An Lie</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Wong, Sook Wai" sort="Wong, Sook Wai" uniqKey="Wong S" first="Sook Wai" last="Wong">Sook Wai Wong</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Wong, Loong Tat" sort="Wong, Loong Tat" uniqKey="Wong L" first="Loong Tat" last="Wong">Loong Tat Wong</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Wong, Theodore Gar Ling" sort="Wong, Theodore Gar Ling" uniqKey="Wong T" first="Theodore Gar Ling" last="Wong">Theodore Gar Ling Wong</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Chong, Shin Yuet" sort="Chong, Shin Yuet" uniqKey="Chong S" first="Shin Yuet" last="Chong">Shin Yuet Chong</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">32212103</idno><idno type="pmc">7095295</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7095295</idno><idno type="RBID">PMC:7095295</idno><idno type="doi">10.1007/s12630-020-01637-0</idno><date when="2020">2020</date><idno type="wicri:Area/Pmc/Corpus">000141</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000141</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic</title><author><name sortKey="Lie, Sui An" sort="Lie, Sui An" uniqKey="Lie S" first="Sui An" last="Lie">Sui An Lie</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Wong, Sook Wai" sort="Wong, Sook Wai" uniqKey="Wong S" first="Sook Wai" last="Wong">Sook Wai Wong</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Wong, Loong Tat" sort="Wong, Loong Tat" uniqKey="Wong L" first="Loong Tat" last="Wong">Loong Tat Wong</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Wong, Theodore Gar Ling" sort="Wong, Theodore Gar Ling" uniqKey="Wong T" first="Theodore Gar Ling" last="Wong">Theodore Gar Ling Wong</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author><author><name sortKey="Chong, Shin Yuet" sort="Chong, Shin Yuet" uniqKey="Chong S" first="Shin Yuet" last="Chong">Shin Yuet Chong</name><affiliation><nlm:aff id="Aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Canadian Journal of Anaesthesia</title><idno type="ISSN">0832-610X</idno><idno type="eISSN">1496-8975</idno><imprint><date when="2020">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p id="Par1">Coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization on 11 March 2020 because of its rapid worldwide spread. In the operating room, as part of hospital outbreak response measures, anesthesiologists are required to have heightened precautions and tailor anesthetic practices to individual patients. In particular, by minimizing the many aerosol-generating procedures performed during general anesthesia, anesthesiologists can reduce exposure to patients’ respiratory secretions and the risk of perioperative viral transmission to healthcare workers and other patients. To avoid any airway manipulation, regional anesthesia should be considered whenever surgery is planned for a suspect or confirmed COVID-19 patient or any patient who poses an infection risk. Regional anesthesia has benefits of preservation of respiratory function, avoidance of aerosolization and hence viral transmission. This article explores the practical considerations and recommended measures for performing regional anesthesia in this group of patients, focusing on control measures geared towards ensuring patient and staff safety, equipment protection, and infection prevention. By doing so, we hope to address an issue that may have downstream implications in the way we practice infection control in anesthesia, with particular relevance to this new era of emerging infectious diseases and novel pathogens. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not the first, and certainly will not be the last novel virus that will lead to worldwide outbreaks. Having a well thought out regional anesthesia plan to manage these patients in this new normal will ensure the best possible outcome for both the patient and the perioperative management team.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Li, Q" uniqKey="Li Q">Q Li</name></author><author><name sortKey="Guan, X" uniqKey="Guan X">X Guan</name></author><author><name sortKey="Wu, P" uniqKey="Wu P">P Wu</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Young, Be" uniqKey="Young B">BE Young</name></author><author><name sortKey="Ong, Sw" uniqKey="Ong S">SW Ong</name></author><author><name sortKey="Kalimuddin, S" uniqKey="Kalimuddin S">S Kalimuddin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chen, N" uniqKey="Chen N">N Chen</name></author><author><name sortKey="Zhou, M" uniqKey="Zhou M">M Zhou</name></author><author><name sortKey="Dong, X" uniqKey="Dong X">X Dong</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wang, D" uniqKey="Wang D">D Wang</name></author><author><name sortKey="Hu, B" uniqKey="Hu B">B Hu</name></author><author><name sortKey="Hu, C" uniqKey="Hu C">C Hu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Guan, Wj" uniqKey="Guan W">WJ Guan</name></author><author><name sortKey="Ni, Zy" uniqKey="Ni Z">ZY Ni</name></author><author><name sortKey="Hu, Y" uniqKey="Hu Y">Y Hu</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="Wu, Z" uniqKey="Wu Z">Z Wu</name></author><author><name sortKey="Mcgoogan, Jm" uniqKey="Mcgoogan J">JM McGoogan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kamming, D" uniqKey="Kamming D">D Kamming</name></author><author><name sortKey="Gardam, M" uniqKey="Gardam M">M Gardam</name></author><author><name sortKey="Chung, F" uniqKey="Chung F">F Chung</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Caputo, Km" uniqKey="Caputo K">KM Caputo</name></author><author><name sortKey="Byrick, R" uniqKey="Byrick R">R Byrick</name></author><author><name sortKey="Chapman, Mg" uniqKey="Chapman M">MG Chapman</name></author><author><name sortKey="Orser, Bj" uniqKey="Orser B">BJ Orser</name></author><author><name sortKey="Orser, Ba" uniqKey="Orser B">BA Orser</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Yu, It" uniqKey="Yu I">IT Yu</name></author><author><name sortKey="Xie, Zh" uniqKey="Xie Z">ZH Xie</name></author><author><name sortKey="Tsoi, Kk" uniqKey="Tsoi K">KK Tsoi</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Peng, Pw" uniqKey="Peng P">PW Peng</name></author><author><name sortKey="Ho, Pl" uniqKey="Ho P">PL Ho</name></author><author><name sortKey="Hota, Ss" uniqKey="Hota S">SS Hota</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Tan, Tk" uniqKey="Tan T">TK Tan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hutton, M" uniqKey="Hutton M">M Hutton</name></author><author><name sortKey="Brull, R" uniqKey="Brull R">R Brull</name></author><author><name sortKey="Macfarlane, Aj" uniqKey="Macfarlane A">AJ Macfarlane</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Rowlands, J" uniqKey="Rowlands J">J Rowlands</name></author><author><name sortKey="Yeager, Mp" uniqKey="Yeager M">MP Yeager</name></author><author><name sortKey="Beach, M" uniqKey="Beach M">M Beach</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Loftus, Rw" uniqKey="Loftus R">RW Loftus</name></author><author><name sortKey="Koff, Md" uniqKey="Koff M">MD Koff</name></author><author><name sortKey="Birnbach, Dj" uniqKey="Birnbach D">DJ Birnbach</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chan, Mt" uniqKey="Chan M">MT Chan</name></author><author><name sortKey="Chow, Bk" uniqKey="Chow B">BK Chow</name></author><author><name sortKey="Lo, T" uniqKey="Lo T">T Lo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pusapati, Rn" uniqKey="Pusapati R">RN Pusapati</name></author><author><name sortKey="Sivashanmugam, T" uniqKey="Sivashanmugam T">T Sivashanmugam</name></author><author><name sortKey="Ravishankar, M" uniqKey="Ravishankar M">M Ravishankar</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Saraswat, V" uniqKey="Saraswat V">V Saraswat</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Mccarthy, Gs" uniqKey="Mccarthy G">GS McCarthy</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wong, J" uniqKey="Wong J">J Wong</name></author><author><name sortKey="Goh, Qy" uniqKey="Goh Q">QY Goh</name></author><author><name sortKey="Tan, Z" uniqKey="Tan Z">Z Tan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Chee, Vw" uniqKey="Chee V">VW Chee</name></author><author><name sortKey="Khoo, Ml" uniqKey="Khoo M">ML Khoo</name></author><author><name sortKey="Lee, Sf" uniqKey="Lee S">SF Lee</name></author><author><name sortKey="Lai, Yc" uniqKey="Lai Y">YC Lai</name></author><author><name sortKey="Chin, Nm" uniqKey="Chin N">NM Chin</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Peng, Pw" uniqKey="Peng P">PW Peng</name></author><author><name sortKey="Wong, Dt" uniqKey="Wong D">DT Wong</name></author><author><name sortKey="Bevan, D" uniqKey="Bevan D">D Bevan</name></author><author><name sortKey="Gardam, M" uniqKey="Gardam M">M Gardam</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ong, Sw" uniqKey="Ong S">SW Ong</name></author><author><name sortKey="Tan, Yk" uniqKey="Tan Y">YK Tan</name></author><author><name sortKey="Chia, Py" uniqKey="Chia P">PY Chia</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Dobson, G" uniqKey="Dobson G">G Dobson</name></author><author><name sortKey="Chong, Ma" uniqKey="Chong M">MA Chong</name></author><author><name sortKey="Chow, L" uniqKey="Chow L">L Chow</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hui, Ds" uniqKey="Hui D">DS Hui</name></author><author><name sortKey="Hall, Sd" uniqKey="Hall S">SD Hall</name></author><author><name sortKey="Chan, Mt" uniqKey="Chan M">MT Chan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hui, Ds" uniqKey="Hui D">DS Hui</name></author><author><name sortKey="Chow, Bk" uniqKey="Chow B">BK Chow</name></author><author><name sortKey="Ng, Ss" uniqKey="Ng S">SS Ng</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hui, Ds" uniqKey="Hui D">DS Hui</name></author><author><name sortKey="Ip, M" uniqKey="Ip M">M Ip</name></author><author><name sortKey="Tang, Jw" uniqKey="Tang J">JW Tang</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hui, Ds" uniqKey="Hui D">DS Hui</name></author><author><name sortKey="Hall, Sd" uniqKey="Hall S">SD Hall</name></author><author><name sortKey="Chan, Mt" uniqKey="Chan M">MT Chan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Loibner, M" uniqKey="Loibner M">M Loibner</name></author><author><name sortKey="Hagauer, S" uniqKey="Hagauer S">S Hagauer</name></author><author><name sortKey="Schwantzer, G" uniqKey="Schwantzer G">G Schwantzer</name></author><author><name sortKey="Berghold, A" uniqKey="Berghold A">A Berghold</name></author><author><name sortKey="Zatloukal, K" uniqKey="Zatloukal K">K Zatloukal</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johnson, At" uniqKey="Johnson A">AT Johnson</name></author><author><name sortKey="Grove, Cm" uniqKey="Grove C">CM Grove</name></author><author><name sortKey="Weiss, Ra" uniqKey="Weiss R">RA Weiss</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johnson, At" uniqKey="Johnson A">AT Johnson</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Johnson, At" uniqKey="Johnson A">AT Johnson</name></author><author><name sortKey="Weiss, Ra" uniqKey="Weiss R">RA Weiss</name></author><author><name sortKey="Grove, C" uniqKey="Grove C">C Grove</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Song, X" uniqKey="Song X">X Song</name></author><author><name sortKey="Vossebein, L" uniqKey="Vossebein L">L Vossebein</name></author><author><name sortKey="Zille, A" uniqKey="Zille A">A Zille</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Wax, Rs" uniqKey="Wax R">RS Wax</name></author><author><name sortKey="Christian, Md" uniqKey="Christian M">MD Christian</name></author></analytic></biblStruct><biblStruct></biblStruct><biblStruct><analytic><author><name sortKey="El Boghdadly, K" uniqKey="El Boghdadly K">K El-Boghdadly</name></author><author><name sortKey="Chin, Kj" uniqKey="Chin K">KJ Chin</name></author><author><name sortKey="Chan, Vw" uniqKey="Chan V">VW Chan</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Walsh, Ee" uniqKey="Walsh E">EE Walsh</name></author><author><name sortKey="Shin, Jh" uniqKey="Shin J">JH Shin</name></author><author><name sortKey="Falsey, Ar" uniqKey="Falsey A">AR Falsey</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="review-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Can J Anaesth</journal-id><journal-id journal-id-type="iso-abbrev">Can J Anaesth</journal-id><journal-title-group><journal-title>Canadian Journal of Anaesthesia</journal-title></journal-title-group><issn pub-type="ppub">0832-610X</issn><issn pub-type="epub">1496-8975</issn><publisher><publisher-name>Springer International Publishing</publisher-name><publisher-loc>Cham</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">32212103</article-id><article-id pub-id-type="pmc">7095295</article-id><article-id pub-id-type="publisher-id">1637</article-id><article-id pub-id-type="doi">10.1007/s12630-020-01637-0</article-id><article-categories><subj-group subj-group-type="heading"><subject>Review Article/Brief Review</subject></subj-group></article-categories><title-group><article-title>Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic</article-title><trans-title-group><trans-title xml:lang="fr">Considérations pratiques pour laréalisation de l’anesthésie régionale: les leçons tirées de la pandémie de COVID-19</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Lie</surname><given-names>Sui An</given-names></name><degrees>MBBS, MRCP, MMed</degrees><address><email>lie.sui.an@singhealth.com.sg</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Wong</surname><given-names>Sook Wai</given-names></name><degrees>MBBS</degrees><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Wong</surname><given-names>Loong Tat</given-names></name><degrees>MBBS, MMed, CHSE</degrees><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Wong</surname><given-names>Theodore Gar Ling</given-names></name><degrees>MD, FRCPC</degrees><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Chong</surname><given-names>Shin Yuet</given-names></name><degrees>MBBS (Hons), MMed, CHSE</degrees><xref ref-type="aff" rid="Aff1"></xref></contrib><aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.163555.1</institution-id><institution-id institution-id-type="ISNI">0000 0000 9486 5048</institution-id><institution>Division of Anesthesiology and Perioperative Medicine,</institution><institution>Singapore General Hospital,</institution></institution-wrap>Outram Road, Singapore, 169608 Singapore</aff></contrib-group><pub-date pub-type="epub"><day>24</day><month>3</month><year>2020</year></pub-date><fpage>1</fpage><lpage>8</lpage><history><date date-type="received"><day>17</day><month>3</month><year>2020</year></date><date date-type="accepted"><day>18</day><month>3</month><year>2020</year></date></history><permissions><copyright-statement>© Canadian Anesthesiologists' Society 2020</copyright-statement><license><license-p>This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.</license-p></license></permissions><abstract id="Abs1"><p id="Par1">Coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization on 11 March 2020 because of its rapid worldwide spread. In the operating room, as part of hospital outbreak response measures, anesthesiologists are required to have heightened precautions and tailor anesthetic practices to individual patients. In particular, by minimizing the many aerosol-generating procedures performed during general anesthesia, anesthesiologists can reduce exposure to patients’ respiratory secretions and the risk of perioperative viral transmission to healthcare workers and other patients. To avoid any airway manipulation, regional anesthesia should be considered whenever surgery is planned for a suspect or confirmed COVID-19 patient or any patient who poses an infection risk. Regional anesthesia has benefits of preservation of respiratory function, avoidance of aerosolization and hence viral transmission. This article explores the practical considerations and recommended measures for performing regional anesthesia in this group of patients, focusing on control measures geared towards ensuring patient and staff safety, equipment protection, and infection prevention. By doing so, we hope to address an issue that may have downstream implications in the way we practice infection control in anesthesia, with particular relevance to this new era of emerging infectious diseases and novel pathogens. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not the first, and certainly will not be the last novel virus that will lead to worldwide outbreaks. Having a well thought out regional anesthesia plan to manage these patients in this new normal will ensure the best possible outcome for both the patient and the perioperative management team.</p></abstract><trans-abstract xml:lang="fr" id="Abs2"><title>Résumé</title><p id="Par2">Le 11 mars 2020, l’Organisation mondiale de la Santé déclarait que la nouvelle maladie du coronavirus 2019 (COVID-19) était une pandémie en raison de sa propagation mondiale rapide. En salle d’opération, dans le cadre des mesures de réponse aux épidémies, les anesthésiologistes doivent prendre des précautions supplémentaires et adapter les pratiques anesthésiques au cas par cas selon chaque patient. Plus particulièrement, en minimisant les nombreuses interventions générant des aérosols pendant la réalisation de l’anesthésie générale, les anesthésiologistes peuvent réduire l’exposition aux sécrétions respiratoires des patients et le risque de transmission virale périopératoire aux travailleurs de la santé et aux autres patients. Afin d’éviter toute manipulation des voies aériennes, il convient d’envisager la réalisation d’une anesthésie régionale si une chirurgie est prévue chez un patient sous enquête de COVID-19 ou confirmé, ou chez tout patient posant un risque infectieux. L’anesthésie régionale comporte des avantages en matière de maintien de la fonction respiratoire et ce, tout en évitant la production d’aérosols et par conséquent la transmission virale. Cet article explore les considérations pratiques et les mesures recommandées pour réaliser une anesthésie régionale dans ce groupe de patients, en se concentrant sur les mesures de surveillance visant à garantir la sécurité des patients et du personnel soignant, la protection des équipements et la prévention des infections. Ce faisant, nous espérons répondre à des interrogations qui pourraient avoir des implications à plus long terme dans la manière dont nous pratiquerons la prévention de la contagion en anesthésie, avec une pertinence toute particulière pour cette nouvelle ère de maladies infectieuses émergentes et de nouveaux pathogènes. Le coronavirus du syndrome respiratoire aigu sévère 2 (SARS-CoV-2) n’est pas le premier et ne sera certainement pas le dernier nouveau virus qui entraînera des épidémies mondiales. En disposant d’un plan bien conçu d’anesthésie régionale pour prendre en charge ces patients dans cette nouvelle ère, les meilleures issues possibles seront assurées tant pour le patient que pour l’équipe de prise en charge périopératoire.</p></trans-abstract></article-meta></front><body><p id="Par3">Coronavirus disease, named officially by the World Health Organization (WHO) on 11 February 2020 as COVID-19,<xref ref-type="bibr" rid="CR1">1</xref> emerged from Wuhan, China in early December 2019. Since then, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that causes COVID-19 has rapidly achieved effective and sustained human-to-human transmission via contact, droplet, and likely airborne routes.<xref ref-type="bibr" rid="CR2">2</xref> The COVID-19 outbreak was initially labelled a “public health emergency of international concern”,<xref ref-type="bibr" rid="CR3">3</xref> but with more than 150,000 confirmed cases of infection, and 5,000 deaths globally<xref ref-type="bibr" rid="CR4">4</xref> at the time of writing, WHO declared COVID-19 a pandemic on 11 March 2020, triggering upscaling of emergency response mechanisms worldwide.<xref ref-type="bibr" rid="CR5">5</xref> Clinical presentation was varied, with most patients having respiratory tract symptoms.<xref ref-type="bibr" rid="CR6">6</xref>–<xref ref-type="bibr" rid="CR8">8</xref> A study of 1,099 patients with COVID-19 showed that 19% presented with shortness of breath, 41% required oxygen supplementation, 5% became critically ill, and 2.3% required invasive mechanical ventilation.<xref ref-type="bibr" rid="CR9">9</xref> Singapore saw the first case of COVID-19 on 23 January 2020, with subsequent community spread linked to several infection clusters.<xref ref-type="bibr" rid="CR10">10</xref>,<xref ref-type="bibr" rid="CR11">11</xref> Following this, the nation instituted a series of outbreak response measures aimed at containing and mitigating the risk of imported cases and community transmission. In hospitals, these included enhanced surveillance, administrative and environmental controls, environment hygiene, correct work practices, and appropriate use of personal protective equipment (PPE), in keeping with recommendations from the WHO<xref ref-type="bibr" rid="CR12">12</xref> and the Centers for Disease Prevention and Control.<xref ref-type="bibr" rid="CR13">13</xref></p><p id="Par4">As anesthesiologists at the front line of the management of surgical patients, and with the rapidly increasing number of COVID-19 cases worldwide, we can expect to encounter more of these patients (or patients with other emerging viral pathogens in future) presenting for surgical intervention. To make matters worse, as there are unconfirmed reports of transmission before symptoms manifest, it may be challenging to identify and isolate patients carrying the virus before deciding to institute appropriate precautions. As with previous outbreaks such as severe acute respiratory syndrome (SARS), influenza A (H1N1) 2009 infection, and the Middle East Respiratory Syndrome, this would require heightened precautions and tailoring our anesthetic practice to reduce exposure to patients’ respiratory secretions and the risk of perioperative viral transmission to healthcare workers and other patients.<xref ref-type="bibr" rid="CR14">14</xref>–<xref ref-type="bibr" rid="CR16">16</xref> In particular, this should involve minimizing the many aerosol-generating procedures we perform during general anesthesia (GA), such as bag mask ventilation, open airway suctioning, and endotracheal intubation. During the SARS outbreak, intubation was one of the independent risk factors for super-spreading nosocomial outbreaks affecting many healthcare workers in Hong Kong and Guangzhou, China.<xref ref-type="bibr" rid="CR17">17</xref> As such, some considerations during airway management of confirmed/suspected COVID-19 patients have been suggested to reduce the risk of nosocomial viral transmission.<xref ref-type="bibr" rid="CR12">12</xref>,<xref ref-type="bibr" rid="CR13">13</xref>,<xref ref-type="bibr" rid="CR18">18</xref> Nevertheless, to avoid any airway manipulation, the use of regional anesthesia (RA) techniques (e.g., peripheral nerve blocks and/or central neuraxial blocks) may be preferred.<xref ref-type="bibr" rid="CR19">19</xref></p><p id="Par5">Other than the general benefits of reduced pain and opioid consumption, postoperative pulmonary complications, postoperative nausea and vomiting, and possibly postoperative cognitive dysfunction and delirium offered by RA over GA (with systemic opioids),<xref ref-type="bibr" rid="CR20">20</xref> the main advantage in patients with infectious respiratory viral diseases would be the avoidance of airway instrumentation and patient coughing during intubation and extubation,<xref ref-type="bibr" rid="CR21">21</xref>,<xref ref-type="bibr" rid="CR22">22</xref> thus reducing the risk of infecting staff via the associated aerosol generation and dispersion of viral particles.<xref ref-type="bibr" rid="CR23">23</xref> Secondly, and broadly speaking, RA has fewer effects on respiratory function and dynamics compared with GA with or without muscle paralysis.<xref ref-type="bibr" rid="CR24">24</xref>–<xref ref-type="bibr" rid="CR26">26</xref> This relative preservation of respiratory function could theoretically reduce postoperative pulmonary complications in COVID-19 patients who may already have reduced respiratory function from COVID-19-associated pneumonia or acute respiratory distress syndrome.</p><p id="Par6">Given the above logical advantages of RA over GA in managing patients with infectious respiratory viral diseases such as COVID-19 and the paucity of literature on this aspect, this narrative review aims to explore the practical considerations and recommended measures for performing RA in this group of patients, focusing on control measures geared towards ensuring patient and staff safety, and infection prevention. By doing so, the authors hope to address an issue that may have downstream implications in the way we practice infection control in anesthesia, particularly in this era of emerging infectious diseases and novel pathogens. A description of control measures taken in the hospital<xref ref-type="bibr" rid="CR27">27</xref> and nationwide to contain and mitigate the spread of COVID-19 is beyond the scope of this article.</p><sec id="Sec2"><title>Practical considerations and suggested solutions</title><sec id="Sec3"><title>Preparation phase: prior to performing RA</title><sec id="Sec4"><title>I<sc>ntra</sc>-<sc>hospital transport</sc></title><p id="Par7">Transporting a COVID-19 patient from an isolation ward to the operating room (OR) presents opportunities for contaminating both the environment and personnel. At our institution, patients wear a surgical face mask during transfer from the isolation ward to the OR, and the accompanying healthcare workers wear fitted, National Institute of Occupational Safety and Health-certified N95 respirators, eye protection (either goggles or full face shield), caps, gowns, and gloves.<xref ref-type="bibr" rid="CR13">13</xref> We transport these patients along a designated route to minimize contact with other people, in the presence of an infection prevention nurse and security personnel to prevent environmental contamination and ensure compliance with infection control measures.</p></sec><sec id="Sec5"><title>P<sc>reoperative assessment</sc></title><p id="Par8">Consent-taking is still largely paper-based in our institution. This may lead to potential paper contamination during the process of consent-taking. A possible solution would be to use digital consent forms signed on laptops or mobile devices, which can be protected with single-use plastic wraps.</p></sec><sec id="Sec6"><title>P<sc>reparation of</sc> OR <sc>and equipment</sc></title><p id="Par9">The patient should be reviewed, blocked, and recovered inside the OR where surgery will be performed to limit contamination to a single location. The number of personnel within the OR should be kept to a minimum. Only necessary equipment and drugs required should be brought into the OR to prevent contamination and wasting resources (as unused consumables will be discarded at the end of the operation).<xref ref-type="bibr" rid="CR28">28</xref>,<xref ref-type="bibr" rid="CR29">29</xref> Additional equipment required that was initially unanticipated can be obtained through a “runner”. This is usually a dedicated anesthetic trained nurse in our institution. As far as possible, single-use equipment should be selected.</p><p id="Par10">The ultrasound machine has a large footprint and numerous surfaces that can harbor droplets thus serving as reservoirs for the virus if proper protection or decontamination processes are not followed.<xref ref-type="bibr" rid="CR30">30</xref> In our institution, to prevent contamination of the ultrasound machine but still be able to obtain satisfactory images, the ultrasound machine’s screen and controls are protected with a single-use plastic cover (Fig. <xref rid="Fig1" ref-type="fig">1</xref>). Additional ultrasound probes that are not needed for the block should be detached from the machine to minimize areas for potential contamination. The ultrasound probe that comes into contact with the patient should be covered along its entire length with a disposable probe sheath. The probe sheath in our institution is too short to cover the entire length of the probe, so we cut off one end of a sheath to form a tube and slide it over the probe to cover the proximal half, and then use another (sterile) sheath to cover the distal half so that no part of the probe will come in direct contact with the patient (Fig. <xref rid="Fig2" ref-type="fig">2</xref>). This facilitates cleaning after the procedure. Alternatively, portable handheld point-of-care ultrasound devices can be considered, given that their smaller size will make decontamination much easier post-procedure. Pre-scanning with an unprotected ultrasound probe should be avoided to prevent probe contamination.<fig id="Fig1"><label>Fig. 1</label><caption><p>A) The ultrasound machine’s screen and controls are protected with a single-use plastic cover to prevent contamination and to ease disinfection post-procedure. B) Despite being covered in plastic, we were still able to obtain satisfactory images for a popliteal nerve block. CPN = common peroneal nerve; PA = popliteal artery; PV = popliteal vein; TN = tibial nerve.</p></caption><graphic xlink:href="12630_2020_1637_Fig1_HTML" id="MO1"></graphic></fig><fig id="Fig2"><label>Fig. 2</label><caption><p>The ultrasound probe is covered with a disposable sheath along its entire length so that any part of the probe that potentially may come in contact with the patient is protected. Depending on the type of sheath available, it may need to be extended with the use of more than one sheath. A) For example, the probe sheath in our institution is too short to cover the entire length of the probe, so we cut off one end of a sheath to form a tube and slide it over the probe to cover the proximal half, and then B) use another (sterile) sheath to cover the distal half.</p></caption><graphic xlink:href="12630_2020_1637_Fig2_HTML" id="MO2"></graphic></fig></p></sec></sec><sec id="Sec7"><title>Intraprocedural phase: performance of RA</title><sec id="Sec8"><title>S<sc>edation</sc></title><p id="Par11">Sedation should be used with caution in COVID-19 patients as they may have co-existing respiratory compromise from COVID-19 pneumonia. Oxygenation and ventilation should be closely monitored if the patient is sedated. Although it is recommended that carbon dioxide (CO<sub>2</sub>) monitoring should be immediately available for any patient undergoing sedation,<xref ref-type="bibr" rid="CR31">31</xref> one should avoid connecting the CO<sub>2</sub> sampling line directly so as to prevent contamination of the patient monitor. Instead, we improvise by connecting a 15-mm endotracheal tube (ETT) connector and a high-efficiency particulate air (HEPA) heat and moisture exchanging (HME) filter either directly to the simple face mask or interposed by a cut segment of suction tubing. The CO<sub>2</sub> sampling line is then connected to the HEPA HME so that sampled gas is filtered and a CO<sub>2</sub> tracing can be obtained to monitor respiratory rate (Fig. <xref rid="Fig3" ref-type="fig">3</xref>). Alternatively, the respiratory rate can be monitored by clinical observation and assessment by a vigilant anesthesiologist or by electrocardiogram systems that use impedance plethysmography.<fig id="Fig3"><label>Fig. 3</label><caption><p>Set up of capnography monitoring. A) The 15-mm endotracheal tube connector together with a heat and moisture exchanger/filter are connected to the simple face mask. The carbon dioxide (CO<sub>2</sub>) sampling line is then connected to the heat and moisture exchanger. B) In an alternative set up, a cut section of a suction catheter is interposed between the simple face mask and the endotracheal tube connector. C) Both setups allowed us to obtain CO<sub>2</sub> tracing and monitor respiratory movements.</p></caption><graphic xlink:href="12630_2020_1637_Fig3_HTML" id="MO3"></graphic></fig></p><p id="Par12">Oxygen therapy was identified as an independent risk factor for super-spreading nosocomial outbreaks of SARS in Hong Kong and Guangzhou, China.<xref ref-type="bibr" rid="CR17">17</xref> Extrapolating from these lessons, the patient should wear a surgical face mask at all times to prevent droplet transmission. Oxygen supplementation via venturi mask, non-invasive positive pressure ventilation, and high-flow nasal cannula such as the transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) should be avoided to prevent risk of aerosolization and subsequent cross infection.<xref ref-type="bibr" rid="CR13">13</xref>,<xref ref-type="bibr" rid="CR15">15</xref>,<xref ref-type="bibr" rid="CR32">32</xref>,<xref ref-type="bibr" rid="CR33">33</xref> If needed, supplemental oxygen can be delivered via nasal prongs under the surgical face mask to reduce dispersion of exhaled air posing an infectious risk.<xref ref-type="bibr" rid="CR34">34</xref> If using a simple face mask, flow of oxygen should be kept as low as needed to maintain oxygen saturation. Hui and colleagues showed that dispersal distances of exhaled air increased with increasing oxygen flow rates (lateral distances of 0.2, 0.22, 0.3, and 0.4 m from the sagittal plane during the delivery of oxygen at 4, 6, 8, and 10 L·min<sup>−1</sup> respectively).<xref ref-type="bibr" rid="CR35">35</xref> Coughing can extend the dispersion distance further, posing an infectious risk to surrounding healthcare workers at a short distance away. Since substantial exposure to exhaled air occurs generally within 0.4 m from the patients receiving supplemental oxygen via a simple mask, healthcare workers should take appropriate respiratory precautions and observe the principles of safe oxygen delivery.</p></sec><sec id="Sec9"><title>P<sc>ersonal protective equipment and its challenges</sc></title><p id="Par13">Operators performing RA on a COVID-19 patient should, at minimum, don PPE, goggles, and a surgical face mask.<xref ref-type="bibr" rid="CR13">13</xref> The option of donning an N95 respirator or powered air purifying respirator (PAPR) is at the discretion of the proceduralist as RA is not an aerosol-generating procedure. The physical encumbrance of PAPR may be associated with reduced peripheral vision and auditory acuity, leading to impaired communication between team members, decreased mobility, restricted view, and heat stress in healthcare providers. The combination of these factors can affect concentration and hence performance of RA techniques.<xref ref-type="bibr" rid="CR36">36</xref>–<xref ref-type="bibr" rid="CR39">39</xref> The execution of the nerve block may also be impaired by the proceduralist’s unfamiliarity with using PPE during the procedure, and the time to do the block may thus be prolonged.</p></sec><sec id="Sec10"><title>A<sc>ssessment of adequacy of</sc> RA</title><p id="Par14">Reusable cooling blocks used to assess adequacy of RA techniques may be a source for contamination. As such, they should be placed in disposable plastic bags to prevent contamination, which can then be removed using a non-touch technique. The cooling block used should be cleaned with quaternary ammonium chloride disinfectant wipes thereafter.<xref ref-type="bibr" rid="CR40">40</xref> Alternatively, ice cubes can be placed in a disposable plastic bag and used instead of a reusable cooling block. These can then be discarded after a single use.</p></sec></sec><sec id="Sec11"><title>Postoperative phase</title><sec id="Sec12"><title>R<sc>ecovery of patient</sc></title><p id="Par15">After the surgical procedure, the patient should remain in the same OR for post-anesthetic recovery to prevent contamination of other clinical areas.</p></sec><sec id="Sec13"><title>D<sc>econtamination of equipment</sc></title><p id="Par16">The plastic sheets covering the ultrasound machine should be removed and discarded in clearly labelled biohazard bins. The ultrasound machine should be wiped down with quaternary ammonium chloride disinfectant wipes.<xref ref-type="bibr" rid="CR40">40</xref> It should then be left in the OR for ultraviolet C irradiation or hydrogen peroxide vaporization before it is used on another patient.</p></sec></sec><sec id="Sec14"><title>Managing complications related to RA technique</title><sec id="Sec15"><title>F<sc>ailed block</sc></title><p id="Par17">Prior to the start of surgery, the block should be tested to ensure optimal operating conditions so as to avoid urgent conversion to GA when surgery is already underway. Anesthesiologists may be pressed to hastily don PAPR and convert to GA, increasing the risk of an inadvertent breach of infection control. Therefore, the anesthesiologist may choose to don PAPR (or similar PPE used for intubation) even when performing the block so as to be able to respond to intraoperative emergencies in a timely yet safe manner. Should the need to convert to GA arise, the anesthesiologist should follow PPE guidelines and use an induction technique that reduces aerosol generation to the minimum.<xref ref-type="bibr" rid="CR13">13</xref>,<xref ref-type="bibr" rid="CR15">15</xref>,<xref ref-type="bibr" rid="CR29">29</xref>,<xref ref-type="bibr" rid="CR41">41</xref></p></sec><sec id="Sec16"><title>L<sc>ocal anesthetic systemic toxicity</sc> (<sc>last</sc>)</title><p id="Par18">If the patient develops signs and symptoms of LAST, a crisis should be declared and help summoned early as time is needed for additional personnel to be appropriately protected with PPE/PAPR before entering the resuscitation.<xref ref-type="bibr" rid="CR41">41</xref> Management of LAST should follow current established guidelines.<xref ref-type="bibr" rid="CR42">42</xref> The anesthesia drug trolley containing the standard resuscitation drugs and defibrillator cart should then be pushed in for use in patient resuscitation. In our institution, we have reduced the drugs kept in the drug trolley to minimize unnecessary wastage. A “runner” stationed outside the OR for all cases is responsible for replenishing drugs and equipment that are not found in the trolley.</p></sec><sec id="Sec17"><title>S<sc>pecific to</sc> RA <sc>technique</sc>: <sc>brachial plexus block</sc></title><p id="Par19">Potential complications specific to brachial plexus blocks include pneumothorax and phrenic nerve involvement causing diaphragmatic paralysis that may cause further respiratory compromise in the COVID-19 patient. The most experienced operator should perform the block and the needle tip should always be visualized to prevent a pneumothorax. Diaphragmatic paralysis occurs because of the inhibitory effects of local anesthetics on the phrenic nerve or its nerve roots from C3–5. Various methods can be adopted to minimize the occurrence of diaphragmatic paralysis. These include modifying the local anesthetic dose via volume and concentration or the injection site and technique in an interscalene block, or performing an entirely different RA technique such as a suprascapular or infraclavicular block instead.<xref ref-type="bibr" rid="CR43">43</xref></p></sec></sec></sec><sec id="Sec18"><title>Discussion</title><p id="Par20">The aim of this article is to present a useful and easily accessible guide for the anesthesiologist who would like to perform RA for suspect or confirmed COVID-19 infected patients coming for surgery. Although we have not yet been able to study the effectiveness of our proposed strategies (as we have yet to perform RA in a confirmed COVID-19 infected patient), we have recently performed a supraclavicular nerve block on a patient at risk of COVID-19 infection due to positive travel history, and popliteal nerve block in another patient with known coronavirus OC43 viral infection. The coronavirus OC43 is a member of the <italic>Coronaviridae</italic> family known to cause acute upper respiratory tract infections. It is spread by droplet transmission, similar to SARS-CoV-2 and other respiratory viruses.<xref ref-type="bibr" rid="CR44">44</xref> In this case, we thought through the considerations beforehand and adopted the suggested protective measures (Fig. <xref rid="Fig4" ref-type="fig">4</xref>). So far, none of the perioperative management team members developed any upper respiratory tract infection symptoms in the subsequent two weeks.<fig id="Fig4"><label>Fig. 4</label><caption><p>A summary of considerations and practical recommendations aimed at ensuring patient and staff safety, and infection prevention during regional anesthesia for patients with coronavirus disease (COVID-19) infection or infection with other infectious respiratory viral diseases.</p></caption><graphic xlink:href="12630_2020_1637_Fig4_HTML" id="MO4"></graphic></fig></p><p id="Par21">The isolation OR workflow and clinical care guidelines are institution- and department-specific, so our recommendations for the possible challenges may not be applicable to all healthcare facilities. Furthermore, the level of expertise in RA techniques may vary between institutions, so GA may be the default technique of choice in some hospitals. Nevertheless, we believe that our article fills an important void in the literature and presents important considerations when performing RA for such patients.</p><p id="Par22">Anesthesia providers for these patients should be well-versed in both GA and RA techniques. In our institution, the most senior member of the on-call anesthesia team (attending grade) is the primary anesthesiologist for suspect or confirmed COVID-19 infected patients. The technique selected should be one that is best suited for the patient and type of surgery, with the least risk of viral transmission to the perioperative management team.</p></sec><sec id="Sec19"><title>Conclusion</title><p id="Par23">Because it preserves respiratory function and avoids aerosolization and hence viral transmission, RA should be considered whenever surgery is planned for a suspected or confirmed COVID-19 patient. The practical considerations and recommendations covered in this article can therefore be applied to all patients who pose a similar infectious risk, not just those with COVID-19 infection. The SARS-CoV-2 virus is not the first and certainly will not be the last novel virus to achieve worldwide outbreaks. Having a well thought out RA plan to manage infected patients in this new normal will ensure the best possible outcome for both the patient and the perioperative management team.</p></sec></body><back><fn-group><fn><p><bold>Publisher's Note</bold></p><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p></fn></fn-group><ack><title>Acknowledgement</title><p>The authors wish to thank Dr. Lai Fook Onn (Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital) for his valuable and constructive suggestions for this article.</p><sec id="d29e596"><title>Conflicts of interest</title><p>None.</p></sec><sec id="d29e601"><title>Funding statement</title><p>None.</p></sec><sec id="d29e606"><title>Editorial responsibility</title><p>This submission was handled by Dr. Hilary P. Grocott, Editor-in-Chief, <italic>Canadian Journal of Anesthesia.</italic></p></sec></ack><ref-list id="Bib1"><title>References</title><ref id="CR1"><label>1.</label><mixed-citation publication-type="other"><italic>World Health Organization.</italic> WHO Director-General’s remarks at the media briefing on 2019-nCoV on 11 February 2020. Available from URL: <ext-link ext-link-type="uri" xlink:href="https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020">https://www.who.int/dg/speeches/detail/who-director-general-s-remarks-at-the-media-briefing-on-2019-ncov-on-11-february-2020</ext-link> (accessed March 2020).</mixed-citation></ref><ref id="CR2"><label>2.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Li</surname><given-names>Q</given-names></name><name><surname>Guan</surname><given-names>X</given-names></name><name><surname>Wu</surname><given-names>P</given-names></name><etal></etal></person-group><article-title>Early transmission dynamics in Wuhan, China, of novel coronavirus–infected pneumonia</article-title><source>N Engl J Med</source><year>2020</year></element-citation></ref><ref id="CR3"><label>3.</label><mixed-citation publication-type="other"><italic>World Health Organization.</italic> Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Available from URL: <ext-link ext-link-type="uri" xlink:href="https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-%25282005%2529-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-%25282019-ncov%2529">https://www.who.int/news-room/detail/30-01-2020-statement-on-the-second-meeting-of-the-international-health-regulations-%282005%29-emergency-committee-regarding-the-outbreak-of-novel-coronavirus-%282019-ncov%29</ext-link> (accessed March 2020).</mixed-citation></ref><ref id="CR4"><label>4.</label><mixed-citation publication-type="other"><italic>World Health Organization.</italic> Coronavirus disease (COVID-2019) situation reports. Available from URL: <ext-link ext-link-type="uri" xlink:href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports">https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports</ext-link> (accessed March 2020).</mixed-citation></ref><ref id="CR5"><label>5.</label><mixed-citation publication-type="other"><italic>World Health Organization.</italic>WHO Director-General’s opening remarks at the media briefing on COVID-19 – 11 March. Available from URL: <ext-link ext-link-type="uri" xlink:href="https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19%e2%80%9411-march-2020">https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19—11-march-2020</ext-link> (accessed March 2020).</mixed-citation></ref><ref id="CR6"><label>6.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Young</surname><given-names>BE</given-names></name><name><surname>Ong</surname><given-names>SW</given-names></name><name><surname>Kalimuddin</surname><given-names>S</given-names></name><etal></etal></person-group><article-title>Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore</article-title><source>JAMA</source><year>2020</year></element-citation></ref><ref id="CR7"><label>7.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chen</surname><given-names>N</given-names></name><name><surname>Zhou</surname><given-names>M</given-names></name><name><surname>Dong</surname><given-names>X</given-names></name><etal></etal></person-group><article-title>Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study</article-title><source>Lancet</source><year>2020</year></element-citation></ref><ref id="CR8"><label>8.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wang</surname><given-names>D</given-names></name><name><surname>Hu</surname><given-names>B</given-names></name><name><surname>Hu</surname><given-names>C</given-names></name><etal></etal></person-group><article-title>Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China</article-title><source>JAMA</source><year>2020</year></element-citation></ref><ref id="CR9"><label>9.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Guan</surname><given-names>WJ</given-names></name><name><surname>Ni</surname><given-names>ZY</given-names></name><name><surname>Hu</surname><given-names>Y</given-names></name><etal></etal></person-group><article-title>Clinical characteristics of coronavirus disease 2019 in China</article-title><source>N Engl J Med</source><year>2020</year></element-citation></ref><ref id="CR10"><label>10.</label><mixed-citation publication-type="other"><italic>Ministry of Health</italic> . News Highlights. Risk Assessment Raised to Dorscon Orange. Available from URL: <ext-link ext-link-type="uri" xlink:href="https://www.moh.gov.sg/news-highlights/details/risk-assessment-raised-to-dorscon-orange">https://www.moh.gov.sg/news-highlights/details/risk-assessment-raised-to-dorscon-orange</ext-link> (accessed March 2020).</mixed-citation></ref><ref id="CR11"><label>11.</label><mixed-citation publication-type="other"><italic>Ministry of Health.</italic> News Highlights. Four More Cases Discharged, Two New Cases of COVID-19 Infection Confirmed. Available from URL: <ext-link ext-link-type="uri" xlink:href="https://www.moh.gov.sg/news-highlights/details/four-more-cases-discharged-two-new-cases-of-covid-19-infection-confirmed-2Mar">https://www.moh.gov.sg/news-highlights/details/four-more-cases-discharged-two-new-cases-of-covid-19-infection-confirmed-2Mar</ext-link> (accessed March 2020).</mixed-citation></ref><ref id="CR12"><label>12.</label><mixed-citation publication-type="other"><italic>World Health Organization.</italic> Coronavirus disease (COVID-19) technical guidance: infection prevention and control / WASH. Available from URL: <ext-link ext-link-type="uri" xlink:href="https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/infection-prevention-and-control">https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance/infection-prevention-and-control</ext-link> (accessed March 2020).</mixed-citation></ref><ref id="CR13"><label>13.</label><mixed-citation publication-type="other"><italic>Centers for Disease Control and Prevention.</italic> Coronavirus Disease 2019 (COVID-19). Available from URL: <ext-link ext-link-type="uri" xlink:href="https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html%3fCDC_AA_refVal%3dhttps%253A%252F%252Fwww.cdc.gov%252Fcoronavirus%252F2019-ncov%252Fhcp%252Finfection-control.html">https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fhcp%2Finfection-control.html</ext-link> (accessed March 2020).</mixed-citation></ref><ref id="CR14"><label>14.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wu</surname><given-names>Z</given-names></name><name><surname>McGoogan</surname><given-names>JM</given-names></name></person-group><article-title>Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China</article-title><source>JAMA</source><year>2020</year></element-citation></ref><ref id="CR15"><label>15.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Kamming</surname><given-names>D</given-names></name><name><surname>Gardam</surname><given-names>M</given-names></name><name><surname>Chung</surname><given-names>F</given-names></name></person-group><article-title>Anaesthesia and SARS</article-title><source>Br J Anaesth</source><year>2003</year><volume>90</volume><fpage>715</fpage><lpage>718</lpage><pub-id pub-id-type="pmid">12765882</pub-id></element-citation></ref><ref id="CR16"><label>16.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Caputo</surname><given-names>KM</given-names></name><name><surname>Byrick</surname><given-names>R</given-names></name><name><surname>Chapman</surname><given-names>MG</given-names></name><name><surname>Orser</surname><given-names>BJ</given-names></name><name><surname>Orser</surname><given-names>BA</given-names></name></person-group><article-title>Intubation of SARS patients: infection and perspectives of healthcare workers</article-title><source>Can J Anesth</source><year>2006</year><volume>53</volume><fpage>122</fpage><lpage>129</lpage><pub-id pub-id-type="pmid">16434750</pub-id></element-citation></ref><ref id="CR17"><label>17.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Yu</surname><given-names>IT</given-names></name><name><surname>Xie</surname><given-names>ZH</given-names></name><name><surname>Tsoi</surname><given-names>KK</given-names></name><etal></etal></person-group><article-title>Why did outbreaks of severe acute respiratory syndrome occur in some hospital wards but not in others?</article-title><source>Clin Infect Dis</source><year>2007</year><volume>44</volume><fpage>1017</fpage><lpage>1025</lpage><pub-id pub-id-type="pmid">17366443</pub-id></element-citation></ref><ref id="CR18"><label>18.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Peng</surname><given-names>PW</given-names></name><name><surname>Ho</surname><given-names>PL</given-names></name><name><surname>Hota</surname><given-names>SS</given-names></name></person-group><article-title>Outbreak of a new coronavirus: what anaesthetists should know</article-title><source>Br J Anaesth</source><year>2020</year></element-citation></ref><ref id="CR19"><label>19.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Tan</surname><given-names>TK</given-names></name></person-group><article-title>How severe acute respiratory syndrome (SARS) affected the department of anaesthesia at Singapore General Hospital</article-title><source>Anaesth Intensive Care</source><year>2004</year><volume>32</volume><fpage>394</fpage><lpage>400</lpage><pub-id pub-id-type="pmid">15264737</pub-id></element-citation></ref><ref id="CR20"><label>20.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hutton</surname><given-names>M</given-names></name><name><surname>Brull</surname><given-names>R</given-names></name><name><surname>Macfarlane</surname><given-names>AJ</given-names></name></person-group><source>Regional anaesthesia and outcomes. BJA Educ</source><year>2018</year><volume>2</volume><fpage>52</fpage><lpage>56</lpage></element-citation></ref><ref id="CR21"><label>21.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Rowlands</surname><given-names>J</given-names></name><name><surname>Yeager</surname><given-names>MP</given-names></name><name><surname>Beach</surname><given-names>M</given-names></name><etal></etal></person-group><article-title>Video observation to map hand contact and bacterial transmission in operating rooms</article-title><source>Am J Infect Control</source><year>2014</year><volume>42</volume><fpage>698</fpage><lpage>701</lpage><pub-id pub-id-type="pmid">24969122</pub-id></element-citation></ref><ref id="CR22"><label>22.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Loftus</surname><given-names>RW</given-names></name><name><surname>Koff</surname><given-names>MD</given-names></name><name><surname>Birnbach</surname><given-names>DJ</given-names></name></person-group><article-title>The dynamics and implications of bacterial transmission events arising from the anesthesia work area</article-title><source>Anesth Analg</source><year>2015</year><volume>120</volume><fpage>853</fpage><lpage>860</lpage><pub-id pub-id-type="pmid">25790210</pub-id></element-citation></ref><ref id="CR23"><label>23.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chan</surname><given-names>MT</given-names></name><name><surname>Chow</surname><given-names>BK</given-names></name><name><surname>Lo</surname><given-names>T</given-names></name><etal></etal></person-group><article-title>Exhaled air dispersion during bag-mask ventilation and sputum suctioning - implications for infection control</article-title><source>Sci Rep</source><year>2018</year></element-citation></ref><ref id="CR24"><label>24.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Pusapati</surname><given-names>RN</given-names></name><name><surname>Sivashanmugam</surname><given-names>T</given-names></name><name><surname>Ravishankar</surname><given-names>M</given-names></name></person-group><article-title>Respiratory changes during spinal anaesthesia for gynaecological laparoscopic surgery</article-title><source>J Anaesthesiol Clin Pharmacol</source><year>2010</year><volume>26</volume><fpage>475</fpage><lpage>479</lpage><pub-id pub-id-type="pmid">21547173</pub-id></element-citation></ref><ref id="CR25"><label>25.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Saraswat</surname><given-names>V</given-names></name></person-group><article-title>Effects of anaesthesia techniques and drugs on pulmonary function</article-title><source>Indian J Anaesth</source><year>2015</year><volume>59</volume><fpage>557</fpage><lpage>564</lpage><pub-id pub-id-type="pmid">26556914</pub-id></element-citation></ref><ref id="CR26"><label>26.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>McCarthy</surname><given-names>GS</given-names></name></person-group><article-title>The effect of thoracic extradural analgesia on pulmonary gas distribution, functional residual capacity and airway closure</article-title><source>Br J Anaesth</source><year>1976</year><volume>48</volume><fpage>243</fpage><lpage>248</lpage><pub-id pub-id-type="pmid">1259891</pub-id></element-citation></ref><ref id="CR27"><label>27.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wong</surname><given-names>J</given-names></name><name><surname>Goh</surname><given-names>QY</given-names></name><name><surname>Tan</surname><given-names>Z</given-names></name><etal></etal></person-group><article-title>Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore</article-title><source>Can J Anesth</source><year>2020</year></element-citation></ref><ref id="CR28"><label>28.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Chee</surname><given-names>VW</given-names></name><name><surname>Khoo</surname><given-names>ML</given-names></name><name><surname>Lee</surname><given-names>SF</given-names></name><name><surname>Lai</surname><given-names>YC</given-names></name><name><surname>Chin</surname><given-names>NM</given-names></name></person-group><article-title>Infection control measures for operative procedures in severe acute respiratory syndrome–related patients</article-title><source>Anesthesiology</source><year>2004</year><volume>100</volume><fpage>1394</fpage><lpage>1398</lpage><pub-id pub-id-type="pmid">15166557</pub-id></element-citation></ref><ref id="CR29"><label>29.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Peng</surname><given-names>PW</given-names></name><name><surname>Wong</surname><given-names>DT</given-names></name><name><surname>Bevan</surname><given-names>D</given-names></name><name><surname>Gardam</surname><given-names>M</given-names></name></person-group><article-title>Infection control and anesthesia: lessons learned from the Toronto SARS outbreak</article-title><source>Can J Anesth</source><year>2003</year><volume>50</volume><fpage>989</fpage><lpage>997</lpage><pub-id pub-id-type="pmid">14656775</pub-id></element-citation></ref><ref id="CR30"><label>30.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Ong</surname><given-names>SW</given-names></name><name><surname>Tan</surname><given-names>YK</given-names></name><name><surname>Chia</surname><given-names>PY</given-names></name><etal></etal></person-group><article-title>Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient</article-title><source>JAMA</source><year>2020</year></element-citation></ref><ref id="CR31"><label>31.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Dobson</surname><given-names>G</given-names></name><name><surname>Chong</surname><given-names>MA</given-names></name><name><surname>Chow</surname><given-names>L</given-names></name><etal></etal></person-group><article-title>Procedural sedation: a position paper of the Canadian Anesthesiologists’ Society</article-title><source>Can J Anesth</source><year>2018</year><volume>65</volume><fpage>1372</fpage><lpage>1384</lpage><pub-id pub-id-type="pmid">30264187</pub-id></element-citation></ref><ref id="CR32"><label>32.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hui</surname><given-names>DS</given-names></name><name><surname>Hall</surname><given-names>SD</given-names></name><name><surname>Chan</surname><given-names>MT</given-names></name><etal></etal></person-group><article-title>Noninvasive positive-pressure ventilation: an experimental model to assess air and particle dispersion</article-title><source>Chest</source><year>2006</year><volume>130</volume><fpage>730</fpage><lpage>740</lpage><pub-id pub-id-type="pmid">16963670</pub-id></element-citation></ref><ref id="CR33"><label>33.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hui</surname><given-names>DS</given-names></name><name><surname>Chow</surname><given-names>BK</given-names></name><name><surname>Ng</surname><given-names>SS</given-names></name><etal></etal></person-group><article-title>Exhaled air dispersion distances during noninvasive ventilation via different respironics face masks</article-title><source>Chest</source><year>2009</year><volume>136</volume><fpage>998</fpage><lpage>1005</lpage><pub-id pub-id-type="pmid">19411297</pub-id></element-citation></ref><ref id="CR34"><label>34.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hui</surname><given-names>DS</given-names></name><name><surname>Ip</surname><given-names>M</given-names></name><name><surname>Tang</surname><given-names>JW</given-names></name><etal></etal></person-group><article-title>Airflows around oxygen masks: a potential source of infection?</article-title><source>Chest</source><year>2006</year><volume>130</volume><fpage>822</fpage><lpage>826</lpage><pub-id pub-id-type="pmid">16963681</pub-id></element-citation></ref><ref id="CR35"><label>35.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Hui</surname><given-names>DS</given-names></name><name><surname>Hall</surname><given-names>SD</given-names></name><name><surname>Chan</surname><given-names>MT</given-names></name><etal></etal></person-group><article-title>Exhaled air dispersion during oxygen delivery via a simple oxygen mask</article-title><source>Chest</source><year>2007</year><volume>132</volume><fpage>540</fpage><lpage>546</lpage><pub-id pub-id-type="pmid">17573505</pub-id></element-citation></ref><ref id="CR36"><label>36.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Loibner</surname><given-names>M</given-names></name><name><surname>Hagauer</surname><given-names>S</given-names></name><name><surname>Schwantzer</surname><given-names>G</given-names></name><name><surname>Berghold</surname><given-names>A</given-names></name><name><surname>Zatloukal</surname><given-names>K</given-names></name></person-group><article-title>Limiting factors for wearing personal protective equipment (PPE) in a health care environment evaluated in a randomised study</article-title><source>PLoS One</source><year>2019</year></element-citation></ref><ref id="CR37"><label>37.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Johnson</surname><given-names>AT</given-names></name><name><surname>Grove</surname><given-names>CM</given-names></name><name><surname>Weiss</surname><given-names>RA</given-names></name></person-group><article-title>Mask performance rating table for specific military tasks</article-title><source>Mil Med</source><year>1993</year><volume>158</volume><fpage>665</fpage><lpage>670</lpage><pub-id pub-id-type="pmid">8264926</pub-id></element-citation></ref><ref id="CR38"><label>38.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Johnson</surname><given-names>AT</given-names></name></person-group><article-title>Respirator masks protect health but impact performance: a review</article-title><source>J Biol Eng</source><year>2016</year></element-citation></ref><ref id="CR39"><label>39.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Johnson</surname><given-names>AT</given-names></name><name><surname>Weiss</surname><given-names>RA</given-names></name><name><surname>Grove</surname><given-names>C</given-names></name></person-group><article-title>Respirator performance rating table for mask design</article-title><source>Am Ind Hyg Assoc J</source><year>1992</year><volume>53</volume><fpage>193</fpage><lpage>202</lpage><pub-id pub-id-type="pmid">1642172</pub-id></element-citation></ref><ref id="CR40"><label>40.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Song</surname><given-names>X</given-names></name><name><surname>Vossebein</surname><given-names>L</given-names></name><name><surname>Zille</surname><given-names>A</given-names></name></person-group><article-title>Efficacy of disinfectant-impregnated wipes used for surface disinfection in hospitals: a review</article-title><source>Antimicrob Resist Infect Control</source><year>2019</year></element-citation></ref><ref id="CR41"><label>41.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Wax</surname><given-names>RS</given-names></name><name><surname>Christian</surname><given-names>MD</given-names></name></person-group><article-title>Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients</article-title><source>Can J Anesth</source><year>2020</year></element-citation></ref><ref id="CR42"><label>42.</label><mixed-citation publication-type="other"><italic>Association of Anaesthetists.</italic> Management of severe local anaesthetic toxicity. Available from DOI: 10.21466/g.MOSLAT2.2010 (accessed March 2020).</mixed-citation></ref><ref id="CR43"><label>43.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>El-Boghdadly</surname><given-names>K</given-names></name><name><surname>Chin</surname><given-names>KJ</given-names></name><name><surname>Chan</surname><given-names>VW</given-names></name></person-group><article-title>Phrenic nerve palsy and regional anesthesia for shoulder surgery: anatomical, physiologic, and clinical considerations</article-title><source>Anesthesiology</source><year>2017</year><volume>127</volume><fpage>173</fpage><lpage>191</lpage><pub-id pub-id-type="pmid">28514241</pub-id></element-citation></ref><ref id="CR44"><label>44.</label><element-citation publication-type="journal"><person-group person-group-type="author"><name><surname>Walsh</surname><given-names>EE</given-names></name><name><surname>Shin</surname><given-names>JH</given-names></name><name><surname>Falsey</surname><given-names>AR</given-names></name></person-group><article-title>Clinical impact of human coronaviruses 229E and OC43 infection in diverse adult populations</article-title><source>J Infect Dis</source><year>2013</year><volume>208</volume><fpage>1634</fpage><lpage>1642</lpage><pub-id pub-id-type="pmid">23922367</pub-id></element-citation></ref></ref-list></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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