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2020, Number 4

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Rev Mex Anest 2020; 43 (4)

Perioperative management of the neurosurgical patient COVID-19

Osorio-Santiago MA, Manrique-Carmona LP

Language: Spanish
References: 39
Page: 245-250
PDF size: 253.15 Kb.


ABSTRACT

The disease made by the COVID-19 virus causes the infectious respiratory acute severe syndrome known as SARS-2, this virus can penetrate the central nervous system affecting neurons and glial cells, is clinically manifested as encephalitis, ischemic stroke, and even polyneuropathy. When we confront a neuroquirurgic patient with positive COVID-19 we require a fast but detailed evaluation of the general and neurological status of the sick. Every surgery in presence of a positive COVID-19 patient, must be realized with high-level protection measures while the surgery happens. The use of craniotomes and electrocautery should be minimized in order to reduce aerosol production. Transsphenoidal endonasal procedures should be avoided during the period of the pandemic. We’re based in the concense of experts made by the SNACC (Society for Neuroscience in Anesthesiology and Critical Care) to emit recommendations adapted to our environment. Endovascular therapy is a viable alternative to the intravenous trombolisis for the reestablishment of circulation. It has been observed better reperfusion in those patients who didn’t received sedation, or this was light compared with the ones who did received general anesthesia. In some cases it’s indispensable the post-surgical extubation (specially in those patients who’re infected with COVID-19), so it should be kept as deep sedation and should traslade the patient to UCI. Is important the remember that infection by COVID-19 has been shown in the principal systems, causing multi-organ damage in susceptible patients, reason of why we’ll have to look tightly after every data that takes us to think in dysfunction in small and medium term. Ethical decision making regarding which patient is a candidate to a urgent decompressive craniectomy or endovascular treatment, if more than a vase is occluded, this will have to be discussed with the treating team to not fall in therapeutic cruelty or well in the omission of a opportune treatment.


REFERENCES

  1. Aguayo-Moscoso X, Mora Coello CL, Proaño-Constante MJ, Revelo-Ochoa EJ, Molina Vásquez PA VPJ. Accidente cerebrovascular trombótico en paciente COVID-19. Rev Científica Digit INSPILIP. 2020;4.

  2. Carod-Artal FJ. Neurological complications of coronavirus and COVID-19. Rev Neurol. 2020;70:311-322.

  3. Beyrouti R, Adams ME, Benjamin L, Cohen H, Farmer SF, Goh YY, et al. Characteristics of ischaemic stroke associated with COVID-19. J Neurol Neurosurg Psychiatry. 2020;91:889-891. jnnp-2020-323586.

  4. Markus HS. COVID-19 and stroke: a Global World Stroke Organisation perspective. Int J Stroke. 2020;15:361-364.

  5. Ng Kee Kwong KC, Mehta PR, Shukla G, Mehta AR. COVID-19, SARS and MERS: a neurological perspective. J Clin Neurosci. 2020;S0967-5868(20)31185-1.

  6. Pesce A, Palmieri M, Armocida D, Frati A, Santoro A. Neurosurgery and Coronavirus (COVID-19) epidemic: doing our Part. Neurosurgery. 2020;87:E48-E49.

  7. Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany. N Engl J Med. 2020;382:970-971.

  8. Hu YJ, Zhang J-min, Chen Z-ping. Experiences of practicing surgical neuro-oncology during the COVID-19 pandemic. J Neurooncol. 2020;148:199-200.

  9. Talke PO, Sharma D, Heyer EJ, Bergese SD, Blackham KA, Stevens RD. Republished: Society for Neuroscience in Anesthesiology and Critical Care expert consensus statement: anesthetic management of endovascular treatment for acute ischemic stroke. Stroke. 2014;45:e138-150.

  10. Flexman AM, Abcejo AS, Avitsian R, De Sloovere V, Highton D, Juul N. Neuroanesthesia practice during the COVID-19 pandemic: Recommendations from Society for Neuroscience in Anesthesiology and Critical Care (SNACC). J Neurosurg Anesthesiol. 2020;32:202-209.

  11. Lippi G, Plebani M, Henry BM. Thrombocytopenia is associated with severe coronavirus disease 2019 (COVID-19) infections: a meta-analysis. Clin Chim Acta. 2020;506:145-148.

  12. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395:1033-1034.

  13. Carrillo-Esper R, Mejía-Terrazas GE, Acosta-Nava VM, Alcántara-Muñoz MRA, Arenas-Venegas AD, Carapia-Sadurni A, et al. Guía de recomendaciones para el manejo perioperatorio de pacientes con infección por SARS-CoV-2 (COVID-19). Rev Mex Anest. 2020;43:182-213.

  14. Ozoner B, Gungor A, Hasanov T, Toktas O, Kilic T. Neurosurgery practice during coronavirus disease 2019 (COVID-19) Pandemic. World Neurosurgery. 2020;140:198-207.

  15. Ti LK, Ang LS, Foong TW, Ng BSW. What we do when a COVID-19 patient needs an operation: operating room preparation and guidance. Can J Anesth. 2020;67:756-758.

  16. Muhammad S, Tanikawa R, Lawton MT, Niemelä M, Hänggi D. Safety instructions for neurosurgeons during COVID-19 pandemic based on recent knowledge and experience. Neurosurgery. 2020;87:E220-E221.

  17. Jenkins A. Letter: transmission of COVID-19 during neurosurgical procedures-some thoughts from the united kingdom. Neurosurgery. 2020,87:E68.

  18. Yu Tung Lo, Neville Wei Yang Teo, Beng Ti Ang. Editorial. Endonasal neurosurgery during the COVID-19 pandemic: the Singapore perspective in: J Neurosurg. 2020;17:1-3.

  19. Grelat M, Pommier B, Portet S, Amelot A, Barrey C, Leroy HA, et al. Patients with coronavirus 2019 (COVID-19) and surgery: guidelines and checklist proposal. World Neurosurg. 2020;139:e769-e773.

  20. Sharma D, Rasmussen M, Han R, Whalin MK, Davis M, Andrew Kofke W. Anesthetic management of endovascular treatment of acute ischemic stroke during COVID-19 pandemic: consensus statement from Society for Neuroscience in Anesthesiology & Critical Care (SNACC) of Neurological Surgeons (CNS) Cerebrovascular Section. J Neurosurg Anesthesiol. 2020;32:193-201.

  21. Osorio-Santiago MA, Leticia González-Villavelázquez M, Obregón-Corona A. Manejo anestésico en terapia endovascular neurológica. Reva Mex Anest. 2012;35:S143-S147.

  22. Schönenberger S, Uhlmann L, Hacke W, Schieber S, Mundiyanapurath S, Purrucker JC, et al. Effect of conscious sedation vs general anesthesia on early neurological improvement among patients with ischemic stroke undergoing endovascular thrombectomy: a randomized clinical trial. JAMA. 2016;316:1986-1996.

  23. Jumaa MA, Zhang F, Ruiz-Ares G, Gelzinis T, Malik AM, Aleu A, et al. Comparison of safety and clinical and radiographic outcomes in endovascular acute stroke therapy for proximal middle cerebral artery occlusion with intubation and general anesthesia versus the nonintubated state. Stroke. 2010;41:1180-1184.

  24. Rowat AM, Dennis MS, Wardlaw JM. Hypoxaemia in acute stroke is frequent and worsens outcome. Cerebrovasc Dis. 2006;21:166-172.

  25. Henninger N, Bouley J, Nelligan JM, Sicard KM, Fisher M. Normobaric hyperoxia delays perfusion/diffusion mismatch evolution, reduces infarct volume, and differentially affects neuronal cell death pathways after suture middle cerebral artery occlusion in rats. J Cereb Blood Flow Metab. 2007;27:1632-1642.

  26. Djurberg HG, Seed RF, Price Evans DA, Brohi FA, Pyper DL, Tjan GT, et al. Lack of effect of CO2 on cerebral arterial diameter in man. J Clin Anesth. 1998;10:646-651.

  27. Solaiman O, Singh JM. Hypocapnia in aneurysmal subarachnoid hemorrhage: Incidence and association with poor clinical outcomes. J Neurosurg Anesthesiol. 2013;25:254-261.

  28. Leonardi-Bee J, Bath PMW, Phillips SJ, Sandercock PAG. Blood pressure and clinical outcomes in the international stroke trial. Stroke. 2002;33:1315-1320.

  29. Van der Jagt M. Fluid management of the neurological patient: a concise review. Crit Care. 2016;20:126.

  30. Kirkman MA, Citerio G, Smith M. The intensive care management of acute ischemic stroke: an overview. Intensive Care Med. 2014;40:640-653.

  31. Kase CS, Furlan AJ, Wechsler LR, Higashida RT, Rowley HA, Hart RG, et al. Cerebral hemorrhage after intra-arterial thrombolysis for ischemic stroke: The PROACT II trial. Neurology. 2001;57:1603-1610.

  32. Nukui S, Akiyama H, Soga K, Takao N, Tsuchihashi Y, Iijima N, et al. Risk of hyperglycemia and hypoglycemia in patients with acute ischemic stroke based on continuous glucose monitoring. J Stroke Cerebrovasc Dis. 2019;28:104346.

  33. Gray CS, Hildreth AJ, Sandercock PA, O’Connell JE, Johnston DE, Cartlidge NEF. Articles glucose-potassium-insulin infusions in the management of post-stroke hyperglycaemia: the UK glucose insulin in stroke trial (GIST-UK). Lancet Neurol. 2007;6:P397-406.

  34. Akpinar SH, Yilmaz G. Periprocedural complications in endovascular stroke treatment. Br J Radiol. 2016;89:20150267.

  35. Gill HL, Siracuse JJ, Parrack IK, Huang ZS, Meltzer AJ. Complications of the endovascular management of acute ischemic stroke. Vasc Health Risk Manag. 2014;10:675-681.

  36. Elakkad A, Drocton G, Hui F. Endovascular stroke interventions: procedural complications and management. Semin Intervent Radiol. 2020;37:199-200.

  37. Chen P, Xiong X-H, Chen Y, Wang K, Zhang Q-T, Zhou W. Perioperative management strategy of severe traumatic brain injury during the outbreak of COVID-19 Perioperative management strategy of severe traumatic brain injury during the outbreak of COVID-19. Chinese J Traumatol. 2020. In Press. Journal Pre Proof.

  38. Sibert KS, Long JL, Haddy SM. Extubation and the risks of coughing and laryngospasm in the era of coronavirus disease-19 (COVID-19). 2020;12:e8196.

  39. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ. 2020;26:368.




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