Importance of Regional Anaesthesia in COVID Times

Till a few months back, you might have heard the job title “Anaesthetist” and most of you would have said “ they put people to sleep for surgeries” am I right?

But today, many in the whole world immediately say “Hero”. An anaesthetist became the front line warriors in the COVID times for a dangerous job. 

Dangerous because General Anaesthesia (GA) involves putting a tube inside your breathing pipe (intubation) and reverse (extubation) process at the end to take control of your ventilation to undergo surgery and for the ventilator requirement as life support in ICU (intensive care unit) during critical illness. 

Ventilators are important life-saving equipment for critical corona patients. This procedure exposes anaesthetist to corona infected patients due to a large amount of aerosol generated with high viral load.

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.

Apart from General Anaesthesia (GA), another technique as an option by an Anaesthetist for the patient undergoing surgery is Regional Anaesthesia (RA), where a part of your body is anaesthetised so that it is completely numb and surgery can be performed without a need for GA.

At times the option is not available to the patient to choose between general and regional anaesthesia and your anaesthetist can only suggest and decide the best option for you for a particular surgery. But wherever feasible the time now is to prefer regional anaesthesia. Now, get the best Anesthesiology treatment from the Top Anesthesiology Hospital in Delhi - Manipal hospitals. 

Regional anaesthesia does not require breathing control so causes less exposure to the anaesthetist and the staff deployed in OT (Operation Theatre) in case the patient is positive. 

As a patient-centric approach i.e given patient safety prime importance, regional anaesthesia should be preferred wherever feasible and with the advent of technology like ultrasound machines, the role of regional anaesthesia is gaining popularity by increasing success with safety. 

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. 

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.

Also, a nerve block to control the pain during and after surgery can reduce the use of strong pain killer (opioids) medicines which can also have detrimental effects on breathing especially in corona patients with the advantage of even less nausea and vomiting.

Pain control after surgery is best done with Peripheral Nerve Blocks (part of regional anaesthesia techniques) mostly not requiring strong painkillers. Duration of effect can be managed from a few hours to even a few days with some variation in efficacy.

Studies have shown that the risk of exposure to coronavirus during GA is 6 to 7 times higher in healthcare workers than during RA. So undoubtedly it is good for both patients and healthcare workers

Even the use of ultrasound should be promoted in the anaesthesia department not only for increasing the success and safety of regional anaesthesia but also as a POCUS (Point Of Care Ultrasound).

Rapid brief assessment of a patient's lung, heart and many other vital parameters can be done inside OT and ICU (intensive care unit) by the anaesthetist (POCUS) which can be of significant contribution to a treatment plan improving the outcome.

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.

Consult the Best Anesthesiologist in Delhi or visit the Best Anesthesia Specialist Hospital & Doctor In Delhi at Manipal hospitals. 

Dr Sunil Malik

Consultant - Anaesthetist and Head - Urology and Renal Transplant Anaesthesia

Manipal Hospitals - Dwarka - Delhi

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