Authors (including presenting author) :
Leung ASM 1(), Lam VWS (1), Li MCK (1), Chu HM (1)
Affiliation :
Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital
Introduction :
During COVID-19 pandemic, there were modifications in anaesthetic practices to minimize viral transmission in the operating theatre (OT) in aerosol generating procedures. These include: 1. Use of rapid sequence induction (RSI) for intubation 2. Full PPE during airway manipulation 3. Avoidance laryngeal mask airways (LMA) 4. Use of video laryngoscope to minimize intubation attempts 5. Adopt regional anaesthesia whenever possible. Modifications 1-4 might increase recovery time due to deep neuromuscular blockade and extra time to don and doff PPE.
Objectives :
The primary objective was to assess if the modified anaesthetic practices increased recovery time. Secondary outcomes include prevalence of RSI and choice of airway management in general anaesthesia (GA).
Methodology :
A retrospective audit of GA cases in August 2020 was done. Cases were compared to those in the same period in 2019. Demographic data, choice of airway management, nature of surgery (cancer versus non-cancer) and recovery time were retrieved from anaesthetic record. The data was analyzed with descriptive statistics and Mann-Whitney U test.
Result & Outcome :
A total of 351 and 205 GA cases were identified from 2019 and 2020 respectively. The drop in the number of GA cases in 2020 was possibly due to incomplete resumption of OT services after COVID case surge and a shift towards regional anaesthesia. There was a difference in mean age (58 in 2019; 60.5 in 2020, p<0.007). More surgeries were cancer related in 2020, (19% in 2019; 48% in 2020, p<0.01). These showed elderly and semi-urgent cancer surgeries were prioritized in operating theatre utilization. For airway management, there was a 9% drop in use of direct laryngoscopy, a 45% increase in use of video laryngoscopy and a 7% drop in use of LMA from 2019 to 2020 (p<0.01). This demonstrated an overall lower threshold to intubate to avoid PPV in non-secured airway. RSI also increased from 9% in 2019 to 95% in 2020 (p<0.01) for the same reason. The liberal use of video laryngoscope aimed to minimize intubation attempts. These increased the demand and costs for single-use airway consumables. The mean recovery time increased from 10 minutes in 2019 to 12 minutes in 2020 (p<0.001). The change in practices and increased recovery time should be taken into account when planning elective lists in future epidemic waves.
