An analysis of emergency surgery on coronavirus disease positive patients and their outcomes during the coronavirus pandemic: A retrospective observational study.

Background: The primary objective of this study was to determine the outcome of emergency surgery in coronavirus disease 2019 (COVID-19) patients with regard to presently existing physical status, and highlight its subspecialty distribution. Methods: This retrospective observational study was done on all patients who underwent emergency surgery between March 2020 and Dec 2021 and were positive for COVID-19. Data collection included the age of the patients, gender, diagnosis, the type of surgery performed, and outcome. Physical status was assessed, as per Modified Medical Research Council Dyspnoea Scale (MMRC) and Metabolic Equivalent Scale (METS). Results: A total of 89 patients were analyzed from March 2020 to Dec 2021. There were 63 females and 26 males. The average age of the males was 53.8 ± 8.9 years and the average age of the females was 29.1 ± 4.6 years. The maximum number of surgeries done was lower segment cesarean section (57.3%). 55 out of 60 (91%) cases had a good grade on the MMRC scale (Grade 0 and 1). 3 patients had Grade 4 MMRC scale and all 3 were oncology cases. As per the METS scale, 56/60 (93.3%) patients had METS >10. Conclusion: This study has demonstrated that 55 out of 60 (91%) of cases had a good grade on the MMRC scale (Grade 0 and 1) 6 months to 1-year post-surgery. As per the METS scale, 56/60 (93.3%) patients had METS >10. Most of the cases were asymptomatic COVID-19-positive and presently have good physical status as determined by the study.

Device-Associated Healthcare-Associated Infections (DA-HAI) and the caveat of multiresistance in a multidisciplinary intensive care unit.

BACKGROUND: Device-Associated Healthcare-Associated Infections (DA-HAI), including Ventilator-Associated Pneumonia (VAP), Central-Line-Associated Blood Stream Infection (CLABSI), and Catheter-Related Urinary Tract Infection (CAUTI), are considered as principal contributors to healthcare hazard and threat to patient safety as they can cause prolonged hospital stay, sepsis, and mortality in the ICU. The study intends to characterize DA-HAI in a tertiary care multidisciplinary ICU of a teaching hospital in eastern India. METHODS: This prospective outcome-surveillance study was conducted among 2157 ICU patients of a 760-bedded teaching hospital in Eastern India. Clinical, laboratory and environmental surveillance, and screening of HCPs were conducted using the US Centers for Disease Control and Prevention (CDC)'s National Healthcare Safety Network (NHSN) definitions and methods. RESULTS: With 8824 patient/bed/ICU days and 14,676 device days, pooled average device utilization ratio was 1.66, total episodes of DA-HAI were 114, and mean monthly rates of DA-HAI, VAP, CLABSI, and CAUTI were 4.75, 2, 1.4, and 1.25/1000 device days. Most common pathogens isolated from DA-HAI patients were Klebsiella pneumoniae (24.6%), Escherichia coli (21.9%), and Pseudomonas aeruginosa (20.2%). All Acinetobacter baumanii, >80% K. pneumoniae and E. coli, and >70% P. aeruginosa were susceptible only to colistin and tigecycline. One P. aeruginosa isolate was panresistant. CONCLUSION: Mean rates of VAP, CLABSI, and CAUTI were 14.4, 8.1, and 4.5 per 1000 device days, which are comparable with Indian and global ICUs. Patients and HCPs form important reservoirs of infection. Resolute conviction and sustained momentum in Infection Control Initiatives are an essential step toward patient safety.

A novel approach to airway management in Pierre Robin syndrome-a case report.

Pierre Robin syndrome (PRS) neonates are one of the most difficult cases to intubate even for an experienced paediatric anaesthesiologist. We describe a case of a PRS-related anatomical anomaly that hindered attempts to manage the airway and the final approach that made it possible to insert an endotracheal tube (ETT). We describe the novel use of a video ureteroscope (Olympus URF-V2) as an airway endoscope. A 7-day-old, 2-kg boy was referred to our tertiary care hospital with diagnosed PRS. He was planned for correction of the mandible with mandibular distraction osteogenesis under general anaesthesia. Fibreoptic scope (Olympus, Japan) revealed the epiglottis lying on the posterior pharynx, which could not be manoeuvred. Due to repeated attempts, the patient developed laryngospasm, and his pulse arterial oxygen saturation (SpO2) was reduced to 70%. Following jaw thrust and slight pulling of the tongue with Magill's Forceps, a 150-cm long and 0.035-inch diameter atraumatic, Roadrunner® hydrophilic polyurethane-coated guidewire was introduced through the working channel of the video ureteroscope into the trachea under the vision (and a 3.5-mm ID ETT was railroaded over it and a definitive airway was established). A flexible fibreoptic ureteroscope may be useful in the management of a difficult airway and may become an important tool in the armoury of an anaesthesiologist. At our institute, which is a tertiary care centre, we are now training and utilising video-ureteroscope as an airway endoscope. To our knowledge, there is no documentary evidence of the use of a video ureteroscope for difficult airway management of a neonate.

Novel use of flexible video ureteroscope in airway management: A case series.

Fibreoptic bronchoscopes are vital for difficult airway management. However, many a times, it is not available. Also, the correct size may not be available, especially for use in paediatrics and neonates. We describe the use of a flexible fibreoptic video ureteroscope, as an alternative to a bronchoscope, for airway management. We include five cases of airway management using a 2.8 mm fibreoptic video ureteroscope. The use of a flexible video ureteroscope was successful in all the five cases, and all the patients tolerated the procedure well. No complications were encountered. We conclude that a video ureteroscope can be used for both elective and rescue airway management in small children as well as in adult patients.