Case Report: Anesthesia for a Neonate With Cutis Aplasia.

Cutis aplasia is a rare condition characterized by skin and subcutaneous tissue defects. Researchers have previously described both conservative and surgical management methods. We report herein the case of a neonate with extensive cutis aplasia involving 37% of the total body surface area. Due to the risk of meningitis and catastrophic hemorrhage associated with scalp defects, she underwent staged surgical procedures with skin harvesting and synthetic skin application, followed by the application of cultured epithelial autografts. This report highlights the challenges in temperature and fluid management as well as intraoperative positioning in a neonate with cutis aplasia.

Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic.

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.

RéSUMé: 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.

Production pressures among anaesthesiologists in Singapore.

INTRODUCTION: Production pressure is the pressure on personnel to prioritise production ahead of safety. We assessed the prevalence of production pressures among anaesthesiologists in Singapore. METHODS: A random online survey was conducted among local anaesthesiologists. Questions were asked about attitudes to production pressures in the work environment, occurrence of situations involving unsafe actions, and rating of the intensity of external and internal sources of pressure. RESULTS: Demographically, our respondents were largely similar to all anaesthesiologists in Singapore and were fairly distributed across various tertiary hospitals. Nearly half (44.5%) had witnessed production pressures, with a colleague pressured to conduct anaesthesia in an unsafe manner. Such events included pressure from surgeons to proceed for elective surgery in patients without adequate optimisation, pressure to employ anaesthetic techniques that surgeons wanted, having to source for operating rooms to finish the surgeon's list, and being misled regarding surgical time. Over half (52.3%) made errors in clinical judgement due to excess workload. A heavy elective list workload was significantly associated with proceeding with patients despite lack of appropriate support, making changes to practices to avoid delaying the start of surgery and sourcing for operating rooms to finish the surgeon's list (p < 0.05), and being pressured to proceed with patients that the anaesthesiologist would otherwise have cancelled (p < 0.01). The need to avoid delaying the start of surgery and reduce turnover time between patients were the top-ranked internal and external pressures, respectively. CONCLUSION: Production pressure is prevalent among anaesthesiologists in Singapore and is correlated with a heavy workload.