Restarting Elective Bariatric and Metabolic Surgery Under a Security Protocol During the COVID-19 Pandemic-a Prospective Observational Cohort Study.

BACKGROUND: During the SARS-CoV-2 pandemic, in order to protect the patient and to save hospital beds, cancelation of elective surgeries has become a great challenge. Considering that obesity is a chronic disease and the possible effect imposed by quarantine on weight gain with worsening rates of obesity and metabolic comorbidities, the creation of a protocol for a safe return to bariatric surgery became essential. OBJECTIVE: The aim of this study was to identify the incidence of new-onset severe acute respiratory syndrome coronavirus (SARS-CoV-2) symptoms in patients who underwent bariatric procedures during the declining curve period. SETTING: Private practice METHODS: A prospective observational cohort study was conducted and included patients with indications for bariatric surgery during the decreasing curve period of the SARS-CoV-2 pandemic who underwent surgery under a hospital security protocol. Patients were asked to answer a questionnaire and had a swab PCR test for SARS-CoV-2 detection. The primary outcome measure was the presence of 14-day and 30-day postoperative symptoms associated with COVID-19. Mortality was also analyzed. RESULTS: Three hundred patients with negative RT-PCR were operated on from May to June 2020. Seventeen patients had their surgery postponed because of a positive RT-PCR test or close contact. None of the patients developed new-onset SARS-CoV-2 symptomatic infection after 30 days of observation. No deaths were reported. Eleven had complications not related to SARS-CoV-2. CONCLUSIONS: Even though this population may have a poorer outcome when infected with SARS-CoV-2, this security protocol has shown that the procedure can be safely performed during the outbreak.

Variaçöes do pH e da PaCO2 na veia jugular interna durante: circulaçäo extracorpórea, hipotermia profunda (18-20oC) e clampeamento dos vasos arteriais braquiocefálicos: estudo experimental em cäes / Alterations in the pH and PaCO2 of internal jugular vein during cardiopulmonary bypass, deep hypothermia (18-20oC) and arterial brachial-encephalic clamping

Este trabalho visa avaliar as alteraçöes do pH e da PaCO2 do retorno venoso cerebral durante circulaçäo extracorpórea (CEC) e hipotermia profunda (20oC) em cäes, a fim de avaliar indiretamente o grau de risco de dano cerebral metabólico que pode ocorrer em procedimentos cirúrgicos do arco aórtico. Nessas cirurgias a circulaçäo cerebral encontra-se excluída da CEC através do clampeamento arterial necessário para efetuar o procedimento, enquanto o restante do organismo permanece perfundido (60 kg/min), visando conferir proteçäo aos tecidos miocárdico e renal, medula espinhal e outros. Um grupo de 15 cäes mestiços foi submetido a clampeamento dos vasos supra-aórticos (tronco arterial braquiocefálico, carótida e subclávia esquerdas) durante CEC e hipotermia profunda (18-20oC), sendo colhidas amostras sanguíneas de 15 em 15 min, a partir da veia jugular interna canalizada em direçäo cefálica. Os dados obtidos mostraram uma queda acentuada de pH e uma aumento da PaCO2 a partir de 45 min de clampeamento, levando à conclusäo de que, quando o período de clampeamento arterial dos vasos supra-aórticos excede 45 min, ocorrem alteraçöes metabólicas importantes no retorno venoso cerebral, que podem causar algum dano neurológico