Session Title: Perioperative Management of Patients with SARS-CoV-2

Series Gap:

Members of the department of Anesthesia benefit from structured and regular review of literature and professional guidelines for patient care and management. Such examples include: updates in national guidelines for anticoagulation for regional and neuraxial anesthesia and updates in the perioperative surgical home. In addition, unique to our department is the rare use of critically important emergency drugs, protocols and equipment, which, because of their importance and rare use, need to be reviewed periodically by ALL members of the department. Educational topics are selected each month that provide current information that is relevant to our practice here and have high potential to improve patient care. 

Continual improvement and an evidence-based approach to the practice of anesthesia, with an emphasis on patient safety, improved patient outcomes, reduction in anesthetic complications, crisis management, and proper use of new pharmacologic agents and techniques with special attention to non-opioid modalities of pain management.

Session Gap:

SARS-CoV-2 has caused a global pandemic, resulting in many disruptions across many different industries. For medical providers, there are a number of factors to consider when caring for a patient with SARS-CoV-2. This lecture will review the current understanding and recommendations regarding the perioperative management of patients with SARS-CoV-2.

Target Audience:

Anesthesiologists, CRNA's, and infrequent sub-specialists when appropriate to enhance educational impact

Series Objectives: 

1. Apply the pharmacokinetics/dynamics of new medications in the practice of anesthesia, with an emphasis on providing opioid free anesthesia.

2. Be aware of any updates within the national anesthesia guidelines, such as the American Society of Anesthesiologist and American Society of Regional Anesthesia.

3. Incorporate new techniques such as point of care ultrasound, PECs blocks, etc into everyday practice.

4. Communicate in a more culturally sensitive manner to help improve patient care experience.

Session Objectives:

• To illustrate the pathogenesis of SARS-CoV-2
• To review the pathophysiology of ARDS
• To explain the management of ARDS in the ICU and its translation to care in the operating room
• To review the fundamentals of perioperative infection control, with an emphasis on infection control related to SARS-CoV-2

Series Cultural and Linguistic Competency:

Transgender patients deserve the same high quality care we provide for all patients. However, this patient population faces discrimination quite frequently. Often this discrimination may be unintentional, so we hope to provide the proper training to staff to recognize their implicit biases and improve communication with transgender patients.

Session Cultural and Linguistic Competency:

COVID-19 and its effects, including ARDS, have disproportionately affected elderly patients and patients with lower socio-economic status. By reviewing the pathophysiology and current treatment recommendations for SARS-CoV-2, we aim to provide staff with the proper training to improve the quality of patient care, particularly for patients who are elderly and for those with lower socio-economic status.

Speaker:

• Chris Webb, MD

Series References:

KP Guidelines, American Society of Anesthesiologist, Surgical Journals
References:

• http://journals.lww.com/anesthesia-analgesia/pages/default.aspx
• http://anesthesiology.pubs.asahq.org/journal.aspx
• https://www.asahq.org/
• https://jamanetwork.com/journals/jamasurgery

Session References:

• ARDSNET. ARDSNET.ORG. http://www.ardsnet.org/. Accessed April 24th, 2020 2020.
• Birnbach DJ, Rosen LF, Fitzpatrick M, Carling P, Arheart KL, Munoz-Price LS. Double gloves: a randomized trial to evaluate a simple strategy to reduce contamination in the operating room. Anesth Analg. 2015;120(4):848-852.
• Birnbach DJ, Rosen LF, Fitzpatrick M, Carling P, Arheart KL, Munoz-Price LS. A New Approach to Pathogen Containment in the Operating Room: Sheathing the Laryngoscope After Intubation. Anesth Analg. 2015;121(5):1209-1214.
• Birnbach DJ, Rosen LF, Fitzpatrick M, Carling P, Munoz-Price LS. The use of a novel technology to study dynamics of pathogen transmission in the operating room. Anesth Analg. 2015;120(4):844-847
• Birnbch RPaD. HCA-Infections: Can the Anesthesia Provider be at Fault? APSF. https://www.apsf.org/article/hca-infections-can-the-anesthesia-provider-be-at-fault/. Published 2018. Accessed April 28th, 2020 2020.
• Canelli R, Connor CW, Gonzalez M, Nozari A, Ortega R. Barrier Enclosure during Endotracheal Intubation. N Engl J Med. 2020.
• Dexter F, Parra MC, Brown JR, Loftus RW. Perioperative COVID-19 Defense: An Evidence-Based Approach for Optimization of Infection Control and Operating Room Management. Anesth Analg. 2020.
• Gargiulo DA, Mitchell SJ, Sheridan J, et al. Microbiological Contamination of Drugs during Their Administration for Anesthesia in the Operating Room. Anesthesiology. 2016;124(4):785-794.
• Greenland JR, Michelow MD, Wang L, London MJ. COVID-19 Infection: Implications for Perioperative and Critical Care Physicians. Anesthesiology. 2020.
• Guo YR, Cao QD, Hong ZS, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res. 2020;7(1):11.
• Hirano T, Murakami M. COVID-19: A New Virus, but a Familiar Receptor and Cytokine Release Syndrome. Immunity. 2020.
• Hopf HW. Bacterial reservoirs in the operating room. Anesth Analg. 2015;120(4):700-702.
• Loftus RW, Brown JR, Koff MD, et al. Multiple reservoirs contribute to intraoperative bacterial transmission. Anesth Analg. 2012;114(6):1236-1248.
• Loftus RW, Dexter F, Parra MC, Brown JR. Importance of oral and nasal decontamination for patients undergoing anesthetics during the COVID-19 era. Anesth Analg. 2020.
• Loftus RW, Muffly MK, Brown JR, et al. Hand contamination of anesthesia providers is an important risk factor for intraoperative bacterial transmission. Anesth Analg. 2011;112(1):98-105.
• Munoz-Price LS, Weinstein RA. Fecal patina in the anesthesia work area. Anesth Analg. 2015;120(4):703-705.
• NIH. NIH COVID-19 Treatment Guidelines https://covid19treatmentguidelines.nih.gov/introduction/. Published 2020. Accessed April 28, 2020 2020.
• Pierce RJ, Hillman D, Young IH, et al. Respiratory function tests and their application. Respirology. 2005;10 Suppl 2:S1-19.
• Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth. 2020;67(5):568-576
• Verdecchia P, Cavallini C, Spanevello A, Angeli F. The pivotal link between ACE2 deficiency and SARS-CoV-2 infection. Eur J Intern Med. 2020.
•  Guo J, Huang Z, Lin L, Lv J. Coronavirus Disease 2019 (COVID-19) and Cardiovascular Disease: A Viewpoint on the Potential Influence of Angiotensin-Converting Enzyme Inhibitors/Angiotensin Receptor Blockers on Onset and Severity of Severe Acute Respiratory Syndrome Coronavirus 2 Infection. J Am Heart Assoc. 2020;9(7):e016219.
•  Jean-Louis Vincent EA, Frederick A Moore, Patrick M. Kochanek, Mitchell P. Fink. Textbook of Critical Care 7ed. Philadelphia, PA, USA Elsevier inc; 2017.
•  Gracia MMd. Imaging the coronavirus disease COVID-19. https://healthcare-in-europe.com/en/news/imaging-the-coronavirus-disease-covid-19.html. Published 2020. Accessed April 24th, 2020 2020.
• Atul Malhotra MMK, PhD, RRT. Prone ventilation for adult patients with acute respiratory distress syndrome. In: Geraldine Finlay M, ed. UpToDate. UpToDate, Waltham, MA (Accessed on April 24th, 2020: UpToDate; 2020.
• Guzik TJ, Mohiddin SA, Dimarco A, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovasc Res. 2020

Disclosure: 

Chris Moore, CRNA, has disclosed that he receives salary, incentive, and stocks from Genentech for his spouse's role as an employee. Upon thorough review of all persons in a position to control content including; collection of disclosure information, our policy for Mechanisms to Identify and Resolve Conflicts of Interest, and faculty centered review, Kaiser Permanente South San Francisco has determined that the speakers and the planning committee for this activity do not have any relevant financial relationships and that Mr. Moore's disclosed relationship has been resolved. Mr. Moore has agreed not to mention any products from his respective relationship during this Series. Additionally, Mr. Moore will recuse himself from commenting at all during a Kaiser Permanente South San Francisco CME activity when other discussants may discuss products from Genentech, at which time the CME Planners, Dr. Paul Weyker and Dr. Edward Yap, will ensure balanced therapeutic options are discussed. 

The regular presenters and program planners of this case conference have disclosed that they have no relevant financial relationships with commercial interest (s). The CME Department has reviewed their disclosure information for the planner(s) and/or committee / faculty or this program and they do not have relationships that present a relevant financial conflict of interest.

Kaiser Permanente South San Francisco takes responsibility for the content, quality, and scientific integrity of this CME Activity.

Kaiser Permanente does not endorse any brand-name products.

Accreditation Statement:

Kaiser Permanente South San Francisco Medical Center is accredited by the California Medical Association (CMA) to provide continuing medical education for physicians.

Credit Statement:

The Kaiser Permanente South San Francisco Medical Center designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Nurses may report up to a maximum total of 1.0 AMA PRA Category 1 Credit(s)™ towards the Continuing Medical Education requirements for license renewal by the California Board of Registered Nurses.