Научная статья
в журнале «Anaesthesia 2021»
в журнале «Anaesthesia 2021»
Recommendations for standards of monitoring during
anaesthesia and recovery 2021
anaesthesia and recovery 2021
Guideline fromthe Association of Anaesthetists
This guideline updates and replaces the 5th edition of the Standards of Monitoring published in 2015. The aim of this document is to provide guidance on the minimum standards for monitoring of any patient undergoing anaesthesia or sedation under the care of an anaesthetist. The recommendations are primarily aimed at anaesthetists practising in the UK and Ireland, but it is recognised that these guidelines may also be of use in other areas of the world. Minimum standards for monitoring patients during anaesthesia and in the recovery phase are included. There is also guidance on monitoring patients undergoing sedation and during transfer.
There are new sections specifically discussing capnography, sedation and regional anaesthesia. In addition, the indications for processed electroencephalogram and neuromuscular monitoring have been updated.
There are new sections specifically discussing capnography, sedation and regional anaesthesia. In addition, the indications for processed electroencephalogram and neuromuscular monitoring have been updated.
Дата публикации: 14 июля 2021
Effects of pre-operative isolation on postoperative
pulmonary complications after elective surgery:
an international prospective cohort study
pulmonary complications after elective surgery:
an international prospective cohort study
We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after
elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort
study including patients undergoing elective surgery in October 2020. Isolation was defined as the period
before surgery during which patients did not leave their house or receive visitors from outside their household.
elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort
study including patients undergoing elective surgery in October 2020. Isolation was defined as the period
before surgery during which patients did not leave their house or receive visitors from outside their household.
The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04– 1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively.
Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications.
Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.
Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.
#SARS-Cov-2; #COVID-19; #surgery; #pathways; #pre-operative isolation
