The Invisible Part of The Iceberg in Covid-19 Pandemic: Asymptomatic Cases and Anesthesiologists’ Protective Approaches-Knowledge Levels
Öz
Introduction: According to studies asymptomatic COVID-19 cases are thought to be quite high in the community. Their exact number is unknown. Considering that there are false negative results in PCR tests, it should always be considered that all asymptomatic patients may also be COVID-19 positive. We aimed to evaluate the protective and preventive approaches, knowledge levels and technical facilities of anesthesiologists in the perioperative process, after recognizing the COVID-19 alarm symptoms as much as possible and isolating the suspected cases during the pandemic.
Methods: A survey form was prepared to evaluate the awareness of anesthesiologists about asymptomatic cases, their protective-preventive approaches, knowledge levels and technical facilities. The form was created online, with the aim of reaching more participants. The survey form was sent to the participants via e-mail and WhatsApp. Those who did not fill more than 90% of the survey questions were excluded from the study.
Results: According to our study within 100 participants, 95 participants indicated that they question their patients regarding presence of COVID-19-related symptoms and contact history; 86 participants indicated that they evaluate presence of lymphopenia; 78 participants indicated they evaluate CRP levels; 76 participants indicated that they evaluate chest radiography findings; 75 participants indicated evaluation of D-Dimer levels; 74 participants indicated evaluation of ferritin values and 73 participants indicated evaluation of thorax CT findings for a correlation with COVID-19.
Conclusion: The current tests for SARS-CoV-2 are not sensitive enough to rule out the possibility of asymptomatic carriers entering the operating room. It is important to keep in mind the steps that include detecting the patients with high risk of infection even if their PCR tests are negative.
Anahtar Kelimeler
Kaynakça
- 1. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–42. https://dx.doi.org/10.1001/jama.2020.2648
- 2. WHO. Novel coronavirus (COVID-19) situation. WorldHealthOrganization, 2020. Available from: https://who.sprinklr.com/ (Accessed 10 January 2021)
- 3. T.C. Sağlık Bakanlığı. COVID-19 Bilgilendirme Sayfası. Available from: https://covid19.saglik.gov.tr/TR-66935/genel-koronavirus-tablosu.html# (Accessed 10 January 2021)
- 4. Li W, Su YY, Zhi SS, et al. Virus shedding dynamics in asymptomatic and mildly symptomatic patients infected with SARS-CoV-2. Clin Microbiol Infect. 2020 Nov;26(11):1556.e1-1556.e6. https://dx.doi.org/10.1016/j.cmi.2020.07.008
- 5. Öcal D, Vezir S, Karahan Z.C. Mikrobiyolojik Tanı Yöntemleri. Ankara Üniversitesi Tıp Fakültesi COVID-19 Kitabı. 2020; Bölüm 3; S:20.
- 6. Çınar G, Birengel MS. Genel Klinik Özellikler. Ankara Üniversitesi Tıp Fakültesi COVID-19 Kitabı. 2020; Bölüm 6; S:43.
- 7. Uppal V, Sondekoppam RV, Landau R, et al. Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations. Anaesthesia. 2020 Oct;75(10):1350-63. https://dx.doi.org/10.1111/anae.15105
- 8. Anderson EL, Turnham P, Griffin JR, et al. Consideration of the Aerosol Transmission for COVID-19 and Public Health. Risk Anal. 2020 May;40(5):902-7. https://dx.doi.org/2010.1111/risa.13500
- 9. Wilson NM, Norton A, Young FP, et al. Airborne transmission of severe acute respiratory syndrome coronavirus-2 to healthcare workers: a narrative review. Anaesthesia. 2020 Aug;75(8):1086-95. https://dx.doi.org/10.1111/anae.15093
- 10. Obara S. Anesthesiologist behavior and anesthesia machine use in the operating room during the COVID-19 pandemic: awareness and changes to cope with the risk of infection transmission. J Anesth. 2020 Aug 27:1–5. https://dx.doi.org/10.1007/s00540-020-02846-z
- 11. Vigneshwar, N.G., Krause, M. & Bartels, K. Positive tracheal SARS-CoV-2 RNA test after three negative SARS-CoV-2 RNA tests in a patient with COVID-19. Can J Anesth/J Can Anesth 2020;67:1663–64. https://doi.org/10.1007/s12630-020-01742-0
- 12.Pascarella G, Strumia A, Piliego C, et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med. 2020;288(2):192-206. https://dx.doi.org/10.1111/joim.13091
- 13.Williams E, Bond K, Zhang B, et al. Saliva as a Noninvasive Specimen for Detection of SARS-CoV-2. J Clin Microbiol. 2020;23;58(8):e00776-20. https://dx.doi.org/10.1128/JCM.00776-20
- 14.American Society of Anesthesiologists. The ASA and APSF Joint Statement on Perioperative Testing for the COVID-19 Virus. Available from: https://www.asahq.org/about-asa/newsroom/news-releases/2020/04/asa-and-apsf-joint-statement-on-perioperative-testing-for-the-covid-19-virus (accessed May 2020)
- 15.Pourbagheri-Sigaroodi A, Bashash D, Fateh F, et al. Laboratory findings in COVID-19 diagnosis and prognosis. Clin Chim Acta. 2020;510:475-82. https://dx.doi.org/10.1016/j.cca.2020.08.019
- 16.T.C Sağlık Bakanlığı Halk Sağlığı Müdürlüğü Covid-19. SARS -CoV-2 Enfeksiyonu Rehberi. https://covid19.saglik.gov.tr/Eklenti/39061/0/covid19rehberieriskinhastatedavisipdf.pdf (acsessed Oct. 2020)
- 17.Gündüz Y, Öztürk MH, Tomak Y. The usual course of Thorax CT findings of Covid-19 infection and When should control Thorax CT scan? Turk J Med Sci. 2020 Apr 30;50(4):684–6. https://dx.doi.org/10.3906/sag-2004-293
- 18.World Health Organization. (2020). Rational use of personal protective equipment for coronavirus disease (COVID-19): interim guidance, 27 February 2020 (No. WHO/2019-nCov/IPCPPE_use/2020.1). World Health Organization.
- 19.Türe H, Çelebi Ş, Aytaç E, et al. COVID-19 Tanılı ya da Şüpheli Hastaların Preoperatif Hazırlığı ve Ameliyathane Yöne-timi. JARSS. 2020;28(3):137-49. https://dx.doi.org/10.5222/jarss.2020.70299
- 20.Wong J, Goh QY, Tan Z, et al Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth. 2020 Jun;67(6):732-45. https://dx.doi.org/10.1007/s12630-020-01620-9
- 21.Tan L, Kovoor JG, Williamson P, et al. Personal protective equipment and evidence-based advice for surgical departments during COVID-19. ANZ J Surg. 2020;90(9):1566-72. https://dx.doi.org/10.1111/ans.16194
- 22.Hall D, Steel A, Heij R, et al. Videolaryngoscopy increases ‘mouth‐to‐mouth’ distance compared with direct laryngoscopy. Anaesthesia.2020;75:822823. https://doi.org/10.1111/anae.15047
- 23.Ong S, Lim WY, Ong J, et al. Anesthesia guidelines for COVID-19 patients: a narrative review and appraisal. Korean J Anesthesiol. 2020 Dec;73(6):486-502. https://dx.doi.org/10.4097/kja.20354
- 24.Bevilacqua S, Bottari V, Galeotti I. Systematic Application of Rapid Sequence Intubation With Remifentanil During COVID-19 Pandemic. Semin Cardiothorac Vasc Anesth. 2020 Jul 15:1089253220941369. https://dx.doi.org/10.1177/1089253220941369
- 25.Neal JM, Bernards CM, Hadzic A, et al. ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med. 2008;33(5):404-15. https://dx.doi.org/10.1016/j.rapm.2008.07.527
- 26.Lie SA, Wong SW, Wong LT, et al. Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic. Can J Anaesth. 2020 Jul;67(7):885-92. https://dx.doi.org/10.1007/s12630-020-01637-0
- 27.Brown NW, Parsons AP, Kam PC. Anaesthetic considerations in a parturient with varicella presenting for Caesarean section. Anaesthesia. 2003;58(11):1092-5. https://dx.doi.org/10.1046/j.1365-2044.2003.03442.x
- 28.Tang G, Chan AKM. Perioperative management of suspected/ confirmed cases of COVID-19. Availablefrom: https://www.wfsahq.org/components/com_virtual_library/media/1c4ec5c64b9aaacf7c47f76a61fb6edc-atow-422-01.pdf
- 29.Jain A, Bhardwaj N, Yaddanapudi S. What a pediatric anesthesiologist should know about COVID-19. J Anaesthesiol Clin Pharmacol. 2020;36(Suppl1):S85-S91. https://dx.doi.org/10.4103/joacp.JOACP_237_20
COVID19 Pandemisinde Buzdağının Bilinmeyen Tarafı: Asemptomatik Vakalar ve Anestezistlerin Koruyucu Yaklaşımları-Bilgi Düzeyleri
Öz
Giriş: Çalışmalara göre, toplumda asemptomatik COVID-19 vakalarının oldukça yaygın olduğu düşünülmektedir. Kesin sayıları bilinmemektedir. PCR testlerinde yanlış negatif sonuçlar olduğu göz önüne alındığında, tüm asemptomatik hastaların da pozitif olabileceği dikkate alınmalıdır. Bu çalışmada, COVID-19 alarm semptomlarını mümkün olduğunca tanıdıktan ve pandemi sırasında şüpheli vakaları izole ettikten sonra, perioperatif süreçte anestezistlerin koruyucu ve önleyici yaklaşımlarını, bilgi seviyelerini ve teknik olanaklarını değerlendirmeyi amaçladık.
Materyal ve Metot: Bu çalışma vaka: COVID-19 pandemisinde anestezistlerin asemptomatik vakalara dair farkındalığını, pandemide koruyucu-önleyici yaklaşımları, bilgi düzeylerini ve teknik olanaklarını değerlendiren anket formu hazırlandı. Anket formu online olarak düzenlenip daha fazla katılımcıya ulaşmak hedeflendi. Anket formunun linki internet ortamında mail aracılığıyla ve WhatsApp üzerinden katılımcılara gönderildi. Anket sorularının %90’dan fazlasını doldurmayanlar çalışma dışı bırakıldı.
Bulgular: Çalışmamız sonucunda 100 katılımcının 95’i (%95) hastalarında COVID-19 ilişkili semptom varlığı ve temas öyküsünü, 86’sı (%86) lenfopeni varlığını, 78’i (%78) CRP düzeylerini, 76’sı (%76) akciğer grafisi bulgularını, 75’i (%75) D-Dimer düzeylerini, 74’ü (%74) ferritin değerlerini ve 73’ü de (%73) toraks BT bulgularını preoperatif dönemde COVID-19 ile ilişki açısından değerlendirmektedir.
Sonuç: SARS-CoV-2 için yapılan mevcut testler, asemptomatik taşıyıcıların ameliyathaneye girme olasılığını dışlayacak kadar hassas değildir. PCR testleri negatif olsa bile, yüksek enfeksiyon riski olan hastaları tespit etmeyi içeren adımları akılda tutmak önemlidir.
Anahtar Kelimeler
Kaynakça
- 1. Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–42. https://dx.doi.org/10.1001/jama.2020.2648
- 2. WHO. Novel coronavirus (COVID-19) situation. WorldHealthOrganization, 2020. Available from: https://who.sprinklr.com/ (Accessed 10 January 2021)
- 3. T.C. Sağlık Bakanlığı. COVID-19 Bilgilendirme Sayfası. Available from: https://covid19.saglik.gov.tr/TR-66935/genel-koronavirus-tablosu.html# (Accessed 10 January 2021)
- 4. Li W, Su YY, Zhi SS, et al. Virus shedding dynamics in asymptomatic and mildly symptomatic patients infected with SARS-CoV-2. Clin Microbiol Infect. 2020 Nov;26(11):1556.e1-1556.e6. https://dx.doi.org/10.1016/j.cmi.2020.07.008
- 5. Öcal D, Vezir S, Karahan Z.C. Mikrobiyolojik Tanı Yöntemleri. Ankara Üniversitesi Tıp Fakültesi COVID-19 Kitabı. 2020; Bölüm 3; S:20.
- 6. Çınar G, Birengel MS. Genel Klinik Özellikler. Ankara Üniversitesi Tıp Fakültesi COVID-19 Kitabı. 2020; Bölüm 6; S:43.
- 7. Uppal V, Sondekoppam RV, Landau R, et al. Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations. Anaesthesia. 2020 Oct;75(10):1350-63. https://dx.doi.org/10.1111/anae.15105
- 8. Anderson EL, Turnham P, Griffin JR, et al. Consideration of the Aerosol Transmission for COVID-19 and Public Health. Risk Anal. 2020 May;40(5):902-7. https://dx.doi.org/2010.1111/risa.13500
- 9. Wilson NM, Norton A, Young FP, et al. Airborne transmission of severe acute respiratory syndrome coronavirus-2 to healthcare workers: a narrative review. Anaesthesia. 2020 Aug;75(8):1086-95. https://dx.doi.org/10.1111/anae.15093
- 10. Obara S. Anesthesiologist behavior and anesthesia machine use in the operating room during the COVID-19 pandemic: awareness and changes to cope with the risk of infection transmission. J Anesth. 2020 Aug 27:1–5. https://dx.doi.org/10.1007/s00540-020-02846-z
- 11. Vigneshwar, N.G., Krause, M. & Bartels, K. Positive tracheal SARS-CoV-2 RNA test after three negative SARS-CoV-2 RNA tests in a patient with COVID-19. Can J Anesth/J Can Anesth 2020;67:1663–64. https://doi.org/10.1007/s12630-020-01742-0
- 12.Pascarella G, Strumia A, Piliego C, et al. COVID-19 diagnosis and management: a comprehensive review. J Intern Med. 2020;288(2):192-206. https://dx.doi.org/10.1111/joim.13091
- 13.Williams E, Bond K, Zhang B, et al. Saliva as a Noninvasive Specimen for Detection of SARS-CoV-2. J Clin Microbiol. 2020;23;58(8):e00776-20. https://dx.doi.org/10.1128/JCM.00776-20
- 14.American Society of Anesthesiologists. The ASA and APSF Joint Statement on Perioperative Testing for the COVID-19 Virus. Available from: https://www.asahq.org/about-asa/newsroom/news-releases/2020/04/asa-and-apsf-joint-statement-on-perioperative-testing-for-the-covid-19-virus (accessed May 2020)
- 15.Pourbagheri-Sigaroodi A, Bashash D, Fateh F, et al. Laboratory findings in COVID-19 diagnosis and prognosis. Clin Chim Acta. 2020;510:475-82. https://dx.doi.org/10.1016/j.cca.2020.08.019
- 16.T.C Sağlık Bakanlığı Halk Sağlığı Müdürlüğü Covid-19. SARS -CoV-2 Enfeksiyonu Rehberi. https://covid19.saglik.gov.tr/Eklenti/39061/0/covid19rehberieriskinhastatedavisipdf.pdf (acsessed Oct. 2020)
- 17.Gündüz Y, Öztürk MH, Tomak Y. The usual course of Thorax CT findings of Covid-19 infection and When should control Thorax CT scan? Turk J Med Sci. 2020 Apr 30;50(4):684–6. https://dx.doi.org/10.3906/sag-2004-293
- 18.World Health Organization. (2020). Rational use of personal protective equipment for coronavirus disease (COVID-19): interim guidance, 27 February 2020 (No. WHO/2019-nCov/IPCPPE_use/2020.1). World Health Organization.
- 19.Türe H, Çelebi Ş, Aytaç E, et al. COVID-19 Tanılı ya da Şüpheli Hastaların Preoperatif Hazırlığı ve Ameliyathane Yöne-timi. JARSS. 2020;28(3):137-49. https://dx.doi.org/10.5222/jarss.2020.70299
- 20.Wong J, Goh QY, Tan Z, et al Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in Singapore. Can J Anaesth. 2020 Jun;67(6):732-45. https://dx.doi.org/10.1007/s12630-020-01620-9
- 21.Tan L, Kovoor JG, Williamson P, et al. Personal protective equipment and evidence-based advice for surgical departments during COVID-19. ANZ J Surg. 2020;90(9):1566-72. https://dx.doi.org/10.1111/ans.16194
- 22.Hall D, Steel A, Heij R, et al. Videolaryngoscopy increases ‘mouth‐to‐mouth’ distance compared with direct laryngoscopy. Anaesthesia.2020;75:822823. https://doi.org/10.1111/anae.15047
- 23.Ong S, Lim WY, Ong J, et al. Anesthesia guidelines for COVID-19 patients: a narrative review and appraisal. Korean J Anesthesiol. 2020 Dec;73(6):486-502. https://dx.doi.org/10.4097/kja.20354
- 24.Bevilacqua S, Bottari V, Galeotti I. Systematic Application of Rapid Sequence Intubation With Remifentanil During COVID-19 Pandemic. Semin Cardiothorac Vasc Anesth. 2020 Jul 15:1089253220941369. https://dx.doi.org/10.1177/1089253220941369
- 25.Neal JM, Bernards CM, Hadzic A, et al. ASRA Practice Advisory on Neurologic Complications in Regional Anesthesia and Pain Medicine. Reg Anesth Pain Med. 2008;33(5):404-15. https://dx.doi.org/10.1016/j.rapm.2008.07.527
- 26.Lie SA, Wong SW, Wong LT, et al. Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic. Can J Anaesth. 2020 Jul;67(7):885-92. https://dx.doi.org/10.1007/s12630-020-01637-0
- 27.Brown NW, Parsons AP, Kam PC. Anaesthetic considerations in a parturient with varicella presenting for Caesarean section. Anaesthesia. 2003;58(11):1092-5. https://dx.doi.org/10.1046/j.1365-2044.2003.03442.x
- 28.Tang G, Chan AKM. Perioperative management of suspected/ confirmed cases of COVID-19. Availablefrom: https://www.wfsahq.org/components/com_virtual_library/media/1c4ec5c64b9aaacf7c47f76a61fb6edc-atow-422-01.pdf
- 29.Jain A, Bhardwaj N, Yaddanapudi S. What a pediatric anesthesiologist should know about COVID-19. J Anaesthesiol Clin Pharmacol. 2020;36(Suppl1):S85-S91. https://dx.doi.org/10.4103/joacp.JOACP_237_20
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Anesteziyoloji |
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Nisan 2021 |
| Kabul Tarihi | 24 Mart 2021 |
| Yayımlandığı Sayı | Yıl 2021 Cilt: 4 Sayı: 1 |