Non-Operating Room Anesthesia and the COVID-19 Patient: Evidence Based Strategies

As non-operating room anesthesia (NORA) vastly increases, so does the complexity of both the patients and the procedures. Unfamiliar environment, remote locations, and limited access to resources are some of the many challenges faced by the anesthesiologist in this environment. Understanding the environmental factors such as the room layout, machine placement and patient positioning needs advanced planning in the COVID-19 patient to determine airway management, intravenous access and overall patient safety. Communication with the proceduralist and healthcare workers (HCW) is of essence as both the procedure and anesthetic requirements may need to be altered as the case progresses. Standard monitoring guidelines should apply to all patients regardless of depth of anesthesia. The COVID-19 patient adds to these challenges. Aerosol generating medical procedures (AGMP’s) need to be identified ahead of time in order to ensure the safety of both the staff and patients. This allows for planning and preparation required for transportation of the patient to the room. HCWs may need to be identified and be available to assist with the procedure. Time should be allocated for transportation, briefing, room preparation, personal protective equipment needs of the staff and donning and doffing procedures as per institutional protocol. Communication means with staff outside of the room should be discussed in advance should an emergent situation arise during the procedure. Debriefing should be performed at the end of every procedure to improve patient safety and outcomes.

Mortality Observed in the General Surgery Department “A” at the University Hospital Center of Point “G” in Bamako

In Mali, few studies have concerned overall mortality in general surgery, but several specific studies have concerned the different affections. Reflection on the causes of death is an inherent part of the activity of any motivated surgical team. Objective: To analyze the rate and the main causes of mortality in the General “A” surgical department of the Point “G” CHU. Patients Method: Our study was retrospective, descriptive and covered a period of 5 years from 01/01/2014 to 12/31/2018. We collected 152 deaths for 2011 hospitalized patients. The data were collected from the files of these deaths on pre-established investigation forms. The deceased patients were classified as operative and non-operative death, death from non-cancerous and cancerous diseases, deaths occurring in emergencies and deaths in regulated surgery. Results: We recorded 152 cases of death for 2011 hospitalized patients, either an overall mortality rate of 7.55%. The average age of deaths was 44.20 years +- 17.51 years with extremes ranging from 7 years to 85 years. The sex ratio was 1.62 in favor of men. The causes of death were represented by cancerous pathologies (69 deaths or 34.67%), non-cancerous pathologies (83 deaths or 4.58%). Conclusion: The mortality rate in general surgery remains high and is mainly linked to cancerous pathologies and the delay in taking care of patients.

Intervention Treatment of Non-Operable Central Lung Cancer

From January 1992 to December 1992,32 patients with jung cancer which were centrally located and considered to be non-operable were treated by bronchial artery chemoembolization.