The Role of Anesthesiologists in Fighting Corona Virus Anesthesiologist like Dr. Randal Dull, MD PhD are medical specialist charged with managing patient’s life-sustaining processes during surgery and other painful medical procedures. Now that the world is suffering from the outbreak of corona virus, also known as COVID-19, medical doctors are among the most sought after professionals across the globe. Physicians, nurses and healthcare workers are working around the clock to treat patients stricken with this highly contagious virus while their colleagues in the research laboratories are trying to develop a vaccine to curb the spread and minimize death. The early symptoms of COV-19 are similar to those of other upper respiratory tract infections and influenza starting with headache, sore throat, GI symptoms, cough, body ache and progressing to high fever and shortness of breath. Patients with other health issues may suffer respiratory failure and require mechanical assistance to breathe. Covid19 causes the smallest blood vessels, called capillaries, to become very leaky and fluid leaks out in to the airspaces in lung and prevent oxygen uptake. When patients can no longer breath on their own, anesthesiologists are called to intubate them (insert a breathing tube) and support their breathing with a mechanical ventilator. After the first few cases of Corona virus were reported in China, emergency room doctors and anesthesiologists worked together to care for infected patients who had pneumonia-like symptoms and sudden acute respiratory syndromes (SARS). Early December 2019, as these patients were first entering the Chinese healthcare system, there was no public warning about the illness, how fast it was spreading and how sick patients were getting. Chinese officials originally believed that the source of this novel virus was wet-market wild animals (bats?) sold for human consumption but the rapid spread suggested to the world that this novel virus spread by human to human contact. At that point, all doctors, including anesthesiologists, began advocating for N95 masks that protect them from the smallest airborne particles when interacting with any patient who had cough, fever and flu-like symptoms. Epidemiological data suggested that a patient can be infected with the virus for approximately ten to fourteen days without any signs or symptoms but, apparently they can transmit the virus to other people. At this point all doctors and healthcare workers have been asking “why aren’t we wearing masks all the time when interacting every patient and practice tried and true “universal precautions”? Daily guidelines and recommendations from the CDC change daily. Not unsurprisingly, COVID-19 has spread to other countries including Italy, Spain, the UK and Germany and by February 2020, many countries had started reporting significant cases of corona virus. By mid-March 2020, the entire world was in a frenzy due to this deadly virus; countries went on lock-down while reporting thousands of cases and deaths as a result of this virus. The surgical world and the role of anesthesiologist changed dramatically. To preserve personal protective equipment (PPE) and to open up hospital beds for the anticipated number of patients that would be coming through the ER doors, almost all hospital have reduced operating rooms schedules and outpatient surgery centers have come to a screeching halt. For now, the only surgeries that are allowed are emergencies that include traumas and cancer surgery. Has anesthesia changed with this pandemic? To reduce the risk of airborne contamination during surgery, anesthesiologists have changed their practices significantly. Healthy patients with low risk for covid19 and having low risk surgeries, will receive general anesthesia or sedation depending on the type of procedure they are having. For patients, that are at increased risk or indeterminant risk of covid 19 (e.g, trauma patients), they will be intubated in a negative pressure room, with anesthesiologists wearing full PPE gear, and will be transported to the operating room intubated and sedated. Our goal is to reduce the risk of airborne contamination to as low as possible. More advanced medical centers have operating rooms with negative pressure ventilation and this prevents airborne particles from escaping the operating room. Suspected or known covid19 patients are cared for in negative pressure operating rooms and recovery rooms while caregivers wear full PPE (N95 mask, isolation gown, gloves, face mask shield, surgical cap). To review the modes of anesthesia: General anesthesia This means you are completely unconscious during your surgery or procedure. This type of anesthesia is typically started by administered through the IV and after you are “asleep”, your anesthesiologists inserts a breathing tube (endotracheal tube) into your trachea (airway) and anesthesia gas keeps you unconscious. This kind of anesthesia makes you lose consciousness and that is why it is used in major operations. IV sedation or monitored anesthesia Monitored anesthesia makes the patients feel relaxed and calm and experience different levels of consciousness, but for sure one is not totally unconscious. Sedation varies from minimal levels, which makes one sleepy but you can communicate with your doctors, to deep sedation where the patients will not remember the surgery or procedure. Regional anesthesia This type of anesthesia results in a large part of the patient’s body being numb. Regional anesthesia is administered through a catheter or through a single injection. It is used for processes like childbirth (epidural anesthesia) and arm and leg surgical procdures (nerve blocks). The patient is awake (but sedated) throughout the entire procedure while the area being operated on is numb. Local anesthesia This anesthesia is administered through an injection of a local anesthetic like lidocaine or a related compound called bupivacaine, that numbs a small part of the body where the surgery is being done. Local anesthesia is used for minor surgeries like mole removal, tooth extraction or plastic surgery. The patient will be awake during the procedure but thee anesthesia will numb the pain. Intensive Care Units (ICU) While treating the coronavirus infected patients, anesthesiologists work in acute and intensive care unit and manage airway emergencies, mechanical ventilation and blood pressure. While caring for these covid-infected patients, anesthesiologist and critical care physicians are exposed to a great risk of contracting the disease. Although these medical doctors take precautions as recommended by the Centers for Disease Control (CDC) and the World Health Organization (WHO) regarding the prevention of COVID-19, many doctors and healthcare workers have contracted this virus. Anesthesiologists have lost their lives in line of duty and others have gone on sick leave resulting from contraction of coronavirus. Since the corona virus pandemic was officially declared, over two thousand healthcare workers have been infected by the disease leading them in to isolation wards with other patients. Anesthesiologist like Dr. Randal Dull MD PhD are required to offer their services in three essential stages in the surgical process. Before the surgery Whether it is a minor or major surgery, it is important for a patient meets with their anesthesiologists. This way, the patients are able to ask question they may have on the anesthesia involved and the physician anesthesiologists will be able to answer these questions. It is also important for the anesthesiologists to understand sand document the complete medical history and drug allergies that the patients may have. The patient will feel more comfortable after this meeting and the physician anesthesiologist will know the right kind of anesthesia to use during surgical procedure. During surgical procedure Anesthesiologists monitor the patient during their surgery or other medical procedure to monitor vital body function (blood pressure, heart rate, blood oxygen levels) as well as pain. If any problem arises during the procedure, anesthesiologists are trained to control and ensure patient safety during the surgical procedure. After surgery Anesthesiologists like Dr. Randal Dull monitor patients closely after their surgery to ensure they are safe. While the effects of anesthesia are wearing off, physician anesthesiologists monitor vital signs including respiratory rate, breathing patterns, level of consciousness, blood pressure, heart rate and blood oxygen levels. Anesthesiologists also manage post-operative pain. Summary: Many doctors including anesthesiologists are working around the clock to save as many lives as possible and urging people to practice social distancing, to wash your hands regularly with soap and water and/or sanitizers and visit health facilities only when flu-like symptoms are severe and breathing problems are occurring. People with fever, dry cough and sore throat should be isolated and tested for corona virus. Anyone travelling from affected countries or areas of the US that have high infection rates, should be quarantined for a minimum of 14 days.
