Timing of elective surgery and risk assessment after SARS-CoV-2 infection

“Patients who develop symptoms of SARS-CoV-2 infection within 7 weeks of planned surgery, including on the day of surgery, should be screened for SARS-CoV-2. Elective surgery should not usually be undertaken within 2 weeks of diagnosis of SARS-CoV-2 infection. For patients who have recovered from SARS-CoV-2 infection and who are low risk or having low-risk surgery, most elective surgery can proceed 2 weeks following a SARS-CoV-2 positive test. For patients who are not low risk or having anything other than low-risk surgery between 2 and 7 weeks following infection, an individual risk assessment must be performed. This should consider: patient factors (age; comorbid and functional status); infection factors (severity; ongoing symptoms; vaccination); and surgical factors (clinical priority; risk of disease progression; grade of surgery).”

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“Although the authors acknowledge that cognitive deterioration following surgery is a common phenomenon, there is little evidence that anesthesia itself or other surgical and patient factors can cause or accelerate cognitive decline and AD. The existing controversy in the field between animal and human studies highlights the need for transitioning from population-based studies to high-quality clinical studies especially with regards to dementia.” (Tsolaki)

Tsolaki

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Cognitive decline of elderly patients after anesthesia

“Postoperative neurocognitive decline is a meaningful concern to patients and represents a significant and expanding challenge to health care in the US and worldwide. Surgeons and anesthesiologists should assess, discuss, and optimize associated potential risks for each patient before surgery. Best practices and interventions can begin before surgery and extend well into the recovery period. To be most effective, these strategies require family engagement and the involvement of an interdisciplinary health care team and comprehensive systems of care.” (Vacas)

Vacas

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Perioperative considerations for patients with epilepsy

“Epilepsy is the most common serious neurological disorder, with a prevalence of 0.5–1% of the population. Anaesthetists are frequently faced with patients with epilepsy undergoing
emergency or elective surgery and patients suffering seizures and status epilepticus in the intensive care unit (ICU).”

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Delayed Emergence from Anesthesia

“Despite the medications commonly used in anesthesia allow recovery in a few minutes, a delay in waking up from anesthesia, called delayed emergence, may occur. This phenomenon is associated with delays in the operating room, and an overall increase in costs. Together with the emergence delirium, the phenomenon represents a manifestation of
inadequate emergence. Nevertheless, in delayed emergence, the transition from unconsciousness to complete wakefulness usually occurs along a normal trajectory, although slowed down. On the other hand, this awakening trajectory could proceed abnormally, possibly culminating in the manifestation of emergence delirium. Clinically, delayed emergence often represents a challenge for clinicians who must make an accurate diagnosis of the underlying cause to quickly establish appropriate therapy.”

Cascella
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