Regional Anesthesia in the COVID-19 Pandemic

April 16, 2020

How would you manage a 60-year-old COVID-19 positive patient with acute foot ischemia, who needs urgent thrombectomy of the tibial artery? With bilateral pulmonary infiltrates, general anesthesia poses the risk of hypoxia and ventilatory dependency, whereas spinal anesthesia is contraindicated (anticoagulant therapy). In this case, Dr. Ana Lopez used a popliteal and a saphenous nerve block for complete anesthesia of the extremity to avoid the need for airway manipulation and the perils of general anesthesia in a patient with a COVID-19 infection.

There are a number of highly standardized regional anesthetics for emergency surgeries that eliminate the need for airway management and do not affect the patient’s respiratory function. In COVID-19 positive cases, however, the teaching is minimized as these techniques should be performed by clinicians with experience in regional anesthesia to decrease the length of exposure of residents and staff, as well as, the risk of failure and conversion to general anesthesia.

Moreover, the COVID-19 pandemic has caused difficulties in the residency program’s education due to the cancelation of nearly all elective surgery. The training of regional anesthesia is particularly affected, as elective orthopedic procedures are all canceled. This is unfortunate as the regional anesthesia is particularly applicable as the sole anesthetic modality in many patients requiring urgent surgery. The alarming decrease in resident’s exposure to regional anesthesia skills could be particularly problematic with senior residents who reserved their regional anesthesia and ultrasound guidance rotations for their last year and now may graduate without these highly valuable and marketable skills. Many anesthesiology training programs are looking for alternative educational solutions and have reached out to NYSORA to subscribe to NYSORA LMS (Learning Management System); an interactive platform that offers a complete, standardized and comprehensive approach to ultrasound-guided regional anesthesia techniques. The diagram below outlines the five-stage training method for proficiency in regional anesthesia. NYSORA has developed a training solution for each of the steps.

Five Stages of Learning Ultrasound-Guided RAPM

NYSORA’S TEACHING PLATFORMS

NYSORA WEBSITE

NYSORA.COM is one of the largest regional anesthesia educational platforms created for the anesthesia community for nearly three decades. Here, you will find a great variety of tools and information on the practice of anesthesia, regional anesthesia and education in perioperative medicine. Unique on nysora.com information on regional anesthesia techniques, equipment, pharmacology, management of patients with special considerations and complications. There are also a large number of tools available to download like NYSORA’s posters and management algorithms.

NYSORA LEARNING MANAGEMENT SYSTEM

NYSORA’s LMS is an interactive platform that features the most practical and comprehensive reference guide to ultrasound-guided blocks, optimized for individual and institutional desktop access. It features:

Real-time updates and addition of teaching material
Standardized regional anesthesia procedures and management protocols
Clinically applicable excerpts from NYSORA’s textbooks
An easy-to-navigate menu with a comprehensive collection of regional anesthesia techniques for head and neck, upper extremity, lower extremity, thoracic, and abdominal wall blocks.
Logical step-by-step technique instructions
NYSORA’s trademark functional regional anatomy and reverse ultrasound anatomy used in lectures by instructors worldwide.
Updated, algorithm-driven approach to the prevention, diagnosis, and management of nerve injury and local anesthetic systemic toxicity (LAST)
Teaching collection of must-haves for anatomy images, videos, and reverse ultrasound illustrations created by NYSORA.
The study material for ultrasound certification
Continuous addition of new updates
Online CME courses (coming soon)

Subscribe here.

NYSORA MOBILE APP

A practical step-by-step guide to ultrasound-guided regional anesthesia optimized for mobile devices. The best mobile app with everything you’ll need for daily clinical practice on your smartphone. Available on Android. iOS version coming soon.

Get it on Google Play.

NYSORA SIMULATORS™

The best way to learn or teach ultrasound. A must-have in any training program, NYSORA SIMULATORS™ substantially facilitate and enhance ultrasound hand-eye coordination and procedure-learning without exposing patients to risk. Each simulator includes relevant anatomy, allows for needle insertion and injection, thus providing a complete educational experience.