A Cross-Sectional Study to Ascertain the Effect of COVID-19 Pandemic on Regional Anaesthesia Practices Amongst Anaesthesiologists of India

Effect of COVID-19 pandemic on regional anaesthesia practices amongst anaesthesiologists of India

Dear all,

Greetings of the day!

Hope we are all keeping safe in this tough COVID -19 pandemic time. We are conducting this survey with the aim to find out the challenges being faced by you regarding regional anaesthesia practice and impact of pandemic on its practice, teaching and training during pandemic time and take your suggestions in improving the same so that the application of regional anaesthesia, teaching and training work is not hampered due to the COVID pandemic.

Please fill the following questionnaire regarding the ‘EFFECT of COVID-19 pandemic on regional anaesthesia practices amongst anaesthesiologists of India’ for your kind views on this important aspect. The data thus generated would help guide future practice and identify any lacunae on this sensitive topic. The form also asks your permission to use related observations as data in this study. The participation is completely voluntary.

Please note that the questionnaire does not ask for your identity, so anonymity will be ensured and no personal or institutional details would be disclosed.

Thanking you in anticipation. Best Wishes!

*Required

1.    Email *

2.  Consent to participate: I have reviewed the information provided in the    * participation information sheet provided above and have made required clarification if required from the investigator. I understand that my participation

in this survey is voluntary , and I can decline my participation without giving any reason. By clicking on the “I Agree button”, I give consent to be part of the study.

Mark only one oval.

 

I agree

General information

3.      Type of institution you are affiliated to * (Mark only one oval.)

Medical college (Private/government/autonomous) Government non-teaching hospital

Corporate Hospital

Free Lancing Practitioner

Others

4.   State of India that you work in *

SHAPE * MERGEFORMAT

5.   Years of Experience (Mark only one oval.)

Less than 5 years 5-10 Years

10-15 Years

More than 15 Years

6.  What Percentage of Surgeries are done under Regional Anesthesia Techniques   * in your Department? (Mark only one oval.)

Less than 20%

20-40%

40-60%

More than 60%

 

7.  What percentage of patients undergoing surgery receive regional anesthesia       * techniques for postoperative analgesia? (mark only one oval.)

Less than 10%

10-20%

20-30%

More than 30%

8.  Is there a change in the incidence of using regional anesthesia techniques for     * surgery in your department during COVID-19 Pandemic ?

 

Increased/  Decreased No change

9. Has there been a change in an overall practice of regional anaesthesia with * regards to the utilization, use of PPE, asepsis, disinfection, monitoring, type of technique used for regional anaesthesia techniques for postoperative analgesia in your institute

Yes, there is some change

No, there is no change

10.  What mode of anesthetic technique do your department prefer in COVID 19       * diagnosed / suspected patients undergoing surgery?

General anaesthesia /Regional anesthesia/No preference for any technique over the other

 

11.   If there is a preference, is there a difference in asking COVID-19 testing in         * cases scheduled under regional versus general anaesthesia?

Testing is more stringent for GA cases/ No difference

 

12.  Is a designated Operation theatre available to perform surgeries of COVID         * confirmed/suspected patients in your institution?

(Mark onlyI one oval.)

Yes , with negative Pressure system

Yes, but with no negative Pressure system No

13. Which of the following Preoperative investigations are routinely done in all * COVID-19 confirmed/suspected young adult (18-60) ASA-I patients posted for surgery under regional anaesthesia? (Tick all that apply)

Total Leucocyte count with Hb Platelet count

Coagulation profile Inflammatory markers Chest Xray

CT chest ECG

Renal function tests Liver function tests 2D Echo

Room air saturation Temperature
Other:

14.  Do you routinely provide sedation for all COVID 19 confirmed/ suspected  * patients undergoing surgery under regional anesthesia?

Yes, in all cases

Avoided unless required

 

15.               How do you supplement Oxygen for COVID 19 confirmed/ suspected patients   * undergoing surgery under regional anesthesia?

Mark only one oval.

 

Oxygen supplementation avoided

Using a Nasal Canulla/facemask with a flow rate upto 2L/min

Facemask with a flowrate of 2-4L/min Facemask with a flowrate more than 4L/min Other

 

16. Is a surgical/three ply/N95 mask applied to COVID 19 confirmed/ suspected     * patients undergoing surgery under regional anesthesia

Yes, a surgical mask

Yes, an N-95 mask/FFP3 mask No

 

17.    What type of personal protective equipments are used by the operators * performing central neuraxial block on COVID 19 patient? (can choose more than one option)

Tick all that apply.

Level 3 PPE N95 MASK

face shield Eye goggles

Impermeable Gown Double gloves Shoe cover


Other:

18. How do you document the anesthesia management in a Covid-positive patient in your hospital? (Mark only one oval.)

Anesthesia chart Patient file Online entry

Documentation is done outside in the non-covid area over telephonic conversation

Central Neuraxial blockade and peripheral blockade

19.     What position do you perform neuraxial techniques in a COVID-19 patient? (Mark only one oval.)

Lateral Sitting

position depends on patient

 

20.  What needle size is used to perform spinal anesthesia in COVID-1 9 PATIENT? (Mark only one oval.)

23G

25G

26G

27G

21.  What needle size is used to perform epidural anesthesia in COVID19 PATIENT? (Mark only one oval)

16G

18G

Whichever is available

22. What type of needle do you use for spinal anesthesia in a COVID-1 9 patient? * (Mark only one oval)

Quinckie tip needle Pencil tip needle

23. How do you disinfect the skin prior to performing neuraxial blocks in COVID-19 * patients? (Mark only one oval.

Providone iodine

Chlorhexidine with Isopropyl Alcohol Sterillium – Alcohol based disinfectant Both Povidone iodine and Chlorhexidine

 

24.  What kind of drapes are used in your institution for COVID-19 patients for * perfoming regional anesthesia? (Mark only one oval.)

 

Disposable plastic drapes/ Disposable paper drapes/ Reusable woolen drapes/ Antimicrobial impregnated drapes

25.   Who generally perfoms the block in COVID-1 9 positive patients? (Mark only one oval.)

Consultant/ Senior Resident/Post graduate Trainee

26.     What method do you use for epidural space identification in COVID 19              * Patients? (Mark only one oval)

 

Loss of resistance to Air/ Loss of resistance to Saline/ Hanging drop method/ Ultrasound/Others

27. Which adjuvants do you use in spinal anesthesia for COVID-19 patients? (can choose more than 1, Tick all that apply.)

Morphine Fentanyl Clonidine

Dexmeditomedine

No adjuvants are used

Other adjuvants or combination


Other:

28.               What prophylactic measures do you use to prevent hypotension following         * spinal anesthesia in a COVID-19 patient?

 

No active interventions

Prophylactic vasopressors

Preloading

Coloadin

29.               What are the Issues you have faced while performing a Central neuraxial or       * peripheral nerve block with PPE? Can choose more than one. (Tick all that apply)

Poor vision due to fogging

Difficulty in palpation and identifying the intervertebral spaces Multiple needling attempts

Increased duration of performance Failure of block

Increased incidence of dural puncture while performing epidural

 

30.   Which of the following methods would you use to treat PDPH in COVID positive * patients refractory to conservative management in your hospital? (Tick all that apply.)

 

Sphenopalatine ganglion block/  Epidural blood patch/Bilateral Greater occipital nerve block/ Others

31. How do you use epidural analgesia for postoperative pain relief in COVID  * positive patients in your hospital? (Mark only one oval.)

 

Yes, Repeated bolus at regular intervals/ Yes, as Continous infusion/Bolus when patients complaints/ Patient controlled Analgesia

32. Which investigations will you check prior to removal of epidural catheter? * (Tick all that apply)

Platelet count /Coagulation profile/ Others

33.               is General anesthesia provided prior to performing regional blocks in COVID      * patients? (Mark only one oval.)

Yes/ No

34.       Which technique do you commonly use to perform peripheral nerve blocks in    * COVID positive patients? (Mark only one oval.0

 

USG guided landmark

Nerve stimulator

Combined USG with nerve stimulator

35.                Which adjuvant do you commonly use for performing peripheral nerve blocks    * in COVID positive patients? (Tick all that apply.)

opiods Clonidine

Dexmedetomidine

Dexamethasone

Other:

36.              How do you disinfect the skin prior to performing peripheral nerve blocks in     * COVID positive patients? (Mark only one oval)

 

Povidone iodine

Chlorhexidine with isopropyl alcohol

Pure alcohol based solutions

Other:

SHAPE * MERGEFORMAT

 

37.   Is intralipid stored inside the COVID designated OR in your hospital? * (Mark only one oval)

Yes/No

38.              What issues have you had faced in performing peripheral nerve blocks with PPE? Can choose multiple options: (Tick all that apply)

Poor visibilty due to fogging Poor ultrasound images wrong side block

increased performnace time increased failure rates

Increased volume of local anesthetic use IV injection

multiple attempts Nerve injury Hematoma
Other:

39.             Do you insert perineural catheters for postop analgesia in COVID positive         * patients in your hospital

No/Yes

 

40. If using, what is the Duration for which you keep perineural catheters in COVID positive patients?

Less than 24 hours

24-72hours

More than 72 hours

41.              For upper limb surgeries which among the following blocks is commonly          * preferred in your hospital for COVID positive patients?

 

Interscalene nerve block /Supraclavicular nerve block/ Infraclavicular nerve block/ Axillary nerve block /Individual nerves are blocked

 

42.              Measures to maintain ultrasound sterilty in COVID designated OR in your hospital (Tick all that apply)

Camera cover

Antibiotic impregnated plastic Cover

Sterile gloves Sterile jelly Chlorhexidine rubs

Dipping into Povidone iodine

None Other:

 

43.   How do you disinfect USG after use in a COVID positive patient? (Mark only one oval)

Alcohol based Wipes Chlorhexidine based Wipes Glutaraldehyde ( CIDEX) Hydrogen peroxide

Ultraviolet light based sterilisation

Soap and water

None

Other:

Postoperative period and recovery

44. Where do you monitor COVID Positive patients who underwent surgery under    * regional anesthesia in the immediate postoperative period? (Mark only one oval.)

Within the COVID designated OR PACU

COVID designated ward

45.  How is the Sharps like needles and syringes used in covid positive patients disposed in your hospital? (Mark only one oval)

 

Incineration/ Collected in separate tamper proof bags/autoclaved and recycled /Collected in separate tamper proof bags/ autoclaved and shredded /Either recycled or shredded/Other

 

46. What are the methods for cleaning the operating room after the surgery of a    * COVID positive patient in your hospital? (Tick all that apply)

Fogging with Hydrogen peroxide vapour followed by segregation wiping floors and solid surfaces with sodium hypochlorite solution wiping floors and solid surfaces with 75% alcohol/ Disinfection of metallic equipments with sodium hypochlorite solution/Other:          

47.  What are the training methods provided for residents for performing regional    * anesthesia in your hospital during the peak of COVID pandemic when elective surgeries are stopped?(Tick all that apply)

Simulation based

Deliberate practice on patients under the supervision of faculty Web based learning

Cadaver/phantom model based learning Workshops
Other:

48.  Thank you for your response. Additional remarks if any.