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Why choose RA in the Covid-19 recovery phase - Prof William Harrop-Griffiths
1. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
Why choose regional anaesthesia
in the Covid-19 recovery phase
Professor William Harrop-Griffiths
Consultant Anaesthetist, Imperial College Healthcare NHS Trust, London
@WHarropG
Supported by an unrestricted educational grant from
#RAUKSpinal
2. Why choose regional
anaesthesia in the COVID19
recovery phase?
William Harrop-Griffiths
Professor of Practice (Anaesthesia), Imperial College, London
Consultant Anaesthetist, Imperial College Healthcare NHS Trust
Chair, RCoA Clinical Quality & Research Board
Supported by an unrestricted educational grant from
3. Why choose regional
anaesthesia in the COVID19
recovery phase?
William Harrop-Griffiths
Professor of Practice (Anaesthesia), Imperial College, London
Consultant Anaesthetist, Imperial College Healthcare NHS Trust
Chair, RCoA Clinical Quality & Research Board
Supported by an unrestricted educational grant from
4. Why choose regional
anaesthesia now?
William Harrop-Griffiths
Professor of Practice (Anaesthesia), Imperial College, London
Consultant Anaesthetist, Imperial College Healthcare NHS Trust
Chair, RCoA Clinical Quality & Research Board
Supported by an unrestricted educational grant from
5. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
Competing interests
• I have received honoraria from B Braun and Sintetica
• I am regional anaesthetist whose passion borders on
obsession
Supported by an unrestricted educational grant from
6. A real story of two real anaesthetists
• Specialist private orthopaedic centre in Central London
• Prides itself in doing day case surgery
• Shoulder versus foot ‘n’ ankle lists
• Regional versus general anaesthesia debate
• Perversion versus pragmatism
• Since COVID-19…
• He now does spinals
7. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
Why has COVID-19 driven this change?
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10. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
Aerosol-generating procedures (AGPs)
• “Potentially infectious AGPs for COVID-19”
• Not completely synonymous with AGPs
• Diathermy can create a blood AGP
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17. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
Things that are not currently AGPs
according to PHE
• Powered saws and drills used outside of the respiratory tract
• Diathermy
• Laparoscopy
• Laparotomy
• Pulsed lavage
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18. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
Things on which PHE stays strangely silent
• Supraglottic airways (SGAs)
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19. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
Currently…
• The results of ongoing studies may suggest that some
things we think are AGPs are in fact not AGPs
• But for the time being…
• Airway manipulation under general anaesthesia = AGP
• Breathing spontaneously with a capnomask ≠ AGP
• RA with up to moderate sedation ≠ AGP
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20. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
AGPs come with baggage
• Wearing airborne precaution PPE
• Giving anaesthetics only in the operating
theatre
• Waiting for aerosol clearance after the
AGP at the beginning of the anaesthetic
• Waiting for aerosol clearance after the
AGP at the end of the anaesthetic
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21. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
AGPs come with baggage
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22. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
Why use regional anaesthesia now?
• Planned surgery ground to a halt
• We have to get going again
• Much more surgery could be safely performed under
regional anaesthesia
• Regional anaesthesia increases theatre throughput
significantly
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23.
24.
25. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
Benefits of regional anaesthesia
• Are many (really)
• Even outside of a viral epidemic there are excellent
reasons for making regional anaesthesia your first choice
• Right now, there is a pressing need for increased turnover
• And regional anaesthesia (for once) can be a lot quicker
than general aaesthesia
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26. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
Legacies of COVID-19
• Video conferencing came of age
• Working from home became the norm
• Cycling got really popular
• Waistlines expanded and livers got punished
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27. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
Legacies of COVID-19
• Many luddites tried regional anaesthesia for a change
• Although it takes time and effort to learn how to do a
PECS-15 or TEQUILA-26 block
• Anyone can do a spinal
• Many planned and emergency procedures take place
below the waist
• Spinal anaesthesia and day case surgery do mix
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28.
29. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
Specialist Societies seize the opportunity
• OAA: “put epidurals in early!”
• DAS: “use videolaryngoscopes all the time”
• RAUK: “use regional anaesthesia”
• SIVA: ”buggrit!”
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30. Guidance on Ambulatory
Spinal Anaesthesia: Covid-19 response
Seize the opportunity
• Those who are not RA obsessives can show themselves that:
• RA can be efficient and effective
• Spinal anaesthesia can be used reliably - even in day case surgery
• Hopefully, this change will outlast the COVID-19 pandemic
• Cue the other speakers!
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