Abstract
New corona virus disease COVID-19 is a pandemic outbreak viral infection that is highly contagious. The disease can affect any age groups. Majority of patients show mild or no symptoms. Immunocompromised patients and patients with co-morbidities are more vulnerable to have more aggressive affection with higher rate of complications. Thus, cancer patients carry a higher risk of infection. Diseased patient can transmit infection throughout the disease course starting from the incubation period to clinical recovery. All healthcare workers contacting COVID-19-positive patients are at great risk of infection, especially the anesthesiologists who can be exposed to high viral load during airway manipulation. In the National Cancer Institute of Egypt, we apply a protocol to prioritize cases where elective cancer surgeries that would not affect patient prognosis and outcome are postponed during the early phase and peak of the pandemic till reaching a plateau. However, emergency and urgent surgeries that can compromise cancer patient’s life and prognosis take place after the proper assessment of the patient’s condition.
Aim
This review aims to spot the management of cancer patients undergoing surgery during the COVID-19 pandemic in the National Cancer Institute, Egypt.
Similar content being viewed by others
Background
The emergence and spread of the new coronavirus disease 2019 (COVID-19) is considered a community crisis that threatens the world nowadays (Singhal 2020). The World Health Organization (WHO) has recently stated COVID-19 as a pandemic outbreak (https://www.who.int). All age groups are susceptible to infection by COVID-19, but a high rate of complications usually occurs with immunocompromised patients and older patients with co-morbidities (Singhal 2020; Chen et al. 2020a, 2020b). Also, hypoalbuminemia, lymphopenia, high concentrations of CRP, and elevated LDH predict the severity of acute lung injury. Higher levels of angiotensin II are also proposed to be related to acute lung injury (Liu et al. 2020a, 2020b). Meanwhile, non-survivors are suggested to be those who had higher levels of D-dimer and FDP, longer PT and a PTT, and lower fibrinogen and antithrombin levels (Tang et al. 2020).
In general, poor prognostic indicators for infected patients include neutrophil to lymphocyte ratio more than 3.13, absolute lymphocyte count less than 0.8, LDH more than 245 U/L, ferritin more than 300ug/L, CRP more than 100 mg/L, and D-dimer more than 1000 ng/ml (https://journals.lww.com/em-news/blog/breakingnews/pages/post.aspx?PostID=508) (Liu et al. 2020a, 2020b).
Concerning cancer patients, who are regarded as a highly vulnerable group in the current (COVID-19) pandemic, it was reported that they present with similar features to the general population, except for anemia and hypoproteinemia, which are more frequently found in this cohort. Both could be considered a major consequence of nutritional deterioration in cancer patients, which may adversely affect immunocompetence and increase the susceptibility to respiratory pathogens (Zhang et al. 2020a, 2020b).
Radiological features
Because of the primary involvement of the respiratory system in COVID-19 patients, recent studies addressed the diagnostic value of chest computed tomography (CT) examination especially with an initial false-negative reverse transcription-polymerase chain reaction (RT-PCR) results (**e 2020; Huang et al. 2020a, 2020b). CT examination is of great significance not only in diagnosing COVID-19 but also in monitoring disease progression and evaluating therapeutic efficacy (**e 2020).
Chest radiographs are of little diagnostic value in early stages, as it has a high specificity of up to 90% but a low sensitivity of about 25% for detection of COVID-19-related lung opacities, whereas CT findings may be present even before symptom onset (Huang et al. 2020a, 2020b). However, in the first 4 days of infection with the SARS-cov-2 virus, the CT is not very sensitive, after that the CT has a high sensitivity of up to 98% but moderate to low specificity between 25 and 56% (Fang et al. 2020).
A wide variety of CT findings in COVID-19 was reported in several studies. After combining the available data in the previous literatures, it was found that the characteristic patterns and distribution of initial CT manifestations as ground-glass opacification (GGO) (88%), bilateral involvement (88%), posterior distribution (80%), multi-lobar involvement (79%), and peripheral distribution (76%); however, consolidative opacities (32%) mainly present in the elderly population (**e 2020). Other CT findings include interlobular septal thickening, bronchiectasis, pleural thickening, and subpleural involvement, with various rates across the studies, they present mainly in the later stages of the disease (Kay and Abbara 2020; Shi et al. 2020). Pleural effusion, pericardial effusion, lymphadenopathy, cavitation, CT halo sign, pneumothorax, multiple minute pulmonary nodules, and tree in bud appearance are uncommon or even rare findings. Therefore, the presence of these findings should raise the possibility of other diagnoses rather than COVID-19 disease or may be seen with disease progression (Song et al. 2020; Ai et al. 2020). Hence, CT can play a role in the triage of cancer patients undergoing surgical intervention, it can exclude or diagnose the possibility of COVID-19 infection, it determines the severity of the disease, and it plays a role in predicting the worsening or improvement of the disease.
Prioritization of cancer surgeries during COVID-19 pandemic
Elective cancer surgeries not affecting patient survival or disease prognosis are postponed during the peak and allowed during the plateau for proven COVID-19-free patients. Surgical treatment of cancer patients should be time sensitive with prioritization of emergency cases during the pandemic peak when all the health care workers and resources are consumed in the management of COVID-19-positive patients (Schrag et al. 2020). We follow special guidelines for different subspecialties in surgical oncology. Avoiding major resections and complex anastomoses should be the rule. Surgeons should manage patients with the least surgical procedures to avoid a long postoperative hospital stay and to minimize complications. Precautions to protect health care workers should be taken including wearing all available PPE (personal protective equipment).
Elective cases
Patients undergoing elective surgery should be screened for COVID-19, and surgery should be deferred in COVID-19-positive patients (Aminian et al. 2020).
Emergency cases
Admission of the emergency cases for surgery should follow the general diagnostic rules outlined in this article to diagnose COVID-19. During the pandemic crisis, any patient admitted to the cancer center should be considered a COVID-19-positive patient until proven otherwise. These cases may include:
-
Airway obstruction: Airway compromise needing tracheostomy like laryngeal cancers, post-cricoid carcinoma, and post thyroid surgery vocal cord paralysis or hematoma.
-
Bowel obstruction: Emergent cancer cases presenting with intestinal obstruction from colon cancer or any other cause that cannot be managed except by surgery is a priority (Gallo et al. 2020).
-
Bleeding: Bleeding from the gastrointestinal tract requiring emergency intervention and postoperative bleeding (Gallo et al. 2020).
-
Postoperative complications: Burst abdomen following abdominal procedures. Any postoperative complication that needs surgical interventions like high output fistulae and major leaks from GI anastomoses.
Urgent cases
The most urgent cases are those patients who cannot be given chemo or radiotherapy (tumor not sensitive or will result in major complications), and surgery is their primary mode of treatment and postponing their surgeries would likely affect their survival or results in the advancement of their cancer stage or significantly affect their outcome.
According to tumor site:
-
Breast cancer: Surgery is considered urgent for cases of malignant phyllodes, patients with progressive disease on chemotherapy, and angiosarcoma (Bartlett et al. 2020).
-
Hepatobiliary and pancreatic tumors: Surgery should be considered for patients with aggressive hepatobiliary and pancreatic tumors including colorectal cancer metastatic to the liver, cholangiocarcinoma, gastric, duodenal, and ampullary cancer (Bartlett et al. 2020).
-
Colorectal cancer: Early stage non-metastatic colon cancer should be operated upon as well as early stage rectal cancer. Transfusion-dependent colorectal cancers should undergo surgery urgently (Gallo et al. 2020).
-
Gastroesophageal cancers: Gastrointestinal stromal tumor (GIST) should undergo urgent surgery if the patient is symptomatic or has bleeding. Very early stages of gastric cancer that can undergo endoscopic resection are better to be managed by endoscopy if available. Early gastric cancers should be managed by surgery (Bartlett et al. 2020).
Endocrine tumors:
-
Thyroid gland: Rapidly progressive tumor invading the airway or vocal cords (Bartlett et al. 2020).
-
Para thyroid gland: Life-threatening hypercalcemia secondary to hyperparathyroidism not controlled through medical treatment (Bartlett et al. 2020).
-
Adrenal gland: Functional adrenal tumors not responding to medical treatment, e.g., pheochromocytoma (Bartlett et al. 2020).
-
Soft tissue tumors: Non-metastatic soft tissue sarcoma under staging.
Anesthetic management
Hospitalized patients are at a greater risk for nosocomial infection, thus should receive special attention (Lai et al. 2020). Unless proved negative (−ve) COVID-19 by laboratory and radiological findings, any patient present to surgery can be a diseased asymptomatic COVID-19 patient (He et al. 2020), thus necessitates dealing with such patient as a potentially infected one. Highly suspected cases to have COVID-19 with no time to do the test (due to urgency) should be treated as those confirmed cases with COVID-19 (Li et al. 2020). High-risk cases should be discussed with surgeons regarding the degree of urgency of operation, and the risk benefits if a delay is decided.
The patient is considered highly suspected COVID-19 if there is a history of traveling from high-risk areas, contact with cases of proved COVID-19 or contact with patients who have fever or respiratory symptoms within 14 days, and clustered cases onset, in addition to at least two clinical presentations of fever and/or respiratory symptoms, radiological features of pneumonia, a normal or decreased (white blood cell) WBC count, normal or decreased lymphocyte count in the early stage of onset (** et al. 2020), (http://www.satcm.gov.cn/), Fig. 1.
Preoperative evaluation
The main focus in preoperative assessment is to identify high-risk patients and procedures, in order to optimize the patient’s respiratory condition as appropriate. The infection control team should be involved early in suspected cases considering a prompt request for a rapid test to confirm the diagnosis to guide the managing team.
Elective cases
Health care workers are at risk of infection (Lai et al. 2020). Strict precautions should be followed throughout patient assessment in the preoperative assessment clinic. The responsible anesthetist and healthcare workers should wear gowns, disposable gloves, surgical or fit N95 masks, and eye goggles or face shield. Careful handwashing between patients should be adopted. Any patient suspected of COVID-19-positive should be reported to the infection control team (Chen et al. 2020a, 2020b).
Emergency cases
The responsible anesthetist in full personal protective equipment (PPE) will assess the patient as follows: assessment and evaluation of respiratory status through checking arterial blood gasses, X-ray, and/or CT chest radiography; full assessment of airway; and assessment for signs of shock or organ failure. Patients can present at the time of assessment with fever, chest crepitations, wheezing, and desaturation. Complete blood count, CT chest, liver function, and renal function tests should be requested.
Choice of anesthesia
General or regional anesthesia can be performed according to the site of surgery and patient’s condition, provided normal coagulation profile, platelet count, and function.
Performing regional anesthesia is better adopted whenever possible, thus avoiding airway manipulation and consequently reducing exposure to aerosols during coughing (Lie et al. 2020).
Intraoperative management
Using negative pressure operating theater is preferable to positive pressure one in COVID-19 highly suspected or confirmed cases to minimize the risk of viral spread (Wax and Christian 2020).
The main concern is to minimize as possible the number of health care providers exposed to the infected patient, and protect all of them as well as the patient through lowering the number of personnel in the operating room during the induction of anesthesia and throughout all the time the patient is in the theater, applying a bacterial viral filter to the expiratory limb of the breathing circuit, and applying disposable covers to surfaces to minimize contaminations (Wax and Christian 2020). All health care providers in the theatre should wear personal protective equipment (PPE). They should first have appropriate hand hygiene and then wear a fit N95 respirator, face protector shield, gown, and gloves (Velly et al. 2020).
Induction of anesthesia
Standard monitoring and pre-check intravenous access, instruments, drugs, ventilator, and suction should be applied (Orser 2020). Infection control measures should be strictly followed when intubating a COVID-19 patient, in order to avoid exposure to high viral load (Wang et al. 2020a, 2020b, 2020c) and preoxygenation with 100% oxygen at the minimal possible gas flow to ensure a good seal with a face mask. Intubation is better to be done by video laryngoscopy (Wax and Christian 2020). The use of video laryngoscopes aids to perform the first attempt easy, to keep a distance away from the patient’s airway, and to ensure complete muscle paralysis before endotracheal intubation to avoid cough (Lingappan et al. 2018).
Intubation should be done by an expert anesthesiologist in order to minimize the time of intubation and number of attempts (Wax and Christian 2020). Unless indicated, awake fiberoptic intubation should be avoided as atomized local anesthetic use can cause viral aerosolization and spread (Orser 2020).
Rapid sequence induction after a full dose of muscle relaxant is required to reduce the need for bag-mask manual ventilation of the lungs with the potential aerosolization of the virus from the patient’s airways (Li et al. 2020; Wax and Christian 2020; Caputo et al. 2006). If manual ventilation is anticipated, small tidal volumes should be applied (Kamming et al. 2003) with the use of a two-hand grip technique to ensure a good seal with a face mask. During induction of anesthesia if fentanyl is used, it should be administered slowly and preceded by 0.5 mg/kg lidocaine to suppress cough (Tan et al. 2018).
Apply positive pressure ventilation after inflation of the endotracheal tube cuff and confirm the endotracheal tube in position by observing bilateral chest wall movement and by CO2 curve on capnography, as auscultation may be difficult due to the PPE (Wax and Christian 2020).
Maintenance of anesthesia
Apply lung-protective mechanical ventilation strategy through setting the low tidal volume at 6 ml/kg and adjusting the respiratory rate to maintain minute ventilation and normo-capnea. Peak airway pressure should be noticed to be below 30 mmHg (Fan et al. 2018). During the mechanical ventilation, minimize the circuit disconnection to avoid aerosol dissemination in the environment and try to use a closed suctioning system when necessary.
Emergence from anesthesia
Smooth emergence should be the plan to avoid coughing and using anti-emetics to avoid vomiting. The patient should be kept after emergence in an isolation operating theater and arrange for case handover with the receiving nurse in the operating theater (Li et al. 2020). Administering high flow oxygen, nebulized medications, or noninvasive ventilation should be avoided (Tan 2004).
After the end of surgery, medical health providers should follow the instructions for taking off their PPE with proper hand hygiene to avoid self-contamination (Li et al. 2020; Peng et al. 2020). Disposable equipment should be discarded, and anesthesia machines and monitors should be properly disinfected under the supervision of a member of the infection control team.
Conclusion
The new coronavirus disease 2019 (COVID-19) emerged as a crisis that was stated to be a pandemic by WHO. Cancer patients are more vulnerable to get infected with more morbidity and mortality. Judgmental evaluation and management of each cancer patient should be considered during the pandemic especially during the peak of the disease. Elective cancer surgeries that can be delayed without threatening the patient’s life or prognosis should be postponed till the plateau is reached; however, emergency and urgent surgeries that can affect the patient’s life or prognosis should take place. All healthcare workers especially the anesthetists are at great risk for infection. Full precautions and strict adhesion to infection control measures must be adopted.
Availability of data and materials
Not applicable
Abbreviations
- COVID-19:
-
Coronavirus disease 2019
- WHO:
-
World Health Organization
- RT- PCR:
-
Reverse transcription-polymerase chain reaction
- PT:
-
Prothrombin time
- ALT:
-
Alanine transferase
- LDH:
-
Lactate dehydrogenase
- CRP:
-
C-reactive protein
- CT:
-
Computed tomography
- SARS-COV2:
-
Severe acute respiratory syndrome coronavirus 2
- H1N1:
-
Influenza A
- PPE:
-
Personal protective equipment
- PCR:
-
Polymerase chain reaction
- IgM:
-
Immunoglobulin M
- IgG:
-
Immunoglobulin G
- RNA:
-
Ribonucleic acid
- CD 4:
-
Cluster of differentiation 4
- CD 8:
-
Cluster of differentiation 8
- ICU:
-
Intensive care unit
- FDP:
-
Fibrin degradation product
- aPTT:
-
Activated partial thromboplastin time
- WBC:
-
White blood cell count
- SPO2 :
-
Oxygen saturation
- CO2 :
-
Carbon dioxide
References
Ai T, Yang Z, Hou H, Zhan C, Chen C, Lv W, Tao Q, Sun Z, **a L (2020) Correlation of chest CT and RT-PCR testing for coronavirus disease 2019 (COVID-19) in China: a report of 1014 cases. Radiology 296(2):E32–E40. https://doi.org/10.1148/radiol.2020200642
Al-Shamsi HO, Alhazzani W, Alhuraiji A, Coomes EA, Chemaly RF, Almuhanna M, Wolff RA, Ibrahim NK, Chua MLK, Hotte SJ, Meyers BM, Elfiki T, Curigliano G, Eng C, Grothey A, **e C (2020) A practical approach to the management of cancer patients during the novel coronavirus disease 2019 (COVID-19) pandemic: an international collaborative group. Oncologist 25(6). https://doi.org/10.1634/theoncologist.2020-0213
Aminian A, Safari S, Razeghian-Jahromi A, Ghorbani M, Delaney CP (2020) COVID-19 outbreak and surgical practice. Ann Surg 272(1):e27–e29. https://doi.org/10.1097/sla.0000000000003925
Bartlett DL, Howe JR, Chang G, Crago A, Hogg M, Karakousis G, Levine E, Maker A, Mamounas E, McGuire K, Merchant N, Shibata D, Sohn V, Solorzano C, Turaga K, White R, Yang A, Yoon S (2020) Management of cancer surgery cases during the COVID-19 pandemic: considerations. Ann Surg Oncol 27(6):1717–1720. https://doi.org/10.1245/s10434-020-08461-2
Benvenuto D, Giovanetti M, Ciccozzi A, Spoto S, Angeletti S, Ciccozzi M (2020) The 2019-new coronavirus epidemic: evidence for virus evolution. J Med Virol 92(4):455–459. https://doi.org/10.1002/jmv.25688
Caputo KM, Byrick R, Chapman MG, Orser BA, Orser BJ (2006) Intubation of SARS patients: infection and perspectives of healthcare workers. Can J Anesthesia 53(2):122–129. https://doi.org/10.1007/BF03021815
Chan JFW, Yuan S, Kok KH, To, K. K. W, Chu H, Yang J, **ng F, Liu J, Yip CCY, Poon RWS, Tsoi HW, Lo SKF, Chan KH, Poon VKM, Chan WM, Ip JD, Cai JP, Cheng VCC, Chen H et al (2020) A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet 395(10223):514–523. https://doi.org/10.1016/S0140-6736(20)30154-9
Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, **a J, Yu T, Zhang X, Zhang L (2020a) Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 395(10223):507–513. https://doi.org/10.1016/S0140-6736(20)30211-7
Chen X, Liu Y, Gong Y, Guo X, Zuo M, Li J, Shi W, Li H, Xu X, Mi W, Huang Y (2020b) Perioperative management of patients infected with the novel coronavirus. Anesthesiology 132(6):1307–1316. https://doi.org/10.1097/ALN.0000000000003301
Dignani MC, Costantini P, Salgueira C, Jordán R, Guerrini G, Valledor A, Herrera F, Nenna A, Mora C, Roccia-Rossi I, Stecher D, Carbone E, Laborde A, Efron E, Altclas J, Calmaggi A, Cozzi J (2014) Pandemic 2009 Influenza A (H1N1) virus infection in cancer and hematopoietic stem cell transplant recipients; a multicenter observational study. F1000Research 3. https://doi.org/10.12688/f1000research.5251.1
El Desouky ED (2020) Prediction of the epidemic peak of Covid19 in Egypt. medRxiv 395:931-934.
Fan E, Brodie D, Slutsky AS (2018) Acute respiratory distress syndrome advances in diagnosis and treatment. JAMA 319(7):698–710. https://doi.org/10.1001/jama.2017.21907
Fang Y, Zhang H, **e J, Lin M, Ying L, Pang P, Ji W (2020) Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology 296(2):E115–E117. https://doi.org/10.1148/radiol.2020200432
Gallo G, La Torre M, Pietroletti R, Bianco F, Altomare DF, Pucciarelli S, Gagliardi G, Perinotti R (2020) Italian society of colorectal surgery recommendations for good clinical practice in colorectal surgery during the novel coronavirus pandemic. Techniques Coloproctol 24(6):501–505. https://doi.org/10.1007/s10151-020-02209-6
He G, Sun W, Fang P, Huang J, Gamber M, Cai J, Wu J (2020) The clinical feature of silent infections of novel coronavirus infection (COVID-19) in Wenzhou. J Med Virol 92(10):1761–1763. https://doi.org/10.1002/jmv.25861
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, **a J, Wei Y, Wu W, **e X, Yin W, Li H, Liu M et al (2020a) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 395(10223):497–506. https://doi.org/10.1016/S0140-6736(20)30183-5
Huang P, Liu T, Huang L, Liu H, Lei M, Xu W, Hu X, Chen J, Liu B (2020b) Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology 295(1):22–23. https://doi.org/10.1148/radiol.2020200330
Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, Ippolito G, Mchugh TD, Memish ZA, Drosten C, Zumla A, Petersen E (2020) The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health — the latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis 91:264–266. https://doi.org/10.1016/j.ijid.2020.01.009
** Y-H, Cai L, Cheng Z-S, Cheng H, Deng T, Fan Y-P, Fang C, Huang D, Huang L-Q, Huang Q, Han Y, Hu B, Hu F, Li B-H, Li Y-R, Liang K, Lin L-K, Luo L-S, Ma J et al (2020) A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Military Med Res 7(1):4. https://doi.org/10.1186/s40779-020-0233-6
Kamming D, Gardam M, Chung F (2003) I. Anaesthesia and SARS. Br J Anaesthesia 90(6):715–718. https://doi.org/10.1093/bja/aeg173
Kay F, Abbara S (2020) The many faces of COVID-19: spectrum of imaging manifestations. Radiol Cardiothoracic Imaging 2(1):e200037. https://doi.org/10.1148/ryct.2020200037
Lai CC, Liu YH, Wang CY, Wang YH, Hsueh SC, Yen MY, Ko WC, Hsueh PR (2020) Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths. J Microbiol Immunol Infect 53(3):404–412. https://doi.org/10.1016/j.jmii.2020.02.012
Lauer SA, Grantz KH, Bi Q, Jones FK, Zheng Q, Meredith HR, Azman AS, Reich NG, Lessler J (2020) The incubation period of coronavirus disease 2019 (CoVID-19) from publicly reported confirmed cases: estimation and application. Ann Intern Med 172(9):577–582. https://doi.org/10.7326/M20-0504
Li W, Huang J, Guo X, Zhao J, Mandell MS (2020) Anesthesia management and perioperative infection control in patients with the novel coronavirus. J Cardiothorac Vasc Anesthesia. https://doi.org/10.1053/j.jvca.2020.03.035
Liang W, Guan W, Chen R, Wang W, Li J, Xu K, Li C, Ai Q, Lu W, Liang H, Li S, He J (2020) Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China. Lancet Oncol 21(3):335–337. https://doi.org/10.1016/S1470-2045(20)30096-6
Lie SA, Wong SW, Wong LT, Wong TGL, Chong SY (2020) Practical considerations for performing regional anesthesia: lessons learned from the COVID-19 pandemic. Can J Anesthesia 67(7):885–892. https://doi.org/10.1007/s12630-020-01637-0
Lingappan K, Arnold JL, Fernandes CJ, Pammi M (2018, 2018) Videolaryngoscopy versus direct laryngoscopy for tracheal intubation in neonates. Cochrane Database Syst Rev (6). https://doi.org/10.1002/14651858.CD009975.pub3
Lippi G, Simundic A-M, Plebani M (2020) Potential preanalytical and analytical vulnerabilities in the laboratory diagnosis of coronavirus disease 2019 (COVID-19). Clin Chem Lab Med 58(7):1070–1076. https://doi.org/10.1515/cclm-2020-0285
Liu J, Liu Y, **ang P, Pu L, **ong H, Li C, Zhang M, Tan J, Xu Y, Song R, Song M, Wang L, Zhang W, Han B, Yang L, Wang X, Zhou G, Zhang T, Li B et al (2020a) Neutrophil-to-lymphocyte ratio predicts severe illness patients with 2019 novel coronavirus in the early stage. https://doi.org/10.1101/2020.02.10.20021584
Liu Y, Yang Y, Zhang C, Huang F, Wang F, Yuan J, Wang Z, Li J, Li J, Feng C, Zhang Z, Wang L, Peng L, Chen L, Qin Y, Zhao D, Tan S, Yin L, Xu J et al (2020b) Clinical and biochemical indexes from 2019-nCoV infected patients linked to viral loads and lung injury. SciChina Life Sci 63(3):364–374. https://doi.org/10.1007/s11427-020-1643-8
Mehta V, Goel S, Kabarriti R, Cole D, Goldfinger M, Acuna-Villaorduna A, Pradhan K, Thota R, Reissman S, Sparano JA, Gartrell BA, Smith RV, Ohri N, Garg M, Racine AD, Kalnicki S, Perez-Soler R, Halmos B, Verma A (2020) Case fatality rate of cancer patients with COVID-19 in a New York Hospital System. Cancer Discov 10(7):935–941. https://doi.org/10.1158/2159-8290.CD-20-0516
Orser BA (2020) Recommendations for endotracheal intubation of COVID-19 patients. Anesthesia Analgesia:1109–1110. https://doi.org/10.1213/ANE.0000000000004803
Peng PWH, Ho PL, Hota SS (2020) Outbreak of a new coronavirus: what anaesthetists should know. Br J Anaesthesia 124(5):497–501. https://doi.org/10.1016/j.bja.2020.02.008
Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, Zimmer T, Thiel V, Janke C, Guggemos W, Seilmaier M, Drosten C, Vollmar P, Zwirglmaier K, Zange S, Wölfel R, Hoelscher M (2020) Transmission of 2019-NCOV infection from an asymptomatic contact in Germany. N Eng J Med 382(10):970–971. https://doi.org/10.1056/NEJMc2001468
Schrag D, Hershman DL, Basch E (2020) Oncology practice during the COVID-19 pandemic. JAMA 323(20):2005. https://doi.org/10.1001/jama.2020.6236
Shi H, Han X, Jiang N, Cao Y, Alwalid O, Gu J, Fan Y, Zheng C (2020) Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis 20(4):425–434. https://doi.org/10.1016/S1473-3099(20)30086-4
Singhal T (2020) A review of coronavirus disease-2019 (COVID-19). Indian J Pediatrics 87(4):281–286. https://doi.org/10.1007/s12098-020-03263-6
Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, Ling Y, Jiang Y, Shi Y (2020) Emerging 2019 novel coronavirus (2019-NCoV) pneumonia. Radiology 295(1):210–217. https://doi.org/10.1148/radiol.2020200274
Tan TK (2004) How severe acute respiratory syndrome (SARS) affected the Department of Anaesthesia at Singapore General Hospital. Anaesthesia Intensive Care 32(3):394–400. https://doi.org/10.1177/0310057x0403200316
Tan W, Li S, Liu X, Gao X, Huang W, Guo J, Wang Z (2018) Prophylactic intravenous lidocaine at different doses for fentanyl-induced cough (FIC): a meta-analysis. Sci Rep 8(1). https://doi.org/10.1038/s41598-018-27457-3
Tang N, Li D, Wang X, Sun Z (2020) Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thrombosis Haemostasis 18(4):844–847. https://doi.org/10.1111/jth.14768
Velly L, Gayat E, Quintard H, Weiss E, De Jong A, Cuvillon P, Audibert G, Amour J, Beaussier M, Biais M, Bloc S, Bonnet MP, Bouzat P, Brezac G, Dahyot-Fizelier C, Dahmani S, de Queiroz M, Di Maria S, Ecoffey C et al (2020) Guidelines: anaesthesia in the context of COVID-19 pandemic. Anaesthesia Crit Care Pain Med 39(3):395–415. https://doi.org/10.1016/j.accpm.2020.05.012
Wang C, Horby PW, Hayden FG, Gao GF (2020a) A novel coronavirus outbreak of global health concern. Lancet 395(10223):470–473. https://doi.org/10.1016/S0140-6736(20)30185-9
Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, Tan W (2020b) Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. https://doi.org/10.1001/jama.2020.3786
Wang Y, Wang Y, Chen Y, Qin Q (2020c) Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol 92(6):568–576. https://doi.org/10.1002/jmv.25748
Wax RS, Christian MD (2020) Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anesthesia 67(5):568–576. https://doi.org/10.1007/s12630-020-01591-x
**e X (2020) Chest CT for typical 2019-nCoV pneumonia: relationship to negative RT-PCR testing. J Clin Microbiol 58(April):1–5. https://doi.org/10.1136/bmj.m2516
Ye Q, Wang B, Mao J, Fu J, Shang S, Shu Q, Zhang T (2020) Epidemiological analysis of COVID-19 and practical experience from China. Journal of Medical Virology 92(7):755–769. https://doi.org/10.1002/jmv.25813
Zhang L, Zhu F, **e L, Wang C, Wang J, Chen R, Jia P, Guan HQ, Peng L, Chen Y, Peng P, Zhang P, Chu Q, Shen Q, Wang Y, Xu SY, Zhao JP, Zhou M (2020a) Clinical characteristics of COVID-19-infected cancer patients: a retrospective case study in three hospitals within Wuhan, China. Ann Oncol 31(7):894–901. https://doi.org/10.1016/j.annonc.2020.03.296
Zhang W, Du R-H, Li B, Zheng X-S, Yang X-L, Hu B, Wang Y-Y, **ao G-F, Yan B, Shi Z-L, Zhou P (2020b) Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes. Emerging Microbes Infect 9(1):386–389. https://doi.org/10.1080/22221751.2020.1729071
Zhao J, Yuan Q, Wang H, Liu W, Liao X, Su Y, Wang X, Yuan J, Li T, Li J, Qian S, Hong C, Wang F, Liu Y, Wang Z, He Q, Li Z, He B, Zhang T et al (2020) Antibody responses to SARS-CoV-2 in patients of novel coronavirus disease 2019 | Clinical Infectious Diseases | Oxford Academic. Clin Infect Dis ciaa344. https://doi.org/10.1093/cid/ciaa344/5812996
Acknowledgements
Not applicable
Funding
There was no external funding for this work.
Author information
Authors and Affiliations
Contributions
WE: Initiated the study idea and shared in writing and revising the manuscript. OY: Shared in writing the manuscript. AR: Shared in writing the manuscript. RI: Shared in writing the manuscript. HM: Shared in writing the manuscript. EK: Shared in writing the manuscript. RO: Shared in writing the manuscript. AG: Shared in writing the manuscript. All authors have read and approved the manuscript.
Corresponding author
Ethics declarations
Ethics approval and consent to participate
Not applicable
Consent for publication
Not applicable
Competing interests
The authors declare that they have no competing interests.
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.
About this article
Cite this article
Elsabeeny, W.Y., Abd El Dayem, O.Y., Rabea, A. et al. Insights of COVID-19 pandemic impact on anesthetic management for patients undergoing cancer surgery in the National Cancer Institute, Egypt. Ain-Shams J Anesthesiol 12, 59 (2020). https://doi.org/10.1186/s42077-020-00110-w
Received:
Accepted:
Published:
DOI: https://doi.org/10.1186/s42077-020-00110-w