Surgeries in three-layer PPEs new normal at PGIMER
CHANDIGARH: For doctors at the neurosurgery department of the Post Graduate Institute of Medical Education and Research (PGIMER), it was going to be a routine surgery performed in emergency situations. But only a few minutes before the surgery, the patient tested positive for the coronavirus.
It was the first of its kind surgery that the doctors at the institute had to perform on a Covid positive patient for three hours on May 29. Another such surgery was conducted earlier this week. So far, around four surgeries on suspected or positive patients have been conducted at PGIMER.
“We had been preparing for this. We knew this was going to happen soon, but we expected them to be cases of pregnant women about to deliver, but this was unexpected. We had conducted mock drills in which we noted actual time to shift the patient from the wards concerned to the designated Covid-19 operation theatre,” said professor Vipin Koushal, in-charge of Covid hospital at PGIMER.
The main concerns remain, “How to shift the equipment from the respective departments’ operation theatres to the Covid facility and more importantly, training surgeons to don and doff personal protection equipment,” he added.
REAL CHALLENGE BEGINS IN OT
“It is a totally different setup now. Covid-19 has changed the way surgeries are performed. Surgeons have to don PPE including face shields and perform complicated procedures wearing those heavy suits,” said Dr SK Gupta, head of neurosurgery department, PGIMER, during a media interaction.
The emergency and trauma services of the institute have been fully functional throughout the lockdown period. In surgical specialties, around 40-50 such patients are being managed every day. In neurosurgery alone, 545 emergency and trauma cases have been operated upon. These were patients with head injury, spine injury, brain hemorrhage, brain stroke and brain tumours. However, doctors say it is tough to conduct these procedures wearing three-layer PPE suits, without air-conditioners.
‘TRAINING TO GET IT NORMALISED’
Dr Anurodh Kumar, one of the surgeons, said: “When there is an open skull in front of you, you don’t think about what you are wearing. But when you sit down for a break, you notice the sweat and fog on your face shields. It is tough but there is no choice here. You have to continue anyhow. It has to get normalised and we are getting training for it.”
Commenting upon how this can be managed in the future, Dr Gupta said there is no shortcut to it, but testing has to be ramped up. “For emergency patients, we cannot wait for a long duration for the patient’s Covid status, but PGIMER has started using a tuberculosis machine, GeneXpert, for quicker diagnosis,” he said.
The GeneXpert was launched at PGIMER in 2016 to speedily diagnose multidrug-resistant tuberculosis (MDR-TB). The polymerase chain reaction (PCR) testing system generates results in two hours, which can otherwise take somewhere between 6-7 hours.
“If you know the Covid status of the patient, you plan accordingly. Virus is going to stay, and this process has to become the new normal now,” Dr Gupta said.