Background. During the outbreak of coronavirus disease 2019 (COVID-19), allocating intensive care beds to patients needing acute care surgery became a very difficult task. Moreover, since general anesthesia is an aerosol-generating procedure, its use became controversial. This strongly restricted therapeutic strategies. Here, we report a series of undeferrable surgical cases treated with awake surgery under neuraxial anesthesia. Contextual benefits of this approach are deepened. Methods. During the first pandemic surge, thirteen patients (5 men and 8 women) with a mean age of 80 years, needing undelayable surgery due to abdominal emergencies, underwent awake open surgery at our Hospital. Prior to surgery, all patients underwent nasopharyngeal swab tests for COVID-19 diagnosis. In all cases, regional anesthesia (spinal, epidural, or combined spinal-epidural anesthesia) was performed. Intraoperative and postoperative pain intensities have been monitored and regularly assessed. A distinct pathway has been set up to keep patients of uncertain COVID-19 diagnosis separated from all other patients. Postoperative course has been examined. Results. The mean operative time was 87 minutes (minimum 60 minutes; maximum 165 minutes). In one case, conversion to general anesthesia was necessary. Postoperative pain was always well controlled. None of them required postoperative intensive care support. No perioperative major complications (Clavien–Dindo ≥3) occurred. Early readmission after surgery never occurred. All nasopharyngeal swabs resulted negative. Conclusions. In our experience, awake laparotomy under regional anesthesia resulted feasible, safe, painless, and, in specific cases, was the only viable option. This approach allowed prevention of the need of postoperative intensive monitoring during the COVID-19 era. In such a peculiar time, we believe it could become part of an ICU-preserving strategy and could limit viral transmission inside theatres.

中文翻译：

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COVID-19时代清醒的主要腹部手术

背景。在2019年冠状病毒病（COVID-19）爆发期间，为需要急诊手术的患者分配重症监护床成为一项非常艰巨的任务。此外，由于全身麻醉是一种气雾产生过程，因此其使用引起了争议。这强烈限制了治疗策略。在这里，我们报告了一系列在神经麻醉下用清醒手术治疗的顽固性手术病例。这种方法的上下文优势得到了加深。方法。在第一次大流行期间，我院进行了13例平均年龄80岁的患者（5例男性和8例女性），由于腹部紧急情况而需要进行不延误的手术，因此他们接受了清醒的开放手术。手术前，所有患者均接受了鼻咽拭子测试以诊断COVID-19。在所有情况下，均进行区域麻醉（脊柱，硬膜外或脊柱－硬膜外联合麻醉）。术中和术后疼痛强度已被监测并定期评估。已建立了一条独特的途径，以将COVID-19诊断不确定的患者与所有其他患者区分开。术后经过检查。结果。平均手术时间为87分钟（最少60分钟；最多165分钟）。在一种情况下，必须转换为全身麻醉。术后疼痛始终得到良好控制。他们都不需要术后重症监护支持。围手术期未发生重大并发症（Clavien–Dindo≥3）。手术后早期再入院从未发生过。所有鼻咽拭子均为阴性。结论。根据我们的经验，在区域麻醉下清醒剖腹手术是可行，安全，无痛的，在特定情况下，这是唯一可行的选择。这种方法可以防止在COVID-19时代进行术后强化监护。在如此特殊的时期，我们相信它可能成为保存ICU的策略的一部分，并可能限制剧院内的病毒传播。