Surgeons at Lok Nayak hospital, the 2,000-bed hospital dedicated to patients infected with the coronavirus disease (Covid-19), have performed at least 15 surgeries on such patients.
Of these, 14 were caesarean operations and one was to stem uncontrolled bleeding.
This is the highest number of surgeries performed on Covid-19 patients in a city hospital.
There have been at least four such surgeries at the All India Institute of Medical Sciences (AIIMS), which accommodates the second-highest number of Covid-19 patients and has a dedicated operation theatre for suspected and positive Covid-19 patients.
There are 578 Covid-19 positive patients admitted to Lok Nayak hospital and 403 admitted to AIIMS, according to the daily data shared by the government.
“There have been four surgeries performed on Covid-19 positive patients so far, including two C-sections,” Dr DK Sharma, medical superintendent of AIIMS, said.
Since the virus is highly infectious, the doctors have had to take several measures, such as changing the air-supply mechanism in operation theatres and using a fibre-glass box for the intubation of patients to reduce the risk of healthcare workers contracting the infection.
At Lok Nayak hospital, an isolated air conditioning system and an exhaust are used to create a negative pressure environment that does not allow the virus to escape the operating theatre.
“To further reduce the healthcare workers’ chances of exposure to the virus inside the room, a fibreglass box is placed over the face of the person undergoing surgery while they are intubated or given anaesthesia. Both these procedures generate aerosols from the respiratory tract, which contain the highest viral load,” Dr Bharti Wadhwa, professor, department of anaesthesiology at Lok Nayak hospital, said. The doctors also use a video-guided laryngoscope to perform the intubation so that they do not have to look down the throat of an infected person.
Working with personal protective equipment (PPE) is a challenge as it reduces the doctors’ visibility by 60%.
“We have to don a sterile gown and gloves over the PPE kits, which are not sterile and might pass on an infection to the patient. With the layers of material, it is not just hot to work in the OTs, it also reduces our efficiency by 40%,” Dr Wadhwa said.
“Within 10 minutes of starting the surgery, the goggles and face shields get foggy because of perspiration. This reduces our vision by 60%. So, the doctors have to depend on their experience and tactile memory to work through the surgery,” Dr Abhishek Singh of the department of anaesthesia at AIIMS said.
Currently, only emergent procedures wherein the patient would not survive without surgery for the next 24 hours are performed despite the patient testing positive. Other elective surgeries have been postponed.
“For non-emergency procedures, a patient is tested to determine whether (s)he is infected before the surgery is performed,” Dr Singh said.
“The emergency surgeries—even wherein the patient is suspected to have the infection—are being performed with adequate protective gear. The most common emergency surgeries are caesarean sections and other obstetric surgeries. Other than that, orthopaedic surgeries are also taking place—people have not stopped breaking their bones and falling. Road traffic accidents have reduced, but are not zero. And, doctors at AIIMS are performing some basic surgeries such as cancer surgeries that cannot wait,” Dr Anjan Trikha, professor of anaesthesiology and critical care at AIIMS, said.
Three OTs are running round-the-clock at the hospital.
