A Change of Tide or the Beginning of the End: COVID-19

Abstract

The year 2020 has been unique in the history of mankind, humanity, scientific provocation, and challenge. Amid the ongoing threat to mankind due to coronavirus disease-2019 (COVID-19), a resurfacing of the gruesome reality of racism and inequality emerged. The entire scientific community, while dealing with this ongoing pandemic, busy looking for answers to every aspect of the disease from the origin, to spread, to prevention, to treatment to the distribution of therapies, has been gripped with another tangential part of an implicit and covert culture of racism, bigotry, and discrimination. Moving forward, acknowledging the truth, making amends; eventually, science delivered . . . once again. Indeed, while it has been one of the most threatening times for mankind, it has also been the most successful year for science. Development to deliver a vaccine in 10 months is a remarkable achievement in science’s entire history, never seen before! Moving forward from the “New Normal” as pointed in the previous editorial of the Journal, to the current “Change of Tide” we present another set of scientifically astute articles in perioperative medicine. As the readers will notice, this issue shows an original research article, narrative reviews, and a bunch of case reports. Lefevre et al1 in their basic science study of hemorrhagic shock in rat model demonstrated that intravenous waveform analysis obtained from fast Fourier transform analysis and fundamental frequency amplitude was superior to central venous pressure measurement, and also correlated well with left ventricular end-diastolic area and mean arterial pressure. Hemorrhagic shock experimental models are mainly 4 types, a fixed-pressure, a fixed-volume, a controlled hemorrhage, and an uncontrolled hemorrhage models.2 In their study, the authors evaluated a controlled-hemorrhagic shock model to assess changes in fundamental frequency, central venous pressure, and left ventricular end-systolic dimension in relation to mean arterial pressure. How effectively the rat model of shock translates to humans, considering the complex pathophysiologic process and the immunological alterations during the injury process, is incompletely understood. Microvascular (blood vessels <100 μm diameter) response in rats may not translate similarly as in humans for macrovascular collapse, like hemorrhagic shock, which may lead to different “vulnerability curves.”3 As has been suggested, chasing a continuous central venous pressure in shock may erroneously lead to over-resuscitation or under-resuscitation influenced by the patient being in either the “ebb” or “flow” phase of shock.4 Hence, the role of dynamic monitors has proved to be more useful.5 Several pulsed-wave analyses exist, but each comes with its own set of limitations.6 Lefevre et al go one further step in developing and testing dynamic monitors for which intravenous waveform analysis could be a future way for estimating volume status in different clinical settings such as hemorrhagic shock. Whitener et al7 provide a narrative review of the conundrum of asymptomatic severe aortic stenosis and noncardiac surgery. In the current state of affairs, the clinical decisions in medicine are made to balance risk versus benefit by optimizing care, time, and cost-effectiveness.8 This leads to a lot of individual opinions (bias) based on experience, education, and opinions. As evident in cardiology, several randomized controlled trials have yielded results that have contradicted “common sense” and “observational” studies, often referred to as real-world data.9 For anesthesiologists, probably orthopedic surgeries are the most frequent noncardiac surgery encountered in patients with aortic stenosis, more so after the advent of transcatheter aortic valve replacement.10 A recent retrospective 989132 SCVXXX10.1177/1089253221989132Seminars in Cardiothoracic and Vascular AnesthesiaPal et al editorial2021