Based on our preliminary case series, awake open surgery has resulted feasible and safe. This approach has allowed to perform undelayable major abdominal surgeries on fragile patients when intensive care beds were not available. Surely, it represents a helpful alternative in the COVID-19 era.

A streamlining of workflows would fast-track both fragile patients management, as well as healthcare workers’ tasks and activity.

None of the patients was intubated. Mean operative time was 80 minutes (minimum 30 minutes, maximum 130 minutes).

Intraoperative and postoperative pain were both well controlled. None of them required postoperative intensive care support.

No perioperative complications were observed.

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