- Preoperative evaluation:
- Elective or semi elective cardiac surgeries should be postponed until the results for virus detection are negative
- For emergent cardiac surgery for patients with suspected/confirmed SARS-CoV2, nucleic acid testing and chest CT scanning should be done, and level 3 infection control precautions should be taken by the healthcare staff.
- Intraoperative management and anesthetic preparation
- As any case under general anesthesia, succinylcholine or rocuronium (fast-acting muscle relaxants) are recommended and endotracheal intubation is preferred using video laryngoscopes.
- Lower respiratory secretions should be collected and sent for examination
- The benefits of dexmedetomidine is still unclear for patients with COVID-19
- The use of steroids for critically ill COVID-19 patients is still controversial and steroids are not recommended.
- For long duration surgeries such as aortic dissection repair, direct hemodynamic monitoring with arterial and central lines is essential, ultrasound guidance to increase efficiency should be prioritized, decreased humidity in the OR can allow medical staff to be more comfortable and the use of medical adhesive tape to make the connection between the goggles and mask is suggested.
- Postoperative management:
- To prevent nausea and vomiting, a dose of 5-hydroxytryptamine receptor antagonist should be provided to the patient.
This data comes from two different sources.
The first article is a report based on 4 cases of aortic dissection repair that were successful in patients with suspected COVID-19 in Wuhan. The 4 patients (3 males and 1 female from 51-62 years) had a Stanford type A aortic dissection on computed tomography scan and many pulmonary inflammatory changes. This report analyses the different knowledge and experience on the anesthetic management for critically ill patients that must undergo long surgeries at high risk.
The second article, with the contribution of the members of the Chinese Society of Anesthesiology and Dr. Jiapeng Huang, gives guidelines and knowledge for cardiovascular surgery and different prevention and control measures that must be taken with the new COVID-19 pandemic.
Hao He., Shuai Zhao., Linlin Han., Qi Wang., Haifa Xia., Xin Huang., Shanglong Yao., Jiapeng Huang., Xiangdong Chen., Anesthetic Management of Patients Undergoing Aortic Dissection Repair With Suspected Severe Acute Respiratory Syndrome Coronavirus-2 Infection. (March 16, 2020) Journal of Cardiothoracic and Vascular Anesthesia
Yi He., Jinfeng Wei., Jinjun Bian., Kefang Guo., Jiakai Lu., Wei Mei., Jun Ma., Zhongyuan Xia., Meiying Xu., Fuxia Yan., Chunhua Yu., E. Wang., Weijian Wang, .,
Ni Zeng., Sheng Wang., Junmei Xu., Yuguang Huang., Jiapeng Huang. Chinese Society of Anesthesiology Expert Consensus on Anesthetic Management of Cardiac Surgical Patients With Suspected or Confirmed Coronavirus Disease 2019 (March 30,2020) Journal of Cardiothoracic and Vascular Anesthesia