- Management of the dedicated operating room(OR):
- The OR should be adequately ventilated, ideally with negative pressure.
- The same OR and the same anesthesia machine should be used for COVID-19 positive patients.
- The anesthetic drug trolley should be kept in the induction room and all the drugs and equipment required for the procedure should be placed onto a tray. All unused items on the tray are considered contaminated.
- Transportation of a COVID-19 positive patient :
- The route from the ward or intensive care unit (ICU) to the OR should be cleared.
- The patient should wear face mask during transport.
- The ward nurses and ICU personnel should be in full PPE.
- For ICU patients, gas flow should be turned off and endotracheal tube clamped with forceps while switching of ventilators.
- Anesthesia management :
- General anesthesia is recommended for COVID-19 positive patients to reduce risk of coughing and bucking.
- Spinal anesthesia is still recommended as the primary choice for cesarean delivery in mother with COVID-19.
- Aerosol generation during airway instrumentation should be minimised :
- Airway should be managed by the most experienced anaesthetist.
- Preoxygenation with 100% oxygen and rapid sequence induction should be considered to avoid manual ventilation.
- Awake fibreoptic intubation should be avoided. Video laryngoscope is to be considered.
- Tracheal intubation is preferable to laryngeal mask.
- Closed airway suction system is recommended.
- Breathing circuit filter should be placed between the proximal end of the endotracheal tube and the distal end of the circuit.
- In airway management outside of the OR:
- avoid non-invasive ventilation and early intubation should be considered.
- Chest compressions should be held during intubation.
- After the procedure :
- Patients who do not require ICU care are fully recovered in the OR.
- A minimum of one hour is planned between cases.
- All staff should shower.
- A hydrogen peroxide vaporizer is used to decontaminate the OR.
This data comes from analysis of three articles published in Anesthesiology, British Journal of Anaesthesia and Canadian Journal of Anaesthesia in regards of having to operate and performing aerosol-generating medical procedures in COVID-19 positive patients.
Sources:
- Chen X., Liu Y., Gong Y., et al (March 19, 2020) Perioperative Management of Patients Infected with the Novel Coronavirus. Anesthesiology. DOI:10.1097/ALN.0000000000003301
- Peng PWH., Ho PL., Hota SS. (February 27, 2020) Outbreak of a new coronavirus : what anaesthetists should know. British Journal of Anaesthesia. DOI:10.1016/j.bja.2020.02.008
- Ti LK., Ang LS., Foong TW., et al (March 6 2020) What we do when a COVID-19 patient needs an operation: operating room preparation and guidance. Canadian Journal of Anaesthesia. DOI:10.1007/s12630-020-01617-4