Perioperative Management of Patients Infected with the Novel Coronavirus

Abstract

The outbreak of the new Coronavirus disease, COVID-19, has been involved in 77,262 cases in China as well as in 27 other countries as of February 24, 2020. Because the virus is novel to human beings, and there is no vaccine yet available, every individual is susceptible and can become infected. Healthcare workers are at high risk, and unfortunately, more than 3,000 healthcare workers in China have been infected. Anesthesiologists are among healthcare workers who are at an even higher risk of becoming infected because of their close contact with infected patients and high potential of exposure to respiratory droplets or aerosol from their patients’ airways. In order to provide healthcare workers with updated recommendations on the management of patients in the perioperative setting as well as for emergency airway management outside of the operating room, the two largest anesthesia societies, the Chinese Society of Anesthesiology (CSA) and the Chinese Association of Anesthesiologists (CAA) have formed a task force to produce the recommendations. The task force hopes to help healthcare workers, particularly anesthesiologists, optimize the care of their patients and protect patients, healthcare workers, and the public from becoming infected. The recommendations were created mainly based on the practice and experience of anesthesiologists who provide care to patients in China. Therefore, adoption of these recommendations outside of China must be done with caution, and the local environment, culture, uniqueness of the healthcare system, and patients’ needs should be considered. The task force will continuously update the recommendations and incorporate new information in future versions.

Attitudes of Anesthesiology Specialists and Residents toward Patients Infected with the Novel Coronavirus (COVID-19): A National Survey Study

“…Anesthesiologists are in close contact with infected patients and are vulnerable in terms of exposure to respiratory droplets or aerosols from patients' airways. Therefore, they are at a higher risk of infection than other healthcare providers [9]. The national level of knowledge of anesthesiology and reanimation specialists and residents, as well as their approaches toward COVID-19 patients, are discussed in this study.…”

Social distancing: implications for the operating room in the face of COVID-19

“…For example, the Joint Task Force of the Chinese Society for Anesthesiology (CSA) and the Chinese Association of Anesthesiologists recommends: 1) the use of dedicated, clustered COVID-19 ORs with negative pressure systems, 2) dedicated anesthesia machines for these rooms, and 3) allowing only the minimum number of staff required for direct patient care. 20 The CSA also recommends proceeding directly to modified rapid sequence induction and intubation for suspected COVID-19 patients in respiratory distress, rather than risk exposing healthcare workers to the aerosol formation associated with bag-mask ventilation. 21 In Singapore, specific work spaces near the ORs were designated for the donning and doffing of personal protective equipment and numbered posters were hung to guide staff through the steps.…”

“…Par exemple, le Groupe de travail mixte de la Société chinoise d'anesthésiologie (Joint Task Force of the Chinese Society for Anesthesiology (CSA)) et l'Association chinoise des anesthésiologistes (Chinese Association of Anesthesiologists) recommandent : 1) l'utilisation de SOP dédiées et regroupées pour la COVID-19 munies de système de pression négative; 2) des machines anesthésiques dédiées pour ces salles; et 3) ne permettre que le personnel minimum requis pour les soins directs au patient. 20 La CSA recommande également de procéder directement à une induction en séquence rapide modifiée avec intubation chez les patients suspectés de COVID-19 en détresse respiratoire, plutôt que de risquer d'exposer les travailleurs de la santé à la formation d'aérosols associés à la ventilation au masque. 21 À Singapour, des espaces de travail spécifiques proches des SOP ont été désignés pour le revêtement et le retrait de l'équipement de protection individuelle et des affiches numérotées ont été apposées afin de guider le personnel à travers ces étapes.…”

Rapid Cycle Implementation and Retrospective Evaluation of a SARS-CoV-2 Checklist in Labor and Delivery

“…Our L&D unit serves as a regional referral center serving an urban, metropolitan area of approximately 4.6 million people, and is the academic teaching hospital for Beth Israel Lahey Health, a state-wide hospital network representing more than 15,000 births annually. We reviewed the available literature on both SARS-CoV-2 and other related viruses (14), including recommendations on the standards of care from government and professional bodies such as the American College of Obstetrics and Gynecology (ACOG), the Society for Obstetric Anesthesia and Perinatology (SOAP) and the Anesthesia Patient Safety Foundation (APSF) (15)(16)(17). We combined these recommendations with our own organization's newly designed perioperative work ows for COVID-19 patients to create the L&D work ow for the COVID-19 parturient requiring perioperative care.…”