Post-Acute COVID-19 Syndrome for Anesthesiologists: A Narrative Review and a Pragmatic Approach to Clinical Care

Abstract

Post-acute coronavirus disease 2019 (COVID-19) syndrome is a novel, poorly understood clinical entity with life-impacting ramifications. Patients with this syndrome, also known as “ COVID-19 long-haulers ,” often present with non-specific ailments involving more than one body system. The most common complaints include dyspnea, fatigue, brain fog, and chest pain. There is currently no single agreed-upon definition for post-acute COVID-19 syndrome, but most agree that criterion for this syndrome is the persistence of mental and physical health consequences after initial infection. Given the millions of acute infections in the U.S. over the course of the pandemic, perioperative providers will encounter these patients in clinical practice in growing numbers. Symptoms of the COVID-19 long-haulers should not be minimized as these patients are at higher risk for postoperative respiratory complications and perioperative mortality for up to 7 weeks after initial illness. Instead, a cautious multidisciplinary preoperative evaluation should be performed. Perioperative care should be viewed through the prism of best practices already in use such as avoidance of benzodiazepines in patients with cognitive impairment and use of lung protective ventilation. Recommendations especially relevant to the COVID-19 long-haulers include assessment of critical care myopathies and neuropathies to determine suitable neuromuscular blocking agents and reversal, preoperative workup of insidious cardiac or pulmonary pathologies in previously healthy patients, and thorough medication review, particularly of anticoagulation regimens and chronic steroid use. In this article, we define the syndrome, synthesize the available scientific evidence, and make pragmatic suggestions regarding the perioperative clinical care of COVID-19 long-haulers.

Post-COVID-19 Syndrome: Involvement and Interactions between Respiratory, Cardiovascular and Nervous Systems

“…A study by Frankfurt University Hospital revealed that 78% of survivors of COVID-19 had CV alterations, and 60% of them still showed signs of persistent myocardial inflammation more than two months after the diagnosis [74]. The results propose that long-term sequelae, for example, arrhythmias and HF, are also probable in apparently healthy people [75].…”

COVID-19 in the perioperative setting: A review of the literature and the clinical landscape

“…The emerging knowledge regarding the manifestations and pathophysiology of Long COVID informs the perioperative space, raising concern for postural orthostatic tachycardia syndrome (POTS), orthostasis, post-exertional malaise (PEM), other cardiopulmonary complications, and neuropsychiatric manifestations. 44 …”

The COVID‐19 pandemic and its consequences for chronic pain: a narrative review

“…Published literature related to pain after SARS‐CoV‐2 infection includes survivors with variable severity of illness and a heterogeneous spectrum of symptoms. Hence, pain consequences are described in different terms, such as post‐acute coronavirus disease 2019/COVID‐19 syndrome, COVID‐19 long‐haulers, post‐acute sequelae of SARS‐CoV‐2 infection and long COVID [ 6 , 12 ]. Some consider the constellation of symptoms similar to ‘post‐intensive care syndrome’ [ 9 , 13 ].…”

“…A preliminary literature search identified a need to report the consequences of the pandemic for chronic pain to help improve understanding and serve the needs of affected populations, both for clinical care and research endeavours. Published reviews or editorials have focused on a combination of post‐COVID‐19 symptoms [ 6 ]; considered only acute pain presentation from the infection [ 7 , 8 ]; highlighted the potential for the increased rate and the need for rehabilitation [ 9 , 10 ] or have become outdated [ 11 ]. Considering this gap, we set to review the published reports to evaluate the burden, type and progression of new‐onset chronic pain after SARS‐CoV‐2 infection, as well as the influence of the pandemic on chronic pain patients.…”