The Cutting Edge of Thoracic Anesthesia During the Coronavirus Disease 2019 (COVID-19) Outbreak

Abstract

Coronavirus disease 2019 (COVID-19) has quickly spread globally, causing a real pandemic. In this critical scenario, lung cancer patients scheduled for surgical treatment need to continue to receive optimal care while protecting them from an eventual severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Adequate use of personal protective equipment (PPE) during aerosol-generating procedures (AGPs) and a COVID-19 specific intraoperative management are paramount in order to prevent cross infections. New suggestions or improvement of existing contagion control guidance are needed, even in case of non-symptomatic patients, possibly responsible for virus spread.

Thoracic Anesthesia during the COVID-19 Pandemic: 2021 Updated Recommendations by the European Association of Cardiothoracic Anaesthesiology and Intensive Care (EACTAIC) Thoracic Subspecialty Committee

“…We electronically searched specialist thoracic anesthesia societies’ and groups’ previous recommendations on the perioperative management principles for patients with potential SARS-CoV-2 infection focusing on unique aspects of thoracic anesthesia. 5 , 6 , 7 , 8 , 9 …”

“…We electronically searched specialist thoracic anesthesia societies' and groups' previous recommendations on the perioperative management principles for patients with potential SARS-CoV-2 infection focusing on unique aspects of thoracic anesthesia. [5][6][7][8][9] C. The thoracic subcommittee of EACTIC has performed a survey exploring changes in clinical practice occurring during the COVID-19 era to better understand how practice has evolved and to aid development of further general recommendations on the perioperative management of patients with ‗suspected' or ‗diagnosed' COVID-19 undergoing thoracic surgery (unpublished). This survey included a 36-item questionnaire to explore the changes in daily practice during the COVID-19 pandemic, emphasizing the general aspects of anesthesia, airway management and lung isolation, ventilation, and postoperative analgesia.…”

“…52  We recommend leaving the choice of neuromuscular blocking drug to the individual anesthesiologist to individualize it based on their confidence in the reliability to intubate and the duration of relaxation. 5 -Intubation: 1  Intubation should be performed using VIDEOLARYNGOSCOPY, 52 preferably via a laryngoscope with a single-use blade if available and a separate remote screen. The latter would extend the distance between the airway of the patient and the anesthetist to minimize or avoid -airborne spread‖.…”

“…We recommend leaving the choice of neuromuscular blocking drug to the individual anesthesiologist to individualize it based on their confidence in the reliability to intubate and the duration of relaxation. 5 …”

“…In short procedures. 5. In patients in whom mechanical ventilation will be continued in the postoperative period (to avoid the need for tube exchange at the end of the operation, which can be more difficult because of edema of the airways and be an additional mechanism of contagion).…”