COVID-19: Practical Recommendations For Your Anesthesia Practice
Published on February 24, 2021
During this time of uncertainty, it is important to have protocols in place to use as a guide throughout the duration of the COVID-19 pandemic. Below is an overview of recommendations prepared by the American Society of Anesthesiologists.
Although the need for medical procedures still exists, those that are not time-critical are best to be rescheduled to a time when high community transmission has subsided or is no longer as prevalent. Procedures that are time-critical should be prioritized based on the patient need as well as the resources of the facility. Ambulatory Surgery Centers are a recommended setting to help reduce the demands on hospital resources. By taking both recommendations into consideration, this will help reduce the use of protective equipment, and help to reduce the exposure of health care workers as well as patients who might transmit COVID infections.
What should be considered when prioritizing time-critical procedures? Factors to take into consideration when determining if a procedure is time-critical, is there adequate equipment available, what type of procedure is the patient having, and will delaying the procedure cause more harm? Facilities and all departments therein should work together to create their own guidelines to determine if the case is in fact time-critical and should be consider a priority.
More and more we are becoming aware of reports of COVID-19 transmission without the presence of symptoms. It can be a challenge to identify patient that are carrying the virus. Given this fact the ASA has made a recommendation to escalate the standard of practice during airway management for all patients. To limit the potential for aerosolization of droplet particles the ASA released the following recommendations.
1. Designating the most experienced anesthesia professional to perform intubation, if possible.
2. Wearing personal protective equipment (PPE) including:
a. An N95 mask, for which one has been fit-tested, or a powered air-purifying respirator.
b. A face shield or goggles.
c. A gown.
3. Avoid awake fiberoptic intubation unless specifically indicated.
4. Consider a rapid sequence induction (RSI) to avoid manual ventilation of patient’s lungs and potential aerosolization. If manual ventilation is required, apply small tidal volumes.
Keeping a clean work area and not repurposing anesthesia machines for ICU use is also recommended. Use of more effective PPE is recommended including the use of N95 masks along with wearing a face shield to protect the N95 mask from debris. Finally, at this time the ASA has released findings that it is unaware of COVID-19 contraindicating the use of neuraxial blocks. For patients with confirmed cases of COVID-19, or those suspected of being of having the virus, additional precautions should be taken including isolating the patient and using a dedicated operating room. As always use the recommended PPE including N95 mask, double gloves, protective eyewear, and gowns.
Following these recommendations and setting strict protocol within your practice, will help ensure not only the safety of your colleagues, but your patients as well.