COVID-19 is an infectious syndrome caused by the SARS-CoV-2 virus. The virus has spread quickly since it was first discovered on December 31, 2019. There have been more than 17 million confirmed cases of COVID-19, around 4.5 million of which are in the United States. Globally, there have been around 670,000 deaths from the virus, with around 151,000 of those deaths occurring in the United States. For anesthesiologists, who are often in close contact with patients during surgery, certain protective measures addressing perioperative concerns regarding COVID-19 can reduce the risk of disease transmission.
Hospitals have responded proactively by instituting a variety of protective measures, including creating isolation units for patients with symptoms of COVID-19, providing medical staff with protective gear, and instituting regular temperature checks and testing of staff and patients. The American Society of Anesthesiologists recommends that “all patients should be screened for symptoms before being admitted.” Those exhibiting symptoms require additional screening, and asymptomatic individuals should undergo PCR testing before surgery when feasible.
Patients with COVID-19 can present asymptomatically or with mild symptoms before experiencing rapid deterioration. A Wuhan study documented one patient with abdominal symptoms who “infected 10 healthcare workers.” Research by Huang et al. found that “all 49 patients in the sample developed signs of pneumonia, while 29% developed acute respiratory distress syndrome.” Radiographic patterns include ground glass opacities and evolving “crazy-paving” presentations.
Anesthesiologists perform “aerosol-generating procedures such as intubation, suctioning and cardiopulmonary resuscitation.” The WHO recommends droplet and airborne precautions alongside contact measures. Liberal suction usage and thorough cleaning effectively limit transmission. For suspected COVID-19 cases, operations should occur “in a negative pressure environment and to limit the number of medical staff involved.”
Vascular care requires reconfiguration through closed-lumen IV systems. Open lumens need needleless disinfectable devices, with syringes kept outside contaminated zones. “Ports should be thoroughly cleaned prior to injection and covered with disinfecting caps.”
Higher-risk populations include cancer patients and transplant recipients. Research shows cancer patients were “31% more likely to experience severe events” requiring ICU admission and ventilation. While no confirmed COVID-19 cases existed in transplant recipients at publication, prior coronaviruses proved fatal for this group.