Coronavirus - guidance for anaesthesia and perioperative care providers
On the 11 March 2020 WHO characterised the spread of coronavirus as a pandemic.
The spread of the virus can be monitored through various websites including the COVID-19 Global Cases by Johns Hopkins CSSE
This novel coronavirus route of transmission and clinical presentation is similar to SARS, with flu-like symptoms (typically involving fever, cough, shortness of breath) and acute respiratory failure (commonly bilateral pneumonia, acute respiratory distress). However, patients may present with atypical symptoms.
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While COVID-19 has been suggested to have a lower case fatality rate (2.5%) than SARS (9.6%), MERS (34.4%), or H1N1 (17.4%), the extent of spread means that the death toll is significant. Frontline healthcare workers are at high risk of becoming infected, and are also at risk of spreading infection.
Anaesthesiologists and other perioperative care providers are particularly at risk when providing respiratory care and tracheal intubation of patients with COVID-19. WFSA would like to draw anesthesia team attention to the importance of appropriate precautions when providing respiratory care and intubation for these patients.
The following is intended as interim guidance for anaesthesia and perioperative care providers, largely derived from recommendations released by the Department of Anaesthesiology and Pain Medicine at the University of Toronto, and supported by a useful review published by Wax et al.
Routine Care for Patients with Suspected or Confirmed COVID-19
At a minimum, use droplet and contact precautions for suspected or confirmed cases of the 2019-nCoV.
Some jurisdictions are recommending routine use of airborne, droplet and contact precautions (including an isolation room appropriate for airborne infection isolation) for suspected or confirmed cases of the 2019-nCoV. However, triage for airborne precautions and isolation rooms will necessarily be based on level of suspicion, and types of procedures provided, and available facilities.
All healthcare providers should be trained in infection control and prevention strategies, and in procedures for donning and doffing personal protective equipment (PPE).
Healthcare facilities should provide healthcare workers with adequate PPE isolation facilities to meet the requirements for airborne, droplet and contact precautions.
Practice appropriate hand hygiene before and after all procedures.
Patient rooms with suspected or confirmed COVID-19 should be labelled with a sign, so that all healthcare workers and support staff are aware of the risk before entering the area.
High Risk Procedures – Intubation and other Aerosol-generating medical procedures (AGMP)*
*aerosol generating procedures include intubation, extubation, bronchoscopy, airway suction, high frequency oscillatory ventilation, tracheostomy, chest physiotherapy, nebulizer treatment. These procedures should be performed in the COVID-19 patient only when the benefits outweigh the risks, and when adequate PPE and staff preparation is available.
- APSF - Perioperative Considerations for the 2019 Novel Coronavirus (COVID-19)
- ASA - Coronavirus (2019-nCoV)
- SASA - South African Society of Anaesthesiologists COVID-19 resource page
- Vital Anaesthesia Simulation Training (VAST) - COVID-19 Simulation Resources
- African Federation of Emergency Services - Emergency Care of COVID-19 in Adults in Low Resource Settings
- Anesthesia & Analgesia - COVID-19 collection
- Annals of Surgery [In Press] - COVID-19 preparedness within the surgical, obstetric and anesthetic ecosystem in Sub Saharan Africa
- APSF,ASA,AAAA & AANA - The Use of Personal Protective Equipment by Anesthesia Professionals during the COVID-19 Pandemic
- WFSA - ATOTW 421: Perioperative management of suspected/ confirmed cases of COVID-19
- SIAARTI - Covid 19 - Airway Management
- Prince of Wales, Hong Kong - Covid- 19 Information (Available in English, French, Spanish, Portuguese, Dutch, Chinese, Japanese, Italian, German)
- UCSF - Ventilator management pocket reference
- University of Tasmania - Oxygen therapy with Limited Resources
- Society for Obstetrics Anesthesia & Perinatology (SOAP) - Intermin considerations for obstetric Anaesthesia Care related to COVID-19
- Royal College of Obstetricians & Gynaecologists - Coronavirus (COVID-19) Infection in Pregnancy: Information for healthcare professionals
- RCoA, The Faculty of Intensive Care Medicine, the Intensive Care Society and the Association of Anaesthetists. - Obstetric anaesthesia guidance
- The SFAR (Société Française d’Anesthésie Réanimation (SFAR) – Informations générales sur COVID-19
- Société de Réanimation de Langue Française (SRLF) Lignes directrices et informations
- Gouvernement français - Informations Générales
- CARO - Prise en charge AR pa.ente COVID + ou suspecte en maternité
- WHO - Coronavirus disease (COVID-19) outbreak
- WHO - Novel coronavirus (2019-nCoV)
- WHO - Emerging respiratory viruses, including nCov: methods for detection, prevention, response and control
- WHO - Online training as a weapon to fight the new coronavirus
- CDC - Information for Healthcare Professionals
- MSF - MSF update on novel coronavirus outbreak
- WHO - Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19)