While elective surgeries were put on hold at the height of the COVID-19 pandemic, urgent and emergency surgeries continued. However, with COVID-19 and anesthesia in the operating room additional precautions may be needed.
Tracheal intubation—required for general anesthesia—is an inherently risky process, but even more so during a respiratory-based pandemic. Anesthesiologists open the throat during intubation, allowing for aerosol release that could easily expose clinicians to viral particles.1
In order to balance this reality with a high level of professionalism and commitment to their patients, anesthesia providers have to navigate a landscape that looks drastically different than the one they are accustomed to. Here are just a few ways the practice of anesthesiology has changed since the start of the pandemic.
Increased Use of Regional Anesthesia
Patients undergoing surgery typically receive either general anesthesia (GA) or regional anesthesia (RA). GA was the go-to option in most cases prior to the COVID-19 pandemic. However, due to the intubation issues already described, GA requiring airway intervention may have added COVID-19 transmission risks.
On the other hand, case studies show that regional anesthesia, is generally safe for healthcare staff due to a decreased risk of aerosolized virus particles.2 However, RA isn't always a condition-appropriate choice and may lead to an unplanned conversion to GA mid-surgery. It's important to ensure that RA can be maintained for the duration of the surgical case.
Specialized Airway Management
If a procedure requiring GA must be performed for the health of the patient, the American Society of Anesthesiologists (ASA) advises3 that anesthesiologists consider the safety of their staff as well as their patient while preparing for surgery.
The ASA recommends asking the highest-skilled anesthesiologist on staff to perform intubations. This provides the best chance of rapid induction without aerosolization of respiratory secretions, reducing the risk of transmission. The organization also suggests:
- Planning ahead to avoid intubations in the middle of surgery.
- Using a negative-pressure room.
- Limiting the number of staff within the exposure area.
Beyond these guidelines, the ASA has published a wealth of pandemic resources4 pertaining to COVID-19 and anesthesia.
Updated Environmental Maintenance
Anesthesiology departments are tasked with keeping staff safe, which includes ensuring the cleanliness and decontamination of their many machines and tools. However, COVID-19 presents new complexities. Can hospital departments be expected to keep up with a rising tide of severely ill patients and also abide by the extensive CDC guidelines for sterilizing medical devices? There is no easy answer.
Fortunately, cleaning recommendations for machines have not changed drastically. The ASA still recommends cleaning high-touch surfaces with an EPA-approved hospital disinfectant. They also advise replacing any breathing circuit filters per manufacturer instructions, however, high-quality filters rule out the need to clean internal components between patients.
According to the FDA, improper or insufficient cleaning of reusable medical supplies can lead to healthcare-associated infections.5 This is where a preference for disposable or single-patient-use instruments can help decrease the risk of transmitting the COVID-19 virus from one patient to another. The WHO recommends that devices and materials be either disposable or only used for one patient before being terminally cleaned and disinfected, especially when COVID-19 is suspected or confirmed.6
A Different Tomorrow
Anesthesia providers have found themselves navigating the uncharted waters of the COVID-19 pandemic for over a year now. However, out of crisis often comes strength, resilience, and knowledge.
The need to safeguard both patients and staff from a deadly virus has led to a wealth of exploration and subsequent knowledge that didn't exist before. Knowledge that can be studied, streamlined, recommended, and implemented to make healthcare systems safer and more efficient. Knowledge that can train future anesthetists for future health crises, including pandemics.
As anesthesia providers continue to gain their footing in this new normal, they are creating a stronger, nimbler field that's ready to confront any changes and challenges ahead.7
GE Healthcare has also taken efforts to address COVID-19, you can learn more on our COVID-19 resource page.
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[1] https://link.springer.com/article/10.1007/s00540-020-02834-3
[2] https://rapm.bmj.com/content/45/7/536
[4] https://www.asahq.org/in-the-spotlight/coronavirus-covid-19-information
[6] https://www.who.int/publications/i/item/WHO-2019-nCoV-IPC-2021.1
[7] https://www.advancesinanesthesia.com/article/S0737-6146%2821%2900009-5/fulltext
