Anesthesia in Patients with Known Negative Status & Asymptomatic

Key Points

  • Ideally all patients presented for emergent / urgent surgery during COVID outbreak must be tested for COVID status prior to surgery.  It is generally recommended to delay surgery until results are known except for life or limb threatening conditions.
  • It is recommended that surgery in patients with known COVID negative status but with respiratory symptoms be delayed except for emergency surgery for life or limb threatening condition.  Consult infection protection and control experts for possible retesting.  If surgery cannot be delayed, then proceed per COVID positive status protocol.
  • Anesthesia management in patients with known COVID negative status and with no respiratory symptoms will proceed per standard management principles and protocol that are followed before the outbreak.
  • All staff, both anesthesia and surgery will take standard droplet and contact precautions for low risk surgeries.  This consists of a regular procedure surgical mask (not a N95 respirator), face shield or goggles, gown and gloves.
  • However, for high risk surgery, i.e., any procedure requiring endoscopy, bronchoscopy, redo lung decortication, laparoscopic procedures, surgery on the nasopharynx, oropharynx, trachea, or eyes, all staff must don full PPE (fit tested N95, face shield, gown and gloves) for airborne precaution. (See Infection Control - Aerosol Generating Procedures)
  • The risk is considered highest for surgeries involving the oral cavity and nasal passage. Additional aerosolization minimizing techniques e.g., application of adhesive and sterile drapes in the surgical site must be considered for these surgeries.
  • Anesthesia recovery will follow usual PACU protocol for low risk surgery.  However, for high risk surgery, patient will recover in the OR for 30 minutes before going to the PACU.
  • It is important to note that the accuracy of nasal swab testing has been reported to vary from 64% to 97% (references).  It is therefore worthy to find out test accuracy in your local hospital / laboratory to guide management plan. (WangW,XuY,Gao,R,etal.DetectionofSARS-CoV-2 in Different Types of Clinical Specimens . JAMA. Published online March11,2020).