Special Anesthesia Considerations for High Risk Surgeries

Key Points

• High risk surgery is any procedure requiring endoscopy, bronchoscopy, redo lung decortication, laparoscopic procedures and surgery on the nasopharynx, oropharynx, trachea, or eyes. (See Infection Control - Aerosol Generating Procedures)
   
• Again 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.
   
• All operative team members will don full PPE throughout the case and the number of personnel in the room will be kept to the minimum required.
   
• Endotracheal intubation general anesthesia is recommended to provide the most secure airway and lowest risk of viral aerosolization.
   
• If spontaneous respiration is desired / required, consider airway masks with apertures e.g., a Procedural Oxygen Mask (POM) for oesophago-gastro-duodenoscopic procedures (see picture).