Surgery

What if I need to take a suspected, high-risk or COVID-19 positive patient to the OR?

See the paper published from the Department of Anesthesia at the National University of Singapore. Ti et al. What we do when a COVID-19 patient needs an operation: operating room preparation and guidance. Can J Anesth. 2020.

PPE:

• Almost universally the use of N95 masks is recommended when operating, including patients, this includes on COVID19 high risk, but not confirmed patients (in some instances use of N95 mask is recommended in all instances)

• N95 and more aggressive PPE* is recommended for any patients under going an aerosolized procedure. It remains unclear if laparoscopic surgery is included.
  (*PAPR are recommended by UMichigan when indicated and Wuhan document recommends Level III (highest level of protection) for all surgical interventions)

• SAGES currently recommends against laparoscopic surgery if clinically indicated

  *** Note: in general, there is not much information / hard data regarding if laparoscopic surgery causing viral dissemination, but many speculate it is given it is an aerosolized procedure

OR Workflow/Locations:

• Negative pressure operating rooms should be used

• No one should leave the room or come in during the case (this includes breaks for nursing and anesthesia staff), required equipment should be delivered by an outsider runner to the room

• Disinfection protocols for these operating rooms are significantly more stringent than for normal OR cases (some recommend up to 1 hours of cleaning of all surfaces in the room)