What we do when a COVID-19 patient needs an operation: operating room preparation and guidance - Canadian Journal of Anesthesia

Date: 3 – 3 – 2020
Bron: https://link.springer.com/article/10.1007%2Fs12630-020-01617-4

Aim
To share the protocol used in hospital in Singapore in preparing an operating room (OR) for confirmed or suspected COVID-19 patients coming for surgery.

Key message
As healthcare workers are at increased risk of coronavirus infection, a comprehensive and robust infection control workflow has been put into place.

Summary
Preparation/anesthesia

• Understand the airflow in the OR rooms
• The same anesthesia machine should be used for all COVID19 patients
• All items necessary (e.g. drugs, airway items etc.) should be prepared on the trolley before the patient enters the OR
• The airway should be secured using the method with the highest chance of first-time success to avoid repeated instrumentation of the airway, including using a video-laryngoscope.
• In the induction room, a PAPR is worn during induction and reversal of anesthesia for all personnel within 2 m of the patient.
• regional anesthesia is preferable

Transport from ICU to OR

• Was be done using full personal protective equipment including a well-fitting N95 mask, goggles or face shield, splash-resistant gown, and boot covers.
• Hospital security is responsible for clearing the route, including the elevators.
• A dedicated transport ventilator is used.
• To avoid aerosolization, the gas flow is turned off and the endotracheal tube clamped with forceps during switching of ventilators.

Surgery

• For operative airway procedures such as tracheostomy, all staff keep their PAPR (powered air-purifying respirator) on throughout the procedure.
• A runner is stationed outside the OR if additional drugs or equipment are needed. These are placed onto a trolley that will be left in the ante room for the OR team to retrieve. The runner wears PPE when entering the ante room.
• After Surgery
• Patients who do not require ICU care postoperatively are fully recovered in the OR itself.
• A minimum of one hour is planned between cases to allow OR staff to send the patient back to the ward, conduct thorough decontamination of all surfaces, screens, keyboard, cables, monitors, and anesthesia machine
• All staff have to shower before resuming their regular duties.