Anesthesia and COVID-19 A

s millions of Americans get their COVID-19 vaccination, mortality rates connected to the virus have receded, but the infection rate continues to rise in many states. If you are

operating on a patient who has recently recovered from the disease, do you know when it is safe for them to have anesthesia? A joint statement from the American Society of Anesthesiologists and the Anesthesia Patient

Safety Foundation says that the optimal time and the correct level of preoperative evaluation are tricky given the lack of evidence and precedence. The statement provides the following guidance

with the caveat that as new evidence emerges, the guidance will change. ■

“Four weeks for an asymptomatic patient or recovery from only mild, non-respiratory symptoms. ■ Six weeks for a symptomatic patient (e.g., cough, dyspnea) who did not require hospitalization. ■ Eight to 10 weeks for a symptomatic patient who is diabetic, immunocompromised, or hospitalized.

Twelve weeks for a patient who was admitted to an intensive care unit due to COVID-19 infection.” The statement adds that these timelines are not set in stone and that each patient’s specific set of conditions and circumstances should be assessed to determine time of surgery. Perform elective surgeries on patients who have recovered only when the anesthesiologist and surgeon or proceduralist agree jointly to proceed, the statement emphasizes. The Society for Ambulatory Anesthesia (SAMBA) recommends testing all patients before

surgery. According to one of its recent statements on testing: 1. “All patients should be asked about symptoms of COVID-19. These include well-known symptoms like fever, cough, dyspnea, malaise, and myalgias. In addition, many are advocating screening for more atypical symptoms such as nausea, vomiting, diarrhea and loss of smell and taste.

2. Symptomatic and SARS-CoV-2 virus positive patients should be referred to appropriate resources and have elective procedures postponed.

3. We recommend that patients are screened and tested as close to procedures as possible. Timing depends on available logistics and resources. We recommend testing 24–48 hours before planned procedures and no greater than 72 hours as feasible.

4. Once patients are tested they should be encouraged to self-isolate leading up to their procedures. 5. Patients who have negative tests and continue to screen negative for COVID-19-like symptoms until the time of surgery can proceed with their planned elective surgery. However, given the known false negative rates of testing (up to 30 percent) even a negative test does not guarantee non-infectivity. Therefore, SAMBA continues to endorse that all staff should wear appropriate masks at all times while in the facility. And, they should wear N-95 masks and goggles or face shields for aerosol generating procedures (AGP) such as, upper and lower GI endoscopy, bronchoscopy, head and neck and airway procedures, intubation and extubation.

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6. We warn our members and facilities that different states have different mandates and policies for testing for all patients before non-emergency surgeries so we urge everyone to be familiar with and follow local, county and state requirements.

7. Antibody testing does not replace testing for the SARS-CoV-2 virus, as currently little is known about its protective value and some patients do not develop antibodies with COVID-19. Antibody testing should not be performed for patient triaging.” More guidance is available on the Centers for Disease Control and Prevention website.

Michael J. Patterson, RN, CASC President of ASCA’s Board of Directors


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