Recommendations Developed for Anesthesia Use During COVID-19
Risk for postop complications lower with regional anesthesia; odds of aerosol generation up with general anesthesia
TUESDAY, April 28, 2020 (HealthDay News) -- Recommendations have been developed for use of anesthesia during the COVID-19 pandemic, according to a joint statement issued by the American Society of Regional Anesthesia and Pain Medicine and the European Society of Regional Anesthesia and Pain Therapy.
Vishal Uppal, M.B.B.S., from Dalhousie University in Halifax, Nova Scotia, Canada, and colleagues developed recommendations for use of anesthesia during the COVID-19 pandemic. Where possible, regional anesthesia is preferred due to increased odds of aerosol generation with general anesthesia (GA) and a reduced risk for postoperative complications with regional anesthesia.
The authors note that the first step in anesthesia planning is ascertaining the patients' COVID-19 status. Regional anesthesia can be provided following usual local guidelines if the patient is not COVID-19-positive or suspected to be positive. For COVID-19-positive or suspected-positive patients, neuraxial anesthesia and peripheral nerve blocks require regular contact and droplet precautions, including surgical mask use, eye protection, surgical gowns, and double gloves. The use of spinal anesthesia is not contraindicated in COVID-19-positive or suspected-positive patients, although the evidence is limited. The preparation and asepsis for peripheral nerve block should be similar to that followed for neuraxial procedures; attempts should be made to choose the block least likely to interfere with respiratory function.
"An unplanned need for intraoperative conversion to GA is least desirable. If the duration or complexity of surgery means a high probability of conversion to GA, it is better to start with GA," the authors write.