Anesthetic Management of Patients with COVID 19 Infections during Emergency Procedures

Abstract

Objectives: The aim of the present study was to prevent cross-infection in the operating room during emergency procedures for patients with confirmed or suspected 2019 novel coronavirus (2019-nCoV) by following anesthesia management protocols, and to document clinical- and anesthesia-related characteristics of these patients.

Design: This was a retrospective, multicenter clinical study.

Setting: This study used a multicenter dataset from 4 hospitals in Wuhan, China.

Participants: Patients and health care providers with confirmed or suspected 2019-nCoV from January 23 to 31, 2020, at the Wuhan Union Hospital, the Wuhan Children's Hospital, The Central Hospital of Wuhan, and the Wuhan Fourth Hospital in Wuhan, China.

Interventions: Anesthetic management and infection control guidelines for emergency procedures for patients with suspected 2019-nCoV were drafted and applied in 4 hospitals in Wuhan.

Measurements and main results: Cross-infection in the operating rooms of the 4 hospitals was effectively reduced by implementing the new measures and procedures. The majority of patients with laboratory-confirmed 2019-nCoV infection or suspected infection were female (23 [62%] of 37), and the mean age was 41.0 years old (standard deviation 19.6; range 4-78). 10 (27%) patients had chronic medical illnesses, including 4 (11%) with diabetes, 8 (22%) with hypertension, and 8 (22%) with digestive system disease. Twenty-five (68%) patients presented with lymphopenia, and 23 (62%) patients exhibited multiple mottling and ground-glass opacity on computed tomography scanning.

Conclusions: The present study indicates that COVID 19-specific guidelines for emergency procedures for patients with confirmed or suspected 2019-nCoV may effectively prevent cross-infection in the operating room. Most patients with confirmed or suspected COVID 19 presented with fever and dry cough and demonstrated bilateral multiple mottling and ground-glass opacity on chest computed tomography scans.

Keywords: 2019 nCoV; 2019 novel coronavirus; COVID 19; cross-infection; infection control; occupational health; viral pneumonia.

Fig 1

Timeline of the early stages of the 2019 novel coronavirus outbreak. 2019-nCoV, 2019 novel coronavirus.

Fig 2

Geographical map of the 4 hospitals included in the study and the Huanan Seafood Wholesale market in Wuhan, China. ASA, American Society of Anesthesiologists.

Fig 3

Photo of health care providers, including anesthesiologist, surgeons, and nurses, performing an emergency surgery.

Fig 4

Flow chart of anesthesia and infection control management guidelines for emergency procedures in patients with confirmed or suspected 2019 novel coronavirus. 2019-nCoV, 2019 novel coronavirus; OR, operating room.