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. 2021 Jun;31(6):720-729.
doi: 10.1111/pan.14174. Epub 2021 May 3.

A survey of the global impact of COVID-19 on the practice of pediatric anesthesia: A study from the pediatric anesthesia COVID-19 Collaborative Group

Codruta N Soneru  1 , Allison M Fernandez  2 , Victoria Bradford  3 , Steven J Staffa  4 , Vidya T Raman  5 , Joseph Cravero  4 , David Zurakowski  4 , Petra M Meier  4 ; Pediatric Anesthesia COVID-19 Collaborative
Collaborators, Affiliations

A survey of the global impact of COVID-19 on the practice of pediatric anesthesia: A study from the pediatric anesthesia COVID-19 Collaborative Group

Codruta N Soneru et al. Paediatr Anaesth. 2021 Jun.

Abstract

Background: Pediatric anesthesiology has been greatly impacted by COVID-19 in the delivery of care to patients and to the individual providers. With this study, we sought to survey pediatric centers and highlight the variations in care related to perioperative medicine during the COVID-19 pandemic, including the availability of protective equipment, the practice of pediatric anesthesia, and economic impact.

Aim: The aim of the survey was to determine how COVID-19 directly impacted pediatric anesthesia practices during the study period.

Methods: A survey concerning four major domains (testing, safety, clinical management/policy, economics) was developed. It was pilot tested for clarity and content by members of the Pediatric Anesthesia COVID-19 Collaborative. The survey was administered by email to all Pediatric Anesthesia COVID-19 Collaborative members on September 1, 2020. Respondents had six weeks to complete the survey and were instructed to answer the questions based on their institution's practice during September 1 - October 13, 2020.

Results: Sixty-three institutions (100% response rate) participated in the COVID-19 Pediatric Anesthesia Survey. Forty-one hospitals (65%) were from the United States, and 35% included other countries. N95 masks were available to anesthesia teams at 91% of institutions (n = 57) (95% CI: 80%-96%). COVID-19 testing criteria of anesthesia staff and guidelines to return to work varied by institution. Structured simulation training aimed at improving COVID-19 safety and patient care occurred at 62% of institutions (n = 39). Pediatric anesthesiologists were economically affected by a reduction in their employer benefits and restriction of travel due to employer imposed quarantine regulations.

Conclusion: Our data indicate that the COVID-19 pandemic has impacted the testing, safety, clinical management, and economics of pediatric anesthesia practice. Further investigation into the long-term consequences for the specialty is indicated.

Keywords: COVID-19; hospital economics; pediatric anesthesia; personal protective equipment; preoperative testing; simulation.

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Conflict of interest statement

Bradford: honorarium for American Society of Anesthesiologists (ASA) Self‐Education and Evaluation (SEE) Program questions; Raman: equity in NDS Kalstars and Opus INFLUUNT and Face To Face, honorarium from Merck, honorarium from the American Society of Anesthesiologists (ASA) for Anesthesia Continuing Education (ACE) questions, Nationwide Children's Hospital Intramural grant; Fernandez, Meier, Soneru, Staffa, Zurakowski: none.

Figures

FIGURE 1
FIGURE 1
Description of respondent characteristics. The majority of respondents were at US hospitals, but many international locations were represented. Most respondents came from academic practice settings (65%) and free standing pediatric hospitals (57%). A range of hospital volumes were represented
FIGURE 2
FIGURE 2
COVID‐19 Testing of pediatric anesthesia staff. A, At most institutions, pediatric anesthesia staff are receiving polymerase chain reaction (PCR) testing if having COVID‐19 symptoms, although there is variability across hospitals. B, Most often, a negative COVID‐19 test is considered valid for 72 h or less
FIGURE 3
FIGURE 3
Personal protective equipment (PPE) during a shortage. Among the 43 respondents who had experienced PPE shortages at their institutions, 32 reported that the anesthesia staff was allowed to use their own PPE equipment during a shortage. In the 11 institutions where utilization of own PPE is not allowed, 2 allow going forward without appropriate PPE and 9 allow to cancel or postpone the case if it is elective
FIGURE 4
FIGURE 4
Impact of COVID‐19 on pediatric anesthesia staff. Twenty respondents reported having the voluntary option to not work with COVID‐19 positive cases, and this was most often based on age, comorbidities and pregnancy of the pediatric anesthesia staff. Many workplace procedures and economic factors in pediatric anesthesia staff were impacted due to the COVID‐19 pandemic
FIGURE 5
FIGURE 5
Training of pediatric anesthesia staff. A, At 39 among the 63 institutions, anesthesia staff had structured simulation training including debriefing to improve management of COVID‐19 positive patients. B, At all 39 of these institutions (100%; 95% CI: 91%–100%), staff felt better prepared for clinical management of COVID‐19 patients after simulation training. C, Availability of a designated spotter for donning and doffing of personal protective equipment (PPE) was available at 40/63 institutions. PUI = untested patient under investigation for COVID‐19
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