Anaesthesia and COVID-19

Learning Objectives

By the end of this lecture, you should:

• Understand how COVID-19 affects anaesthetic practice
  
  

• Know which procedures are aerosol-generating and high-risk
  
  

• Learn the appropriate use of personal protective equipment (PPE)
  
  

• Apply safe protocols for airway management and surgery in COVID-19 patients
  
  

Background on COVID-19 (SARS-CoV-2)

• Novel coronavirus causing severe acute respiratory syndrome
  
  

• Transmitted via droplets, contact, and aerosol routes
  
  

• High risk to anaesthetists due to proximity to the airway and aerosol-generating procedures
  
  

• Important to balance infection control with patient safety and effective care
  
  

Risks to Anaesthetists

High-Risk Procedures:

• Endotracheal intubation
  
  

• Bag-mask ventilation
  
  

• Suctioning
  
  

• Bronchoscopy
  
  

• Extubation
  
  

• Tracheostomy
  
  

• Cardiopulmonary resuscitation (CPR)
  
  

• Non-invasive ventilation (NIV): CPAP, BiPAP
  
  

These are all aerosol-generating procedures (AGPs).

Personal Protective Equipment (PPE)

Essential PPE for AGPs:

• N95 respirator or FFP2/FFP3 mask
  
  

• Eye protection (goggles or face shield)
  
  

• Fluid-resistant gown
  
  

• Double gloves
  
  

• Head covering
  
  

• Shoe covers if required
  
  

Always don and doff PPE carefully in a designated clean area to avoid contamination.

Operating Theatre (OT) Setup for COVID-19

• Use a designated COVID-19 OT with negative pressure ventilation if possible
  
  

• Keep personnel to a minimum
  
  

• Use HEPA filters in breathing circuits and at expiratory limbs of ventilators
  
  

• Prepare all drugs and equipment before patient enters
  
  

• Avoid unnecessary movement in/out of theatre
  
  

Airway Management in COVID-19 Patients

Goals:

• Minimise aerosol generation
  
  

• Maximise first-pass intubation success
  
  

• Protect the anaesthetic team
  
  

Key Steps:

1. Pre-oxygenate with tight-fitting mask and 100% oxygen for 3–5 minutes
   
   

2. Use Rapid Sequence Induction (RSI) to avoid mask ventilation
   
   

3. Experienced anaesthetist should intubate
   
   

4. Use video laryngoscopy to increase distance from the airway
   
   

5. Inflate cuff before connecting to circuit
   
   

6. Confirm placement with capnography
   
   

7. Use closed suction systems
   
   

8. Avoid circuit disconnection – if necessary, clamp ETT and stop ventilation
   
   

Induction Agents and Dosing (COVID-19 context)

• Propofol: 1.5–2.5 mg/kg IV
  
  

• Fentanyl: 1–2 mcg/kg IV
  
  

• Rocuronium: 1.2 mg/kg IV (preferred over suxamethonium for RSI to avoid fasciculations and coughing)
  
  

Rocuronium allows prolonged paralysis and reduces risk of coughing during intubation.

Extubation Precautions

• Patient should be fully awake before extubation
  
  

• Administer IV lidocaine 1.5 mg/kg 1–2 minutes before extubation to blunt cough reflex
  
  

• Apply a surgical mask over face immediately after extubation
  
  

• Oxygen via nasal prongs under surgical mask
  
  

• Minimise aerosol-generating coughing and suctioning
  
  

Post-Anaesthesia Care Unit (PACU) Management

• COVID-19 patients should bypass the PACU and be transferred directly to the isolation ward or ICU
  
  

• If PACU is used, maintain distance from other patients
  
  

• Clean and disinfect all surfaces thoroughly after patient transfer
  
  

Key Points for Anaesthetic Management

• Avoid awake intubation unless absolutely necessary
  
  

• Avoid nebulisation – use MDI with spacer instead
  
  

• Prefer regional anaesthesia (e.g., spinal) where appropriate
  
  

• Sedation for non-intubated patients should be carefully monitored
  
  

• Use telecommunication tools to minimise exposure and facilitate remote consultation
  
  

Mental Health and Staff Safety

• Encourage rest, hydration, and support among anaesthetic staff
  
  

• Provide psychological support
  
  

• Rotate teams to prevent fatigue
  
  

• Foster open communication and incident reporting culture