Feby Korandiarkunnel Paul Preoperative assessment pathway for elective non cardiac surgery in patients with history of a positive SARS CoV-19 swab.pptx

1. Preoperative assessment pathway for elective non cardiac surgery in patients with history of a positive SARS CoV-19 swab.
Dr. Feby Korandiarkunnel Paul, Dr. Binu Ravindran.
Dartford and Gravesham NHS Trust, Kent, UK.
Introduction:
The post COVID era presents many anaesthetic challenges as COVID represents a wide spectrum of illness from totally asymptomatic to
extremely unwell patients. Though there is variation in the severity of illness, the long-COVID syndrome is a well established entity,
characterised by very slow recovery of physiological and psychological capacity.1,2
Hence a guideline is essential on the optimal timing of
elective surgery and necessary investigations in such patients. The American Society of Anaesthesiologists (ASA) gives guidance on the wait
period, defined as the period from the day COVID-19 swab test is positive to the date of elective surgery.3
Suggested wait times are as follows:
Methods: At pre operative assessment, patients with a history of SARS-CoV positive swab complete a questionnaire detailing their COVID-19
management. Further information can be obtained from patient notes or GP records. Patient management is individualised based on patient
factors including persistent symptoms, patient ASA and low, intermediate and high risk surgery. Regional anaesthesia is preferred where
feasible and regional analgesia techniques incorporated into general anaesthesia.4
Further investigations, optimisation and specialty referral
including post surgical ICU care are planned as deemed necessary.
Outcomes data on complications and 30 day mortality will be collected once elective surgery lists are back to normal.
Results: Elective surgery has recently started and follow up data on outcomes after surgery will be collected.
Conclusion: We hope to improve perioperative care and outcomes while minimising unnecessary cancellations and delay on the day of surgery
by proper patient selection, early investigations, optimisation and planning of perioperative care.
Acknowledgements: none to declare and no outside funding used.
asymptomatic patient or recovery from mild symptoms 4 weeks
symptomatic patient (cough, dyspnoea), who didn’t require hospitalisation 6 weeks
symptomatic patient, who required hospital admission 8-10 weeks
patient who was admitted in ICU due to SARS-CoV-2 infection 12 weeks

2. ITU/HDU admission
NIV/IPPV
ECMO
Wait 12 weeks
Pre operative assessment pathway for elective non cardiac surgery
History of positive SARS CoV-19 swab
Symptomatic
PFT
Chest-Xray
CPET
PFT/ABG
Chest X-ray
HRCT/ECHO
CPET
Preoperative
optimisation
Bronchodilator
/ pulmonary
vasodilator
HDU/ITU care postop
Referral to Higher centre
Persistent symptoms
SOB/Fatigue
Asymptomatic
Proceed with
surgery
Home management
Asymptomatic/mild
symptoms
Wait 4weeks
A&E admission
Symptomatic
Discharged home
wait 6 weeks
Ward admission
wait 8 to weeks

3. References:
1. Fraser E. Long term respiratory complications of COVID-19. BMJ 2020; 370:m3001 https://doi.org/10.1136/bmj.m3001
2. NICE guideline. COVID-19 rapid guideline: managing the long-term effects of COVID-19. www.nice.org.uk/guidance/ng188.
3. ASA and APSF Joint Statement on Elective Surgery and Anesthesia for Patients after COVID-19 Infection. December 8, 2020.
https://www.asahq.org/about-asa/newsroom/news-releases/2020/12/asa-and-apsf-joint-statement-on-elective-surgery-and-anesthesi
a-for-patients-after-covid-19-infection
29/01/2021).
4. Macfarlane A J R, Harrop-Griffiths W, Pawa A. Regional anaesthesia and COVID-19: first choice at last?. BJA 2020; 125(30) 243-
247. https://doi.org/10.1016/j.bja.2020.05.016
5. Greenhalgh T, Knight M, A’Court C, et al. Management of post-acute covid-19 in primary care. BMJ 2020; 2020;370:m3026
doi: https://doi.org/10.1136/bmj.m3026
6. Imazio M. COVID-19 as a Possible Cause of Myocarditis and Pericarditis. Expert Analysis Aging Clin Exp Res. 2020 Jun 11:
1-8.doi: 10.1007/s40520-020-01616-x
7. Fumagalli A, Misuraca C, Bianchi A, et al. Pulmonary function in patients surviving to COVID-19 pneumonia. Infection 2021; 49(1)
153–157.