Perioperative Care Provider's Considerations in Managing Patients with the COVID-19 Infections

The COVID-19 (also named as 2019-nCoV) is a very contagious novel coronavirus. Though most patients contracted the 2019-nCoV will likely have mild symptoms with good prognosis, some will develop severe acute respiratory infection, pneumonia, or acute respiratory distress syndrome. Some of these patients will need anesthesia care for endotracheal intubation, critical care management and surgical services. Perioperative care services will face enormous challenges in managing these patients with the COVID-19. The challenges are how to protect perioperative care providers and how to avoid cross-infection by transmitting the COVID-19 to other individuals, in addition to managing their respiratory failure and other pathophysiological disturbances. In this article, we discussed the personal protective equipment and techniques of using them, and strategies to prevent or minimize the probability of cross-infection of the COVID-19 from infected patient to other individuals. Perioperative care provider's self-protection includes universal precautions, wearing gloves, facemask, eye protections, and coverall gowns. Preventive measures of cross-infection include isolation room in paranesthesia holding area or straight to the operating room bypassing paranesthesia holding area, ventilation circuit filter(s), and circuit, CO2 absorbent and cannister replacement after each use, airborne and droplet precautions, and establishment of department and hospital-wide crisis management protocols. Perioperative care providers may encounter numerous unexpected difficulties such as poor visibility inside the coverall gowns, difficult to communicate verbally due to voice baffling, providers may become hyperthermia and sweating inside the gowns. The COVID-19 is a new disease, its transmission, clinical presentation, diagnosis and management are evolving, our perioperative care will need modification accordingly.