AJA Asian Journal of Anesthesiology

Advancing, Capability, Improving lives

Practice Guideline
Volume 59, Issue 3, Pages 81-82
Shao-Chun Wu 1 , Ming-Hui Hung 2 , Chien-Kun Ting 3 , Amina Mohamed Illias 4 , Chueng-He Lu 5 , Mei-Yung Tsou 3 , from Taiwan Society of Anesthesiologists and Clinical Guidelines Committee
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Outline


“Autonomy”, “Do No Harm”, “Do Good”, “Informed Consent”, and “Fairness and Justice” are the constituents of important principles in medical ethics. During the coronavirus disease 2019 (COVID-19) outbreak, implementing these principles and saving the most lives should not conflict with the decision to allocate limited medical resources and adhere properly to operating room (OR) safety measures.1-3

Accordingly, Taiwan Society of Anesthesiologists declares OR proactive responses during the COVID-19 outbreak as shown below:

1. Current literature states that prolonged cardiopulmonary resuscitation (CPR) including extracorporeal membrane oxygenation (ECMO) for critically ill COVID-19 patients cannot effectively improve the clinical prognosis. Considering the shortages of essential equipment needed for critically ill patients, including ventilators and ECMO, doctors are advised to discuss, in advance, all possible resuscitation plans with seriously ill patients or their family members. If a Do Not Resuscitate (DNR) order is signed by a patient or their legal representative prior to the operation, then their choice should be respected. CPR should not be initiated for DNR patients when patients suffer a cardiac arrest during an operation, and time of death should be declared in the OR. Subsequently, the body of a deceased, suspected, or confirmed COVID-19 patient will be handled according to COVID-19 protocols dictated by the National Health Command Center (NHCC) and the Centers for Disease Control and Prevention.2-4

2. Considering the announcements made by the NHCC, reduction of non-essential routine operations, isolation, and triage measures must be followed by all medical institutions during an outbreak. Physical inventory count of surgical equipment, anesthesia medications, and machines (ventilators and monitors) should be done frequently in order to meet the increased demand for medical equipment during the pandemic.3-7

3. A special space and anesthesia equipment needed for the induction and operation of confirmed or suspected cases must be prepared inside the OR. In places with limited space and medical resources, it is necessary to ensure that the OR and its equipment are fully cleaned and disinfected after each procedure. Breathing tubes and high efficiency particulate air filters should be replaced after each surgery. When anesthesia machines are deployed as mechanical ventilators because of a shortage of ventilators in intensive care unit, the internal breathing tube in the machine should be removed and cleaned by a qualified personnel or manufacturer. These machines must be carefully cleaned and disinfected, and then sealed for 21 days before resuming their use for surgical anesthesia in non- COVID-19 patients.3-6

4. It is highly recommended to operate in a negatively pressurized OR when doctors deal with COVID-19 positive patients or suspected cases. If a negative pressure room is not available, then the alternative includes utilizing a room with independent air-conditioning (AC) or turning off the AC system and using the adjacent OR as a buffer area. Additionally, when one needs to designate a special OR for COVID-19 cases, it is suggested that the location of the room be close to the elevator in order to adopt the shortest path during patient transportation.3,6

5. Caesarean sections should be considered for pregnant women who have COVID-19 to minimize exposure of the baby to the contaminated environment. A pediatric medical team should provide necessary care for the baby on site, and the surgical team should not have any contact with the baby after delivery.2,3,6,7

6. Surgical team members participating in the care of confirmed or suspected cases should be provided with all essential personal protective equipment (PPE) and must receive sufficient training to properly mount and remove PPE.2,4-7

7. Medical institutions should provide shower facilities, relevant psychological counseling and support, appropriate epidemic prevention advice, and medical treatment (including screening or dormitory isolation requirements, etc.) for all members of the surgical team involved in confirmed or suspected cases.2,4-6

8. Medical institutions should establish a secure internal online messaging platform to transmit real-time epidemic prevention information, institutional policies, and other important work-related information. However, it should be strictly prohibited to use this messaging platform to transmit patient-related personal information or speculations.4-6


References

1
Department of Health and Social Care, UK Government.
COVID-19: ethical framework for adult social care.
GOV. UK. website. Published March 19, 2020. Updated April 28, 2021.
2
Taiwan Society of Pulmonary and Critical Care Medicine.
COVID-19 Taiwan critical care consensus second edition.
Taiwan Society of Pulmonary and Critical Care Medicine website. Updated May 24, 2021. Accessed June 15, 2021.
3
Anesthesia Patient Safety Foundation.
FAQ on anesthesia machine use, protection, and decontamination during the COVID-19 pandemic.
Anesthesia Patient Safety Foundation website. Updated February 19, 2021. Accessed June 15, 2021.
4
Menon V, Padhy SK.
Ethical dilemmas faced by health care workers during COVID-19 pandemic: issues, implications and suggestions.
Asian J Psychiatr. 2020;51:102116.
5
Robert R, Kentish-Barnes N, Boyer A, Laurent A, Azoulay E, Reignier J.
Ethical dilemmas due to the Covid-19 pandemic.
Ann Intensive Care. 2020;10:84.
6
Australian and New Zealand Intensive Care Society./div>
ANZICS COVID-19 guidelines.
ANZICS website. Accessed June 15, 2021.
7
Wong P, Lim WY, Chee HL, lqbal R.
COVID-19 pandemic: ethical and legal aspects of inadequate quantity and quality of personal protective equipment for resuscitation.
Korean J Anesthesiol. 2021;74:73-75.

References

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