Note: The following represent current recommendations based on the best available evidence and expert opinion. These are not guidelines. Recommendations may change as the situation continues to evolve. This document was last updated on March 31, 2020.
General anesthesia (GA) with airway intervention leads to aerosol generation, which exposes the health care team to risk of transmission of COVID-19 both during intubation and extubation.1 The odds of transmission of acute respiratory infection during tracheal intubation to a health care professional is known to be 6.6 times compared to those who are not exposed to tracheal intubation.2
The tracheal intubation for a COVID-19 positive patient is ideally performed in a negative pressure room, which may not be available in all places or situations.3
Avoiding GA is also beneficial for patients as regional anesthesia lowers the risk of postoperative complications, and this becomes more important in the context of ongoing respiratory infection.4,5 Regional anesthesia should be preferred for providing anesthesia care wherever possible.
Careful consideration should be given to allow the surgery to be performed entirely under regional anesthesia. An unplanned need for intraoperative conversion to GA is least desirable. If the duration or complexity of surgery means a high probability of conversion to GA, it is better to start with GA. This requires good communication between the anesthesia and surgical teams.
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