How ASCs can handle aerosol-generating procedures amid COVID-19 risks: 4 key strategies

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The COVID-19 pandemic will affect daily operating room management by ASCs, according to a narrative review published in the Journal of Clinical Anesthesia.

Featured in the September 2020 issue of JCA, the study was authored by Franklin Dexter, MD, PhD, Mohamed Elhakim, MD, Randy Loftus, MD, Melinda Seering, MD, and Richard Epstein, MD.

The review suggested four targeted strategies for surgery centers preoperatively screening patients with the COVID-19 reverse transcription polymerase chain reaction test, but not with chest computed tomography scans.

Four recommended strategies:

1. Use multimodal perioperative infection control practices such as patient decontamination, and monitor environmental transmission and other performance indicators.

2. Dedicate most ORs to procedures that don't require general anesthesia or generate aerosol. Whenever possible, bypass the phase 1 post-anesthesia care unit through strategic anesthetic approaches and drug selection.

3. Patients undergoing procedures that don't generate aerosol but do require general anesthesia should begin their post-anesthesia recovery in the OR where their procedure was performed. Use anesthetic methods that facilitate fast initial recovery.

4. For surgical procedures that cause aerosol production, handle initial post-anesthesia recovery in the OR and conduct multimodal environmental cleaning after every case. Plan for longer turnover times and stagger cases so that anesthesia and nursing teams are handling one case while another room is being decontaminated.


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