Anesthesia and surgery for positive COVID‐19 asymptomatic pediatric patients: How long should we wait?

Geng‐Ramos, Giuliana; Cronin, Jessica; Challa, Chaitanya; Brennan, Marjorie; Matisoff, Andrew; Delaney, Meghan; Campos, Joseph M.; Rana, Sohel; Wyson, Brenna; Pestieau, Sophie R.

doi:10.1111/pan.14191

Cited by 7 publications

(8 citation statements)

References 3 publications

(7 reference statements)

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“…Those with persisting symptoms at 7 weeks are at higher risk (OR 5.96 (3.24-8.68) than asymptomatic (OR 1.3 (0.59-2.01)) and resolved 2.43 (1.42-3.44). In the paediatric cohort, there is limited data but a minimum 28-day delay has been suggested for asymptomatic patients positive for SARS-CoV-2 in a paediatric cohort [36]. In patients undergoing cancer surgery, a 3-week wait has been recommended [37].…”

Section: Management Patients With Positive Testsmentioning

confidence: 99%

Safe Surgery During the COVID-19 Pandemic

et al. 2021

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Purpose of Review Coronavirus Disease-2019 (COVID-19) has had an enormous impact on all aspects of healthcare, but its effect on patients needing surgery and surgeons has been disproportionate. In this review, we aim to understand the impact of the pandemic on surgical patients and teams. We compiled the emerging data on pre-operative screening methods, vaccinations, safe-surgery pathways and surgical techniques and make recommendations for evidence-based safe-surgical pathways. We also present surgical outcomes for emergency, oncological and benign surgery in the context of the pandemic. Finally, we attempt to address the impact of the pandemic on patients, staff and surgical training and provide perspectives for the future. Recent Findings Surgical teams have developed consensus guidelines and established research priorities and safety precautions for surgery during the COVID-19 pandemic. Evidence supports that surgery in patients with a peri-operative SARS-CoV-2 infection carries substantial risks, but risk mitigation strategies are effective at reducing harm to staff and patients. Summary Surgery has increased risk for patients and staff, but this can be mitigated effectively, especially for elective surgery. Elective surgery can be safely performed during the COVID-19 pandemic employing the strategies discussed in this review.

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Section: Management Patients With Positive Testsmentioning

confidence: 99%

Safe Surgery During the COVID-19 Pandemic

et al. 2021

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“…Given the virus's association with anesthetic complications and exposure risk to perioperative staff and patients, many institutions implemented pre‐operative testing. Surgeries were postponed in patients who tested positive when possible 1 . Indeed, depending on symptomatology, patient comorbidities, and surgery urgency, the American Society of Anesthesiology (ASA) guidelines recommend delaying the procedure until the patient has recovered from the infection, with a minimum of 4 weeks for patients who remained asymptomatic or were only mildly symptomatic 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Surgeries were postponed in patients who tested positive when possible. 1 Indeed, depending on symptomatology, patient comorbidities, and surgery urgency, the American Society of Anesthesiology (ASA) guidelines recommend delaying the procedure until the patient has recovered from the infection, with a minimum of 4 weeks for patients who remained asymptomatic or were only mildly symptomatic. 2 While some surgeries can be postponed, a proportion of children require a balanced assessment that weighs perioperative complication risks in the setting of SARS‐CoV‐2 infection with the urgency of the procedure.…”

Section: Introductionmentioning

confidence: 99%

Postanesthesia complications in pediatric patients with previous SARS‐CoV‐2 infection: A cohort study

Geng‐Ramos

Nelson

Lee

et al. 2022

Pediatric Anesthesia

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Background Children with SARS‐CoV‐2 infection are at increased risk for postanesthesia complications. There is minimal data regarding how long that elevated complication risk persists beyond initial SARS‐CoV‐2 diagnosis. Aims We investigated postanesthesia complications in children with SARS‐CoV‐2 infection within 90 days of diagnosis. Methods We completed a single‐center, retrospective, case–control study of pediatric patients with confirmed SARS‐CoV‐2 infection within 90 days undergoing anesthesia between January 3–October 7, 2020. Each SARS‐CoV‐2 positive patient was matched 1:2 by age and type of procedure with a non–SARS‐CoV‐2 cohort. The primary outcome was the rate of all postanesthesia complications within 30 days of the procedure, defined as unplanned escalations of care within 48 h, cardiac, respiratory, thrombotic, and hemorrhagic events within 30 days. Secondary outcomes were 30‐day mortality and hospital length of stay. Results Of the 341 patients included, 114 patients were SARS‐CoV‐2 positive and 227 were SARS‐CoV‐2 negative. Patients with a positive test 0–7 days prior to anesthesia had an increased risk difference in all postanesthesia complications within 30 days (19.9, 95% CI [4.7, 35.1], p = .001) and increased risk difference in length of hospital stay (7.8, 95% CI [1.2, 14.4], p < .001). Patients who underwent anesthesia greater than 42 days from SARS‐CoV‐2 diagnosis had an increased risk difference in cardiac complications within 30 days (4.3, 95% CI [0.9, 10.0], p = .029). There was no increased hospital length of stay among SARS‐CoV‐2 positive patients diagnosed greater than 8 days before anesthetic. There were no deaths within 30 days of anesthetic. Conclusions Postanesthesia complications are higher in children who undergo anesthesia within 7 days of SARS‐CoV‐2 diagnosis. Additional cardiac risk may persist beyond the immediate period of initial diagnosis. Larger samples are needed to further evaluate the risk of delayed postanesthesia complications and guide optimal timing of surgery.

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“…Current guidelines from pediatric anesthesia societies often recommend postponement of nonessential anesthesia and surgery in children until at least 14 days after onset of COVID‐19 symptoms 8,9 . This delay avoids anesthesia in the early course of the disease when nirmatrelvir–ritonavir might be given.…”

Section: Introductionmentioning

confidence: 99%

“…7 Current guidelines from pediatric anesthesia societies often recommend postponement of nonessential anesthesia and surgery in children until at least 14 days after onset of COVID-19 symptoms. 8,9 This delay avoids anesthesia in the early course of the disease when nirmatrelvir-ritonavir might be given. There will be occasions when the need for medical intervention cannot be postponed and anesthesiology practitioners should be mindful of potential interactions between ritonavir and drugs used during anesthesia and adapt perioperative care appropriately.…”

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confidence: 99%

Interactions of the protease inhibitor, ritonavir, with common anesthesia drugs

Svedmyr

Hack

Anderson

2022

Pediatric Anesthesia

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The protease inhibitor, ritonavir, is a strong inhibitor of CYP 3A. The drug is used for management of the human immunovirus and is currently part of an oral antiviral drug combination (nirmatrelvir-ritonavir) for the early treatment of SARS-2 COVID-19-positive patients aged 12 years and over who have recognized comorbidities. The CYP 3A enzyme system is responsible for clearance of numerous drugs used in anesthesia (e.g., alfentanil, fentanyl, methadone, rocuronium, bupivacaine, midazolam, ketamine). Ritonavir will have an impact on drug clearances that are dependent on How to cite this article: Svedmyr A, Hack H, Anderson BJ.Interactions of the protease inhibitor, ritonavir, with common anesthesia drugs.

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Anesthesia and surgery for positive COVID‐19 asymptomatic pediatric patients: How long should we wait?

Abstract: How to cite this article: Geng-Ramos G, Cronin J, Challa C, et al. Anesthesia and surgery for positive COVID-19 asymptomatic pediatric patients: How long should we wait?.

Cited by 7 publications

References 3 publications

Safe Surgery During the COVID-19 Pandemic

Safe Surgery During the COVID-19 Pandemic

Postanesthesia complications in pediatric patients with previous SARS‐CoV‐2 infection: A cohort study

Interactions of the protease inhibitor, ritonavir, with common anesthesia drugs

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