Anesthesia guidelines for COVID-19 patients: a narrative review and appraisal

Abstract

The Coronavirus Disease 2019 (COVID-19) pandemic challenged health systems globally and prompted the publication of many guidelines. Experiences of our international colleagues should be utilized to protect and benefit patients and healthcare workers. The primary aim of this article is to evaluate and appraise national guidelines for the perioperative anesthetic management of patients with COVID-19 so that guidelines could be enhanced to manage any resurgence of the epidemic. PubMed and EMBASE databases were systematically searched to identify guidelines and studies related to SARS-CoV and SARS-CoV-2. Additionally, the World Federation Society of Anesthesiologists COVID-19 resource webpage was searched for national guidelines and expanded to include countries that experienced a high incidence of SARS-CoV. Guidelines were evaluated using the

Critical Appraisal of Clinical Practice Guidelines for the Management of COVID-19: Protocol for a Systematic Review

“…This study included consensus-based CPGs and was conducted before COVID-19 was declared a pandemic by the World Health Organization; therefore, several CPGs developed afterwards have not been assessed. Another study examined COVID-19 CPGs relevant to anesthetic management [12], while Yeo et al examined CPGs for managing neonates born to mothers with COVID-19 [13]. Due to the highly speci c interventions and populations, these studies would not have assessed all evidence-based CPGs relevant to COVID-19 management or TI use [12][13].…”

“…Another study examined COVID-19 CPGs relevant to anesthetic management [12], while Yeo et al examined CPGs for managing neonates born to mothers with COVID-19 [13]. Due to the highly speci c interventions and populations, these studies would not have assessed all evidence-based CPGs relevant to COVID-19 management or TI use [12][13]. Thus, to our knowledge, this study will be the rst to assess the quality of evidence-based CPGs for the management of adult patients with COVID-19.…”

“…To date, only 3 published studies have examined the quality of CPGs for COVID-19 using the AGREE II instrument [11][12][13]. These studies found that the recommendations formulated within the CPGs were lacking evidence and that the overall quality of CPGs was poor and variable [11][12][13]. However, these studies are limited in that they assessed CPGs published very soon after the rst con rmed case of COVID-19 [11], CPGs addressing very speci c interventions [12], or CPGs with very speci c populations [13].…”

“…These studies found that the recommendations formulated within the CPGs were lacking evidence and that the overall quality of CPGs was poor and variable [11][12][13]. However, these studies are limited in that they assessed CPGs published very soon after the rst con rmed case of COVID-19 [11], CPGs addressing very speci c interventions [12], or CPGs with very speci c populations [13]. To our knowledge, this study will be the rst to assess the quality of evidence-based CPGs focused on the use of TIs and/or management of COVID-19.…”

“…The well-established and widely-validated Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument is one tool commonly used to assess the methodological quality of CPGs [10]. To date, only 3 published studies have examined the quality of CPGs for COVID-19 using the AGREE II instrument [11][12][13]. These studies found that the recommendations formulated within the CPGs were lacking evidence and that the overall quality of CPGs was poor and variable [11][12][13].…”