Pediatric anesthetic implications of COVID‐19—A review of current literature

Abstract

China, after the presentation of a cluster of patients with atypical pneumonia. These initial cases had links to a "wet market" where a range of live or freshly slaughtered animals were sold. 1 The virus has since been named SARS-CoV-2 by the World Health Organisation (WHO) and the disease which it can cause is called Coronavirus Disease 2019 (COVID-19). The WHO declared a global pandemic on March 11, 2020. The virus particles have a diameter of 60-140nm and are round-or oval-shaped and studded with spike proteins. 2The virus is highly contagious and gains entry to the host cell via the ACE-2 receptor on respiratory epithelia cells. A global response to the pandemic has included early publication of the pathogen genome, rapid development of diagnostic tests and co-ordinated research efforts to discover treatments and develop a vaccine. | TR AN S MISS I ON AND EPIDEMI OLOGYCases of COVID-19 have spread rapidly around the world, demonstrating the highly contagious nature of the virus. Its main routes of transmission are respiratory droplets and contact with respiratory secretions. However, it is likely that there is also fomite spread via contaminated surfaces based on our knowledge of other coronaviruses. 3 In children, there is also some evidence that the virus continues to shed in the stool for up to a month postinfection. 4 This raises the possibility of fecal-oral transmission during the convalescence stage.Another important route of transmission, particularly for healthcare workers, is aerosol particles. Anesthetists, intensive care physicians, emergency physicians, and some surgical specialities (eg ENT) are involved in airway procedures that generate aerosols, such as bag-mask ventilation, intubation, and extubation. This puts them at AbstractPediatric anesthetists have an important role to play in the management of patients suspected or confirmed to have COVID-19. In many institutions, the COVID-19 intubation teams are staffed with anesthetists as the proceduralists working throughout the hospitals also in the ICU and Emergency Departments. As practitioners who perform aerosol generating procedures involving the airway, we are at high risk of exposure to the virus SARS-CoV-2 and need to ensure we are well prepared and trained to manage such cases. This article reviews the relevant pediatric literature surrounding COVID-19 and summarizes the key recommendations for anesthetists involved in the care of children during this pandemic.

Unique challenges in pediatric anesthesia created by COVID-19

“…Ideally, patients with confirmed COVID-19 should be recovered in a negative pressure recovery room [34]. If unavailable, then recovery within the operating room should occur, with the additional benefit of minimizing transport and exposure to other areas of the hospital.…”

COVID-19 Pandemic: Advisory and Consensus Statement for the provision of surgical services from The Association of Paediatric Surgeons of Pakistan (APSP)

“…The shifting team should wear complete PPEs of level 4 protection and obey general precautions of hand hygiene and social distances religiously. [29] [35] 9. Intraoperative management 1.…”

“…[22] [35] 7. Level-4 protection should be observed during ward rounds in strongly suspected or confirmed cases of COVID-19 with special precautionary measures to avoid contact with patients' secretions/body fluids.…”

“…All unused items on anesthesia trolley, equipment trolley, and linen opened in theater, and other disposable items must be discarded and collected in a red bag for incineration. [35] 4. The reusable equipment, airway equipment, should be placed in a double zip-locked plastic bag and should be moved for decontamination, disinfection, and sterilization.…”

Manejo anestésico en el paciente pediátrico con COVID-19

“…La evaluación debe ser integral, abarcando no únicamente lo referente a las manifestaciones propias de COVID-19, deberá incluir las comorbilidades al igual que la patología primaria que requiere la intervención asociada, sea únicamente la respiratoria o adjunta a patología quirúrgica, los exámenes de laboratorio pertinentes y la prueba específica para SARS-CoV-2 y/o un estudio radiológico o tomográfico (8,9) .…”