Perioperative strategy during pandemic caused by SARS CoV-2 virus: Perioperative strategy during COVID-19 pandemic

The main feature of the SARS CoV-2 virus pandemic is the collapse of the health care system due to a large number of patients. This situation requires strict perioperative control of the infection to suppress the transmission of pathogens among surgical patients. Reduction of residual contamination of the working environment requires a combination of deep cleaning with disinfectants and ultraviolet C radiation. Intubation is a high-risk procedure for virus transmission and demands rigorous respect of personal protection for anesthesia providers, including a protective mask (FFP 2, FFP3), two pairs of gloves ("double gloves technique") and goggles, and disinfectant near the anesthesiology team. The workspace needs pre-planning and control of the movement through the so-called "green" and "red" zones. Before surgery, maintaining of patient's hygiene is important - including hair and body washing with antiseptic skin cleanser gel, rinse of the oral and nasal cavity and hand washing. During preoperative preparation, identification of COVID-19 infection is necessary. If the patient is febrile and the test results show the existence of a lung infection, SpO2 ≤ 90% of unknown cause and the operation is not urgent, the anesthesiologist should inform the patient, family, and surgeon that the operation should be postponed. If the patient is tested positive for SARS-CoV-2, elective surgery is delayed until the complete recovery of the patient, which includes a negative test and recovery from COVID-19. Patient should recover in the operating room after extubation. The surgical mask should be placed over an oxygen mask. Patient is transported with a surgical mask on his face to the ward directly.