The American Society of Anesthesiologists (ASA) sets standards of practice for the more than 55,000 physician anesthesiologists in the United States. The Anesthesia Patient Safety Foundation (APSF) promotes the safety of all patients who receive anesthesia care and the professionals who deliver that care. ASA and APSF make the following recommendations to address patient and health care worker needs during the COVID-19 pandemic.
ASA and APSF support the recommendations of the Centers for Disease Control and Prevention (CDC; https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/guidance-hcf.html) for facilities in areas with growing incidences of COVID-19 to reduce non-urgent surgical, diagnostic, and interventional procedures. Urgency of procedures exists along a continuum and those not time-critical should be rescheduled to a date when community transmission is no longer taking place. Time-critical procedures must be prioritized according to patient need and the resources of the facility. Ambulatory settings for surgery should be considered to reduce demand on hospital resources. This patient-centered approach, tempered with public health principles, will reduce the use of crucial protective equipment that might be needed for others, provide time for all health care providers to be oriented to the use of protective practices such as how to “don and doff” protective wear, and reduce exposure of health care workers to patients who might transmit COVID infection.
ASA and APSF recognize that decisions to reduce non-urgent procedures are dependent on each facility’s geographic location (e.g., the existing and expected community risk for COVID infection), available personal protective equipment (e.g., N95 masks, respirators and body protection), and intensive care resources (e.g., facility and provider capacity).
CDC COVID-19 guidelines advise the elderly and those with serious chronic medical conditions to stay at home as much as possible. This recommendation should be interpreted to include non-urgent surgery. Facilities should also consider social distancing and restrictions on patients and visitors who may be asymptomatic, and to monitor the well-being of their healthcare providers.
Facility leaders should ensure that all physicians, nurses, and staff have access to and training on the personal protection equipment (PPE) recommended by CDC and other standard setting organizations for their specific clinical practices. This includes availability of N95 masks, powered air purifying respirators, and other PPE, appropriately conserved for use by providers exposed to aerosolized viral particles in clinical setting such as endotracheal intubation and bronchoscopy.
Anesthesiologists and other anesthesia professionals care for patients in many parts of the hospital, in operating rooms and procedural areas, in critical care locations, radiology, endoscopy suites, and in our pain clinics. Through effective planning and implementation, the critical needs of our patients can continue to be met, while protecting the health and well being of all health care staff.
Additional important information on anesthesia care in the COVID pandemic may be found at the ASA and APSF websites: