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1. Can the ASA tell me if I can trust the testing done at my facility?
No, the ASA does not vet facility testing accuracy which is dependent on the collection of the sample as well as instrumentation. We encourage you to work with your infection prevention personnel, testing manufacturers and others to determine the efficacy of individual tests.
2. Where can I find examples of testing protocols?
The APSF has gathered and published several preoperative COVID testing protocols from different practices in the United States.
3. What guidelines does ASA have for anesthetizing patients that have a history of test-positive COVID-19, but are now completely asymptomatic? How long should we wait to anesthetize these patients and what kind of precautions (for both personnel and equipment) are necessary?
Because false-negatives may occur with testing, droplet precautions (surgical mask and eye covering) should be used by OR staff for operative cases. Before performing an aerosol -generating procedure, health care providers within the room should wear an N95 mask, eye protection, gloves and a gown.
5. Is a single PCR negative test sufficient to recommend standard operating room attire and no N95 mask for intubation and extubation of an asymptomatic patient having surgery?
No. Because false-negatives may occur with testing, droplet precautions (surgical mask and eye covering) should be used by OR staff for operative cases. Before performing an aerosol -generating procedure, health care providers within the room should wear an N95 mask, eye protection, gloves and a gown.
8. Should anesthesiologists cancel or delay cases when patients refuse preoperative COVID-19 testing?
There are many contingencies that anesthesiologists should consider when patients refuse to take a COVID-19 test prior to surgery. The ASA/APSF Statement on Perioperative Testing for the COVID-19 Virus states that patients showing symptoms of COVID-19 should undergo further evaluation and those with COVID-19 should have their elective surgical procedures delayed until the patient is no longer infectious and has demonstrated recovery from COVID-19.
When patients refuse to take a preoperative COVID-19 test, anesthesiologists must work with their surgical colleagues, perioperative nurses, and local infection prevention experts to assess the surgical and anesthetic risk to the patient and the risk to healthcare workers of contracting the virus. It is important for anesthesiologists to understand why patients refuse to be tested and offer to reschedule procedures when the testing mandate is no longer in effect. When there is an unknown or elevated risk of infection, we recommend delaying their procedures until the risk is either better known (i.e., negative test result) or patients are asymptomatic for at least 10 days.
Patients who refuse preoperative COVID-19 testing put their health and safety at risk. Recent studies and physician experience have indicated that COVID-19+ patients have increased risks of complications and adverse events. ASA, APSF and other organizations recommend that anesthesiologists delay the care of these patients either until they have tested negative for the virus or all symptoms have abated for 10 or more days.
Patients who refuse to take a preoperative COVID-19 test place healthcare workers at risk. Their care can also waste valuable resources. Patients who have not undergone preoperative COVID testing, or who have undergone testing but their test results are not yet available, and in whom clinical assessment of potential infection is not possible, should be cared for as COVID-19+ with all appropriate precautions. This also is true for patients presenting for urgent or emergent surgery when there is insufficient time to obtain COVID-19 tests.
9. Many children have upper respiratory infections (URI) yet are not COVID-19 positive. Should pediatric patients also be tested for COVID-19?
Our statement on perioperative testing applies to all patients. For elective surgery, even for non-COVID positive patients, the risks and benefits of the procedure should be weighed with the increased risk of anesthetizing a child with an active infection.
10. What is the minimum level of pre-operative testing that should be done prior to elective cases?
We believe that all patients should be screened for symptoms prior to presenting to the hospital or other location where the procedure will take place. Patients reporting symptoms should be referred for additional evaluation. Patients not reporting symptoms should undergo nucleic acid amplification testing (including PCR tests) prior to undergoing nonemergent surgery. Knowledge of whether or not patients are COVID-positive is important for guiding their postoperative management, since patients who are infected with SARS-CoV-2, the virus responsible for the COVID-19 disease, can have a higher risk of perioperative morbidity and mortality. Protection of other patients and healthcare workers is another important objective. Please see the ASA/APSF Statement on Perioperative Testing for the COVID-19 Virus ASA/APSF Statement on Perioperative Testing for the COVID-19 Virus for additional information.
We also remind anesthesiologists that all ASA standards and guidelines are publicly available for review. Please remember to review the Basic Standards for PreAnesthesia Care and the Practice Advisory for Preanesthesia Evaluation, as well as other relevant resources, prior to performing any surgical case.
11. Should we proceed with a surgery or procedure in a patient that has again tested positive for COVID-19 more than 45 days after their initial positive test?
12. Should perioperative testing occur on patients who received the COVID-19 vaccine?
Please refer to the Updated ASA and APSF Statement on Perioperative Testing for the COVID-19 Virus. In July 2021, ASA and APSF informally surveyed several medical centers and others to learn how their testing protocols might have evolved, with specific attention to their approach to preoperative testing for patients who have been fully vaccinated for COVID-19. In almost all cases, these leading institutions continue to require COVID preoperative testing for all patients, including those who have been fully vaccinated. The primary concerns are that the prevalence of the Delta variant is increasing in their communities, and the recent findings by the CDC regarding breakthrough infections in fully vaccinated, asymptomatic individuals who have the potential of transmission of SARS-CoV-2 to others. Therefore, all patients undergoing an anesthetic, procedure, or surgery with the potential to generate aerosols should continue to have preoperative PCR testing for SARS-CoV-2, ideally ≤ three days prior to the procedure, irrespective of vaccination status.
Viewers of this material should review these FAQs with appropriate medical and legal counsel and make their own determinations as to relevance to their particular practice setting and compliance with state and federal laws and regulations. The ASA has used its best efforts to provide accurate information. However, this material is provided only for informational purposes and does not constitute medical or legal advice. This response also should not be construed as representing ASA policy (unless otherwise stated), making clinical recommendations, dictating payment policy, or substituting for the judgment of a physician and consultation with independent legal counsel.