Anesth Pain Med.  2020 Jul;15(3):388-396. 10.17085/apm.20044.

The experience of infection prevention for coronavirus disease 2019 (COVID-19) during general anesthesia in an epidemic of COVID-19: including unexpected exposure case - Two cases report -

• Kim H
• Oh J
• Lee SG
• Shim KS

• KMID: 2504904
• DOI: http://doi.org/10.17085/apm.20044

Abstract

Background
Coronavirus disease 2019 (COVID-19) has been an epidemic in the Republic of Korea since the first patient who came in China was confirmed as having the disease on January 19, 2020. Therefore, surgery for COVID-19-related patients is expected to increase. Case: We experienced two cases of COVID-19-related patients who underwent surgery for femur fracture under general anesthesia. In one case, infection control to prevent transmission was achieved, while in the second case, healthcare workers were exposed to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).
Conclusions
In areas where there is COVID-19 epidemic, SARS-CoV-2 RT-PCR should be performed before surgery in patients with symptoms of respiratory infection such as fever, cough, and sputum, or for those in whom the possibility of COVID-19 cannot be completely excluded. Efforts should be made to prevent healthcare worker’s exposure and the contamination of the operating room.

Keyword

COVID-19; Epidemics; General anesthesia; Infection control; Personal protective equipment; SARS-CoV-2

Figure

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  Fig. 1. Chest CT showed consolidations in both lower lung which were suspected as pneumonia. CT: computed tomography.

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  Fig. 2. (A) When planning elective surgery, Chest X-ray was performed first. If the possibility of SARS-CoV-2 infection could not be completely ruled out, chest CT and RT-PCR were also performed. (B) In the case of emergency surgery, chest CT was checked as well as chest X-ray in all patients. SARS-CoV-2 PCR was performed when abnormality in Chest CT was detected, patients had risk factors, or respiratory symptoms such as cough and sputum. RT-PCR: real-time polymerase chain reaction, PPE: personal protective equipment, SARS-CoV-2: severe acute respiratory syndrome coronavirus-2, COVID-19: coronavirus disease 2019, CT: computed tomography, PA: posteroanterior.

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  Fig. 3. (A) Chest CT showed no evidence of active infection and no change in the interval of old tuberculosis. (B) Chest CT showed increased bilateral pleural effusion and no interval change of GGA in the right lower lung. (C) Chest CT showed a multifocal patchy GGA lesion with interlobular septal thickening that appears to be a new suspected viral pneumonia. CT: computed tomography, GGA: ground-glass appearance.

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  Fig. 4. This picture is a schematic diagram of our operating hall. We set up rosette A and rosette B. The rosette close to the entrance was set as a negative pressure zone. PACU: post-anesthesia care unit.

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  Fig. 5. Standard personal protective equipment in frontal view (A) and back view (B).

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  Fig. 6. Enhanced personal protective equipment in frontal view (A) and back view (B).

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