Whenever possible surgical interventions should be postponed until obtaining official results of testing for COVID-19 or recovery of the patient. Surgical interventions should be carried out as far as it is possible, at the patient's bed in ORIT chamber with negative pressure. Number of staff in these cases has to be minimized, and breaks are carried out only in case of need.
In need of carrying out surgical intervention in the operating room all personnel have to study previously the relevant protocol of actions and strictly follow it. The protocol consists of a set of important steps which need to be carried out strictly, and acquaintance with which will help to avoid many mistakes.
Below we will analyze the approximate protocol of actions when performing surgery at the patient with COVID-19.
Before arrival of the patient to the operating room it is necessary to be convinced that all members of surgical, sisterly and anesthesiology crews know that operation to the patient with COVID-19 is planned.
If there is an opportunity, to use in the operating room Wednesday with negative pressure, then it needs to be made.
On all doors operational and preoperative it is necessary to place accurate indexes that there the personnel without the corresponding SIZ did not come.
It is necessary to prepare completely completed cart with standard anesthesiology laying that there was no need to leave the operating room, it is also necessary to pull out everything that can be necessary from boxes of the narcotic device and try not to open any more them.
It is necessary to make every effort to avoid an entrance and an exit in/from the operating room throughout operation, and the neighboring operating room (if it is not used) and preoperative have to be used for delivery of additional surgical materials to the operating room in process of requirement
Preoperative it is considered kontaminirovanny since that moment when the patient is brought to the adjacent operating room.
Any unused materials in the operating room are considered as kontaminirovanny and have to be thrown out on the end of a procedure.
The anesthesiologist needs to be convinced that working space, the rebreathing system and an aspirator are prepared as appropriate, namely: on a rebreathing system highly effective filters, both on an expiratory part of a contour, and on the Y-shaped connector are installed, the endotracheal tube with port for nadmanzhetochny aspiration is available on hand and is ready to use, the line for monitoring of the exhaled mix of gases is located on that end of a contour where the filter is put.
The device ultrasonography and other devices have to be wrapped and contain in the maximum purity.
Leave unnecessary personal belongings (bags, zone bags, etc.) outside the operating room, use phone in the operating room in the mode of the loudspeaker, handles and felt-tip pens should be utilized after each use.
It is necessary to avoid use of a stethoscope, and in case of need to use only disposable.
All members of operational crew have to carry a complete set of SIZ from the infections which are transferred in the contact, airborne and aerosol way (protection against COVID-19 infection) throughout all procedure.
Use of the filtering respirators with compulsory air supply (PAPR) is more preferable, than N95 respirators, in the presence, but both options are completely suitable forms of protection during the work with patients with COVID-19.
The personnel of the operating room have to process as often as possible hands an antiseptic agent and wear two pairs of gloves.
It is necessary to avoid use of laryngeal masks (LMA), deep sedation and a fibreoptic intubation of the patient in consciousness.
It is necessary to avoid use of any sedative drugs which can lead to obstruction of the respiratory tracts/hypoventilation demanding an unforeseen or urgent intubation.
Whenever possible it is necessary to apply regional/local anesthesia.
The patient should establish nasal cannulas with minimum low flow of gas and to put on him a surgical mask which has to be applied throughout all intervention.
It is recommended to apply protective IVL.
The intubation and extubation belongs to aerosol - to the generating medical procedures therefore at the operating room there can be only anesthesiologists and the corresponding personnel.
After operation is finished, the condition of the patient was stabilized, cough and vomiting are absent, the patient should be moved on the wheelchair and to put on him a surgical mask which it has to wear during awakening.
After the operating room was freed, within one hour it has to remain free, and then in it careful processing has to be carried out.