The anesthesiology help can be required by patients with a koronavirusny infection who come on treatment to hospitals for several reasons. First, at such patient developing of acute surgical pathology which demands performing surgery is possible. Secondly, an operative measure can be required in aspect of treatment of actually koronavirusny infection (for example, carrying out a tracheostomy in need of long artificial ventilation of the lungs). Thirdly, patients who are in COVID-19 incubation interval can come to hospitals with surgical pathology, without suspecting that they are infected with an infectious disease.
The situation of existence of a koronavirusny infection at planned patients if they for some reason did not hand over the PTsR-test is also possible, it was negative or they did not allocate a virus by the time of capture of a smear.
All this dictates certain requirements to rendering the anesthesiology help during a pandemic the general rule is that any patient has to be perceived by members of anesthesiology crew as the potential carrier and the distributor of a coronavirus. According to it the grant has to be planned anesthesiology and be held the events directed to protection of other patients and medical personnel.
For the purpose of optimization of rendering the anesthesiology help in pandemic conditions, patients who need carrying out an anesthesiology grant can be divided into several groups:
The patients needing the emergency surgical help about COVID-19 which are on hospital treatment in infectious diseases hospitals;
The patients needing the emergency surgical help about COVID-19 which are on house treatment;
The patients needing the emergency surgical help without COVID-19 who are on a quarantine in house conditions;
The patients needing the emergency surgical help without COVID-19 which handed over the PTsR-test;
The planned patients who handed over the PTsR-test.
Features of carrying out the general anesthesia at a koronavirusny infection
This division is to some extent conditional and does not cancel necessary precautionary measures during the work with patients who according to the PTsR-test have no COVID-19.
Are the most dangerous to medical personnel in aspect of infection with a koronavirusny infection so-called aerosol - the generating procedures. Formation of the most fine liquid particles (aerosols) during the medical procedures can pose a threat for medical personnel because of possible contents in such COVID-19 aerosols. The following procedures are considered as potentially dangerous concerning formation of the aerosols containing COVID-19:
the endoscopy of upper parts of a GIT meaning open aspiration of contents of the upper airways;
surgeries with use of high-speed devices (saws and so forth);
some emergency dental manipulations (for example, high-speed drilling);
noninvasive ventilation, for example two-level ventilation with positive pressure in respiratory tracts and continuous ventilation with positive pressure in respiratory tracts, ventilation by high-frequency fluctuations;
stimulation of an otkhozhdeniye of a phlegm;
high-line nasal oxygenation.
Features of carrying out the general anesthesia at a koronavirusny infection
For patients with suspicion of a koronavirusny infection or with the verified COVID-19, any of these potentially infectious procedures with education aerosols should be seen off only in urgent cases.
The trachea intubation also belongs to the category aerosol - the generating procedures. But, as it is not possible to avoid its use, the anesthesiology personnel have to undertake necessary measures of protection during a trachea intubation:
The anesthesiologist and anestezistka have to put on a complete set of individual protection equipment;
In the operating room during an intubation a bang there has to be the minimum number of people;
It is necessary to avoid manual mask ventilation to a trachea intubation if it is possible;
It is necessary to achieve adequate anesthesia and a muscular relaxation from the intubated patient to avoid tussive reaction to introduction of an endotracheal tube;
Use of the video laryngoscope is preferable;
When using the ordinary laryngoscope the anesthesiologist should avoid approach of the person to the face of the patient;
Right after introduction to a trachea the endotracheal tube is pressed a clip, or use a tube with the bacterial and virus respiratory filter which is in advance put on her.