Patients shoud wear a mask whenever they are transported bypasing through

a special circuit for covid-19 suspects. If oxygen is needed, the oxygen masks are
placed over the surgical ones (6-8l/min). The main goal is to prevent the
transsmission of the infection of COVID-19 and the contamination of the
anaesthesia machine and of the other equipment. After the patient is brought in the
OR only the anaesthesiologist and the designated nurse for intubation remain in the
room. It is important to have hand hygiene during aerosol generating procedures.
The anaesthetic team washes hand with soap water, or uses alcohol based gel. It is
important to have hand hygiene (HH) before each step: first someone helps the
doctor with the wataer resistent gown, then HH, second the mask and cap, HH, eye
protection(goggles or face shield), HH, and at last, two pair of gloves. The
appropiate surgical mask is at least K95 or with higher respiratory. Tracheal
intubation is the highest risk procedure for transsmision of COVID19. On second
place extubation and after bag mask ventilation, brochoscopy.

It should be place a high quality viral filter between the breathing circuit and
the patient’s airway and a second filter is placed on the expiratory limb, where it
connects to anesthesia machine. It should be performed a rapid sequence
induction(RSI) and intubation: first we aspirate stomach content on nasogastric
tube, place nasal prongs under a surgical mask, achieve two intravenous lines with
running fluids, preoperative antacides, atiemetics, antibiotics iv. Optimize
haemodynamics prior to intubating, use of vassopresore if nedded. Elevate the head
of the patient, preoxygenate 3-5 minute with 5L/min., inject low dose opioid,
hypnotic and deep muscle relaxation, to avoid cough, after sedation intubate and
inflate cuff and attach filter before connecting to ventilation machine, clamp tube if
disconnection required.

 Procedures that aerosolise the virus: • Non invasive ventilation for pre-
oxygenation • High flow nasal prongs (>6l/min) / high circuit flow • Manual
ventilation during apnoea – unless needed • Unplanned circuit
disconnections • Cough during intubation. The fresh gas is reduced at 1-2
l/min or less during anaesthesia. After the surgery if the patient is stable, and
has good arterial blood gasses he is awake, and trasport with a surgical mask
and on it an oxygen mask. Like intubation, when extubate,only the
anaesthesist remains in the room. First should aspirate the tracheal secretion,
and put a wet gauze if the patient caughs. If the patient remain intubated, we
clamp the endotracheal tube for five seconds and connect it to the transport
 ventilator( with filter), or a high quality heat and moisture exchanging filter
should be insert between the self inflating bag and endotracheal tube. The
patient should be transported directly to an airbone infection isolation for
recovery. The gas sampling tube should bechange after a covid patient.
We throw everything that was in contact with the patient. All trash and linen
were placed in red biohazard bags. Special care was taken when dismantling
and discarding the circuit from the anesthesia machine. The ultraviolet light
disinfection was set on its normal cycle and run in the OR room to
additionally disinfect the room 30 minutes then cleaning with
with special disinfectants based on peroxide and another 30 minutes cleaning
pump, until all aerosols have been removed.
