What we do when a COVID-19 patient needs an operation: operating room preparation and guidance
Lian Kah Ti
Bryan Su Wei Ng
Lin Stella Ang
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To the Editor, We read with interest the recent review in the Journal by Wax and Christian1 on coronavirus disease 2019 (COVID-19). The ﬁrst case of COVID-19 in Singapore was conﬁrmed on 23 January 2020.2 In the week of February 13–19, the World Health Organization reported that Singapore had more cases of COVID-19 than any other country outside of mainland China.3 We wish to share the protocol that we use in our hospital in preparing an operating room (OR) for conﬁrmed or suspected COVID-19 patients coming for surgery. An OR with a negative pressure environment located at a corner of the operating complex, and with a separate access, is designated for all conﬁrmed (or suspected) COVID-19 cases. The OR actually consists of ﬁve interconnected rooms, of which only the ante room and anesthesia induction rooms have negative atmospheric pressures. The OR proper, preparation, and scrub rooms all have positive pressures (eFig. 1 in the Electronic Supplementary Material [ESM]). Understanding the airﬂow within the OR is crucial to minimizing the risk of infection. The same OR and the same anesthesia machine will only be used for COVID-19 cases for the duration of the epidemic. An additional heat and moisture exchanger (HME) ﬁlter is placed on the expiratory limb of the circuit. Both HME ﬁlters and the soda lime are changed after each case. The anesthetic drug trolley is kept in the induction room. Before the start of each operation, the anesthesiologist puts all the drugs and equipment required for the procedure onto a tray to avoid handling of the drug trolley during the case. Nevertheless, if there is a need for additional drugs, hand hygiene and glove changing are performed before entering the induction room and handling the drug trolley.