Environment

· Day Surgery OT (DSOT) complex cordoned off for COVID confirmed or suspected cases. The whole of DSOT is sealed up with plastic sheets. Neighbouring DSOT for doffing of PPE.

Movement—Aim to minimise movement of personnel and equipment in and out of OT

· Of Patients

· DSOT has a separate entrance away from MOT for transfer of COVID-19 case.

· The trolley of the patient is to be wrapped in plastic sheets, with the patient on the trolley, in the corridor outside MOT reception, before the patient is wheeled into MOT reception.

· Surgical mask is to be worn over a patient’s oxygen nasal prongs/face mask.

· After surgery, the patient is to be recovered in OT before transporting back to the isolation ward/ICU.

· Of Personnel

· Surgeons and Scrub Nurses are to only enter the OT AFTER intubation.

· Anaesthesia Personnel are to stay with patients in OT till they fully recover in OT, before Porter takes over from outside OT.

· During CODE BLUE, standby personnel in appropriate PPE will enter via scrub room

· Of Equipment

· Intraoperatively, requests for items are to be made via phone to Runner Nurse outside OT. This Runner (circulating) Nurse then places the requested item in the scrub room, leaves the scrub room first before the personnel in OT retrieves the item.

· Requests for blood products are made in a similar manner. Clean personnel are to bring the blood product to MOT Reception and the circulating nurse will collect it from there.

Conduct of Anaesthesia

· As far as possible, minimise aerosol-generating procedures e.g. face-mask ventilation, patient coughing/retching, awake FOB intubation, high-flow nasal cannula, BIPAP.

· RA is preferred over GA. Patients should wear a surgical face mask at all times if surgery is performed under RA. If a patient requires oxygen supplementation, the surgical mask is to be worn over the nasal cannula/face mask.

· ETT is preferred over an LMA for the better air seal.

· Using a video laryngoscope to intubate is recommended for better vision of the glottis when wearing the PAPR, and to increase the distance between the intubator and patient’s airway.

· Minimise circuit disconnection. If this is unavoidable, ensure positive pressure ventilation is ceased, turn the APL valve to zero, and clamp the endotracheal tube prior to disconnection. This technique may also be used before switching a patient from the transport ventilator to the anaesthetic machine. The patient should be preoxygenated and the duration of disconnection should be kept to a minimum to avoid exacerbating hypoxia in critically ill COVID-19 patients with respiratory failure.