Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) Position Statement and Advisory for the Practice of Neuroanesthesia during COVID-19 PandemicEndorsed by Indian Society of Anaesthesiologists (ISA)
The coronavirus disease 2019 (COVID-19) is a major health emergency in today’s time. In December 2019, a cluster of pneumonia cases in Wuhan, China was attributed to a novel coronavirus. The World Health Organization declared it as a pandemic. As the majority of the cases suffering from COVID-19 are mildly symptomatic or asymptomatic, it becomes a great challenge to identify the infected persons in the absence of extensive testing. In the hospital environment, it can infect several other vulnerable patients and healthcare providers, significantly impacting the hospital services. Anesthesiologists are at an increased risk of COVID-19 transmission from the patients, as they are frequently involved in several aerosol-generating procedures. It is not possible to identify asymptomatic COVID-19 patients solely based on history-taking during their first point of contact with the anesthesiologists at the preanesthetic checkup clinic.
Most of the neurosurgical conditions are of urgent in nature and cannot be postponed for a longer duration. In view of this, the position statement and practice advisory from the Indian Society of Neuroanaesthesiology and Critical Care (ISNACC) provides guidance to the practice of neuroanesthesia in the present scenario. The advisory has been prepared considering the current disease status of the COVID-19 pandemic, available literature, and consensus from experts in the field of neuroanesthesiology. Since the pandemic is still progressing and the nature of the disease is dynamic, readers are advised to constantly look for updated literature from ISNACC and other neurology and neurosurgical societies.
06 July 2020 (online)
© 2020. Indian Society of Neuroanaesthesiology and Critical Care. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).
Thieme Medical and Scientific Publishers Private Ltd.
A-12, Second Floor, Sector -2, NOIDA -201301, India
- 1 Huang C, Wang Y, Li X. et al Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395 (10223) 497-506
- 2 World Health Organization. Coronavirus disease (COVID-19) Pandemic. Available at: https://www.who.int/emergencies/diseases/novel-coronavirus-2019?gclid=Cj0KCQjwudb3BRC9ARIsAEa-vUsctFlD6aobT3Kv3DULXTWG_n6djvGHw8YFr3DBVsdtI520KhEcsTwaAp8TEALw_wcB. Accessed April 9, 2020
- 3 Nahshon C, Bitterman A, Haddad R, Hazzan D, Lavie O. Hazardous postoperative outcomes of unexpected COVID-19 infected patients: a call for global consideration of sampling all asymptomatic patients before surgical treatment. World J Surg 2020; DOI: 10.1007/s00268-020-05575-2.
- 4 Indian Council of Medical Research Department of Health Research, Ministry of Health and Family Welfare, Government of India. Advisory on Use of Rapid Antigen Detection Test for COVID-19. Published on: 14th June 2020. Available at: https://www.icmr.gov.in/pdf/covid/strategy/Advisory_for_rapid_antigen_test_14062020_.pdf. Accessed June 16, 2020
- 5 COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet 2020; DOI: 10.1016/S0140-6736(20)31182-X.
- 6 Tenenbein P, Riazi S, Johnstone J, Keshavjee S, Karkouti K. The case for routine screening for SARS-CoV-2 before surgery. Can J Anaesth 2020; 3: 1-6 DOI: 10.1007/s12630-020-01730-4.
- 7 MOHFW. Ministry of Health and Family Welfare Directorate General of Health Services [Emergency Medical Relief]. Available at: https://www.mohfw.gov.in/pdf/AdditionalguidelinesonrationaluseofPersonalProtectiveEquipmentsettingapproachforHealthfunctionariesworkinginnonCOVIDareas.pdf. Accessed May 25, 2020
- 8 Malhotra N, Bajwa SJ, Joshi M, Mehdiratta L, Trikha A. COVID Operation Theatre Advisory and Position Statement of Indian Society of Anaesthesiologists (ISA National). Indian J Anaesth 2020; 64: 355-362
- 9 Jangra K, Paliwal S, Tripathi M. COVID-19 and neurosurgery: time for triage. J Neuroanaesth Crit Care 2020; 07 (02) 067-069
- 10 Zoia C, Bongetta D, Veiceschi P. et al Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy. Acta Neurochir (Wien) 2020; 162 (06) 1221-1222
- 11 Lee Ting Soh T, Loong Ho SW, Quan Yap WM, Yoong-Leong Oh J. Spine surgery and COVID-19: challenges and strategies from the front lines. J Bone Joint Surg Am 2020; DOI: 10.2106/JBJS.20.00503.
- 12 Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia 2020; 75 (06) 785-799
- 13 Centers for Medicare & Medicaid Services. Non-Emergent, Elective Medical Services, and Treatment Recommendations. Available at: https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf. Accessed May 21, 2020
- 14 The Society of British Neurological Surgeons. BNVG/SBNS Guide for the Neurosurgical Management of Neurovascular Conditions During the COVID-19 Pandemic. Available at: https://www.sbns.org.uk/index.php/policies-and-publications/covid/. Accessed May 21, 2020
- 15 Kolias A, Tysome J, Donnelly N. et al A safe approach to surgery for pituitary and skull base lesions during the COVID-19 pandemic. Acta Neurochir (Wien) 2020; 162 (07) 1509-1511
- 16 Huang X, Zhu W, Zhao H, Jiang X. In reply: precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery 2020; 17: nyaa145
- 17 Patel ZM, Fernandez-Miranda J, Hwang PH. et al Letter: Precautions for Endoscopic Transnasal Skull Base Surgery During the COVID-19 Pandemic. Neurosurgery 2020; 87 (01) 66-67
- 18 Mady LJ, Kubik MW, Baddour K, Snyderman CH, Rowan NR. Consideration of povidone-iodine as a public health intervention for COVID-19: Utilization as “Personal Protective Equipment” for frontline providers exposed in high-risk head and neck and skull base oncology care. Oral Oncol 2020; 105: 104724
- 19 Castelnuovo P, Turri-Zanoni M, Karligkiotis A. Skull base surgery during the Covid-19 pandemic. The Italian Skull Base Society Recommendations. Int Forum Allergy Rhinol 2020; DOI: 10.1002/alr.22596.
- 20 American Clinical Neurophysiological Society. Guidelines -Covid Resources. Available at: https://www.acns.org/practice/covid-19-resources. Accessed May 22, 2020
- 21 Meng L, McDonagh DL, Berger MS, Gelb AW. Anesthesia for awake craniotomy: a how-to guide for the occasional practitioner. Can J Anaesth 2017; 64 (05) 517-529
- 22 Meng L, Berger MS, Gelb AW. The potential benefits of awake craniotomy for brain tumor resection: an anesthesiologist’s perspective. J Neurosurg Anesthesiol 2015; 27 (04) 310-317
- 23 Simonds AK, Hanak A, Chatwin M. et al Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections. Health Technol Assess 2010; 14 (46) 131-172
- 24 Hansen E, Seemann M, Zech N, Doenitz C, Luerding R, Brawanski A. Awake craniotomies without any sedation: the awake-awake-awake technique. Acta Neurochir (Wien) 2013; 155 (08) 1417-1424
- 25 Weiner HL, Adelson PD, Brockmeyer DL. et al Editorial. Pediatric neurosurgery along with Children’s Hospitals’ innovations are rapid and uniform in response to the COVID-19 pandemic. J Neurosurg Pediatr 2020; 1-3 DOI: 10.3171/2020.4.PEDS20240.
- 26 Matava CT, Kovatsis PG, Summers JL. et al PeDI-Collaborative. Pediatric airway management in COVID-19 patients - Consensus Guidelines from the Society for Pediatric Anesthesia’s Pediatric Difficult Intubation Collaborative and the Canadian Pediatric Anesthesia Society. Anesth Analg 2020; 10: 1213
- 27 Emanuel EJ, Persad G, Upshur R. et al Fair allocation of scarce medical resources in the time of covid-19. N Engl J Med 2020; 382 (21) 2049-2055
- 28 Environmental Protection Agency. List N: Disinfectants for Use Against SARS-CoV-2 (COVID-19). Available at: https://www.epa.gov/pesticide-registration/list-n-disinfectants-use-against-sars-cov-2-covid-19. Accessed June 18, 2020
- 29 Fraser JF, Arthur AS, Chen M. et al Society of NeuroInterventional Surgery recommendations for the care of emergent neurointerventional patients in the setting of COVID-19. J Neurointerv Surg 2020; 12 (06) 539-541
- 30 Sharma D, Rasmussen M, Han R. et al Anesthetic management of endovascular treatment of acute Ischemic stroke during COVID-19 pandemic: consensus statement from society for neuroscience in anesthesiology & critical care (SNACC). J Neurosurg Anesthesiol 2020; 32 (03) 193-201
- 31 Flexman AM, Abcejo AS, Avitsian R. et al Neuroanesthesia practice during the COVID-19 pandemic: recommendations from Society for Neuroscience in Anesthesiology and Critical Care (SNACC). J Neurosurg Anesthesiol 2020; 32 (03) 202-209
- 32 Mao L, Jin H, Wang M. et al Neurologic manifestations of hospitalized patients with Coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020; 77 (06) 683-690
- 33 Oxley TJ, Mocco J, Majidi S. et al Large-vessel stroke as a presenting feature of Covid-19 in the young. N Engl J Med 2020; 382 (20) e60
- 34 American Psychiatric Association. Practice Guidance for COVID-19. Available at: https://www.psychiatry.org/psychiatrists/covid-19-coronavirus/practice-guidance-for-covid-19. Accessed June 18, 2020
- 35 Gupta P, Muthukumar N, Rajshekhar V. et al Neurosurgery and neurology practices during the novel COVID-19 Pandemic: A consensus statement from India. Neurol India 2020; 68 (02) 246-254
- 36 American Society of Anesthesiologists. Joint Statement: Roadmap for Resuming Elective surgery after Covid19Pandemic. Available at: https://www.asahq.org/about-asa/newsroom/news-releases/2020/04/joint-statement-on-elective-surgery-after-covid-19-pandemic. Accessed June 18, 2020