California Society of Anesthesiologists Issues Updated Recommendations in Response to COVID-19 Crisis

California Society of Anesthesiologists Issues Updated Recommendations in Response to COVID-19 Crisis

(March 17, 2020 - Sacramento, CA) – The California Society of Anesthesiologists wants to ensure that our members, their patients, and their families remain safe during this pandemic crisis.  In addition to the ASA recommendations*, due to regional conditions and given the significant number of cases here in California, we have the following recommendations:

Whether in a hospital or a surgery center, we strongly encourage our members to:

  • Create a daily case-review committee with your Anesthesia Medical Director/Department Chair, your Chief Medical Officer, and your OR Nursing Director, to determine which cases should be done using criteria consistent with the guidance from the CDC, the American College of Surgeons, and others.
    • Cancel cases if the patient has flu-like symptoms, low grade fever, or a new onset cough.
    • Cancel elective cases if a patient in any way might require SNF care after surgical treatment.
    • Cancel elective cases for all patients classified as ASA 4, ASA3 and >65 years old, presence of COPD, uncontrolled asthma, cardiovascular disease, and/or immunosuppression.
    • Cancel elective cases that might require an ICU bed.
    • Cancel elective cases that might require a length of stay over 2 days. 
    • Cancel elective cases that might require transfusion.
  • Ensure that all staff have available to them and are wearing the appropriate recommended Personal Protective Equipment (PPE) when providing patient care.  At this time, this includes mask, eye protection (goggles or face shield), and gloves for all patients for all invasive procedures likely to generate aerosol (i.e., intubation), plus frequent hand hygiene.  For patients who are diagnosed or under investigation for COVID-19, this includes N95+eye protection/PAPR/CAPR for all invasive procedures (i.e., intubation), along with gloves/gowns/boots.*

We ask that you and your surgical colleagues communicate directly with your patients, preferably by phone/video conference, to assess their concerns, discuss the current plan, and help make educated decisions for moving forward.

It is unclear how long these restrictions will last.  The timeline from China is about 3 months until things started to stabilize; Italy is still earlier in the process, but looks to be about the same.

* https://www.asahq.org/about-asa/newsroom/news-releases/2020/03/asa-apsf-joint-statement-on-non-urgent-care-during-the-covid-19-outbreak

* https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html

The California Society of Anesthesiologists is a physician organization dedicated to promoting the highest standards of the anesthesiology profession. CSA provides public education, offers valuable resources and insight for anesthesiologists’ practice and engages in healthcare policy-making in California. http://www.csahq.org/