Anesthesia and the “post-COVID syndrome”: Perioperative considerations for patients with prior SARS-CoV-2 infection

• Published in: Journal of clinical anesthesia Vol. 72; p. 110283
• Main Authors: Hoyler, Marguerite M., White, Robert S., Tam, Christopher W., Thalappillil, Richard
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2021; Elsevier Limited
• Subjects: Anesthesia; Cohort Studies; Coronaviruses; Correspondence; COVID-19; Fatigue; Hospitalization; Hospitals; Humans; Illnesses; Infections; Inflammation; Kidneys; Lung diseases; Medical personnel; Pain; Pandemics; Patient Discharge; Patients; Peripheral neuropathy; Recovery (Medical); Regional anesthesia; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Surveillance; Thromboembolism; Ventilators
• DOI: 10.1016/j.jclinane.2021.110283
• ISSN: 0952-8180; 1873-4529

Huang et al found that 35% of patients demonstrated decreased glomerular filtration rate at follow up, as did 10% of patients with no evidence of AKI in the acute illness setting [1], Further research is needed to determine the duration of COVID-induced kidney injury, and it has been recommended that patients who develop AKI in the setting of SARS-CoV-2 infection receive medical follow-up for at least 2–3 months to monitor renal function [8]. Fatigue or muscle weakness Myalgias Sleep difficulties Hair loss Smell disorder Palpitations / Tachycardia Joint Pain Decreased appetite Taste disorder Dizziness Diarrhea or vomiting Chest pain Chest tightness Sore throat or dysphagia Rash Headache Anxiety Low grade fever Table 1 Symptoms reported by patients recovered from COVID-19 [1,2]. Symptom or finding Management considerations and strategies Neurologic Peripheral neuropathy Judicious use of neuromuscular blockade (NMB) Quantitative reversal of NMB Avoidance of regional anesthesia Perioperative Neurology consult Cardiovascular Palpitations Chest pain Decreased myocardial perfusion Perioperative EKG Transthoracic Echocardiogram Cardiology referral/evaluation Pulmonary Residual small airway dysfunction Restrictive lung disease Diffusion impairment Avoidance of general endotracheal anesthesia Discussion of possible postoperative mechanical ventilation with patients, families and proceduralist team Hematologic Hypercoagulability Venous and arterial thromboses Pre- and intraoperative thromboprophylaxis (mechanical and pharmacologic) Use of Enhanced Recovery After Surgery (ERAS) protocols to facilitate early mobilization and ambulation Functional status Fatigue Muscle weakness Decreased mobility Referral to pre-operative exercise and conditioning programs Table 2 Management considerations for the anesthesia provider when caring for patients with Post-COVID symptoms.