key: cord-0972181-6hf6d8cl
authors: Geng‐Ramos, Giuliana; Cronin, Jessica; Challa, Chaitanya; Brennan, Marjorie; Matisoff, Andrew; Delaney, Meghan; Campos, Joseph; Rana, Sohel; Wyson, Brenna; Pestieau, Sophie
title: Anesthesia and surgery for positive COVID‐19 asymptomatic pediatric patients: How long should we wait?
date: 2021-04-27
journal: Paediatr Anaesth
DOI: 10.1111/pan.14191
sha: 1a9ce89ed47d0e63cb814d63aa9816866365b22e
doc_id: 972181
cord_uid: 6hf6d8cl

The worldwide spread of the novel SARS-CoV-2 coronavirus (COVID-19) led to significant challenges for healthcare institutions. Our institution implemented guidelines to protect perioperative staff and patients from exposure to COVID-19, including pre-procedural testing.1 Patients who tested positive SARS-CoV-2 had their elective procedure postponed and quarantined as per Center for Disease Control and Prevention (CDC) guidelines.2 A test-based strategy is no longer recommended by the CDC for COVID-19 patients to come off isolation. 2 Instead, patients can be cleared from isolation precautions using time and symptom-based criteria. However, there is limited data addressing the role of re-testing and appropriate scheduling of procedures after a positive test in an asymptomatic patient.3 Following a positive test, our institution delayed surgery and re-tested the patient requiring a negative test result to proceed with elective procedures. We herein describe the patterns of laboratory values of COVID-19 positive patients with a focus on those who we define as "persistently positive" to elucidate a safe pathway to bring patients to surgery.

The worldwide spread of the novel SARS-CoV-2 coronavirus (COVID-19) led to significant challenges for healthcare institutions.

Our institution implemented guidelines to protect perioperative staff and patients from exposure to COVID-19, including pre-procedural testing. 1 Patients who tested positive SARS-CoV-2 had their elective procedure postponed and quarantined as per Center for Disease Control and Prevention (CDC) guidelines. 2 A test-based strategy is no longer recommended by the CDC for COVID-19 patients to come off isolation. 2 Instead, patients can be cleared from isolation precautions using time and symptom-based criteria. However, there are limited data addressing the role of retesting and appropriate scheduling of procedures after a positive test in an asymptomatic patient. 3 Following a positive test, our institution delayed surgery and retested the patient requiring a negative test result to proceed with elective procedures. We herein describe the patterns of laboratory values of COVID-19-positive patients with a focus on those who we define as "persistently positive" to elucidate a safe pathway to bring patients to surgery. This is a retrospective review of pediatric patients scheduled for Even with a 28-day delay, the risk of infection is not zero; therefore, full personal protective equipment (PPE) remains essential for all aerosol-generating procedures. Further research is warranted to better determine the optimal length of delay of anesthesia for asymptomatic COVID-19 patients as well as how testing and Ct values can guide our practice.

None.

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Giuliana Geng-Ramos https://orcid.org/0000-0003-0692-8371

Jessica Cronin https://orcid.org/0000-0002-2583-084X

Implementation and expansion of a preoperative COVID-19 testing process for pediatric surgical patients

Center for disease control and prevention: symptom-based strategy to discontinue isolation for persons with COVID-19

American Society of Anesthesia/Anesthesia Patient Safety Foundation Joint Statement on Elective Surgery and Anesthesia for Patients after COVID-19 Infection

Ct values of persistently positive COVID-19 patients over time

A trend line was created using Locally Estimated Scatterplot Smoothing method. The shaded region is the 95% confidence interval around the mean

Viral RNA load as determined by cell culture as a management tool for discharge of SARS-CoV-2 patients from infectious disease wards

Correlation between 3790 qPCR positives samples and positive cell cultures including 1941 SARS-CoV-2 isolates