Anesthesia guidelines for COVID-19 patients - A narrative review and appraisal.

Abstract

The Coronavirus Disease 2019 (COVID-19) pandemic challenged health systems globally and prompted the publication of many guidelines. Experiences of our international colleagues should be utilized to protect and benefit patients and healthcare workers. The primary aim of this article is to evaluate and appraise national guidelines for the perioperative anesthetic management of patients with COVID-19 so that guidelines could be enhanced to manage any resurgence of the epidemic. PubMed and EMBASE databases were systematically searched to identify guidelines and studies related to SARS-CoV and SARS-CoV-2. Additionally, the World Federation Society of Anesthesiologists COVID-19 resource webpage was searched for national guidelines and expanded to include countries that experienced a high incidence of SARS-CoV. Guidelines were evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. Guidelines from Australia, Canada, China, India, Italy, South Africa, South Korea, Taiwan, the United Kingdom, and the United States of America were evaluated. All guidelines focused predominantly on intubation and infection control. The scope and purpose of guidelines from China were most comprehensive. The UK and South Africa provided the best clarity. Editorial independence, rigor of development and applicability scored poorly. Heterogeneity and gaps pertaining to preoperative screening, anesthesia technique, subspecialty anesthesia and the lack of auditing of guidelines were identified. Evidence supporting recommendations was weak. Early guidelines for the anesthetic management of COVID-19 patients lack quality and a robust reporting framework. As new evidence emerges, national guidelines should be updated as suggested by the AGREE criteria to enhance rigor, clarity, and applicability.