Mitigation of COVID-19 transmission in endoscopic and surgical aerosol-generating procedures: a narrative review of early-pandemic literature

Furthermore, air recirculation and thorough cleaning of the CT scan room after each patient may severely disrupt patient flow. [...]reverse transcription polymerase chain reaction (PCR) analysis of samples from the nasopharynx or oropharynx should remain the gold standard for diagnosis of COVID-19, as recommended by the WHO.12 13 In patients with confirmed or suspected COVID-19, elective and non-emergency procedures should be postponed or cancelled because they carry considerable risks of pulmonary complications and postoperative mortality.14 If emergency surgery operations must proceed, they should be performed in a dedicated negative-pressure OT where possible.15 Intraoperative considerations Erbabacan et al12 and Lie et al15 recommended considering regional anaesthesia (when feasible) for patients with suspected or confirmed COVID-19 who are undergoing surgery; regional anaesthesia minimises viral transmission because it avoids airway manipulation, thus reducing aerosolisation.12 15Chen et al16 recommended spinal anaesthesia as the preferred method for patients undergoing caesarean section. Only essential personnel should be present in OTs, and all surgical personnel should wear appropriate PPE, including N95 masks or powered air-purifying respirators.9 The use of face masks for source control has not been proven effective in OT settings,19 but they are widely used in healthcare facilities to prevent infections via spills and sputum. [...]the effectiveness of UV-C action is unclear; therefore, this method should be used as a supplement to manual cleaning.21 If UV-C light is unavailable, quaternary ammonium compounds should be sprayed on all surfaces using a top-down approach.20 Additionally, the World Health Organization recommends the use of 75% alcohol and chlorine-based products at concentrations of 0.05% to 0.5%.22 Endoscopic considerations Chan et al23 revealed that oesophagogastroduodenoscopy (OGD) is an AGP. Viruses can also remain in aerosols for up to 3 hours after OGD.7 The use of anaesthetic throat sprays for sedation, rather than a lidocaine swallow, can reduce retching and cough; this approach may reduce viral transmission via aerosols.24 The design of endoscopic instruments, as well as the movement of instruments during OGD, can further enhance aerosol generation.25 However, continuous use of a dental suction device in the oral cavity can significantly decrease aerosol generation and reduce the risk of disease transmission.23 As an adjunct