Anaesthesia and Critical Care Department at a Major Academic Centre’s Adaptation to Face the COVID-19 Pandemic

Figures & data

Table 1 COVID-19 Operating Room Schedule

	Main Operating Rooms														Day Care Unit		Labour and Delivery		Anaesthesia Outside Service
	OR2	OR3	OR4	OR5	OR6	OR7	OR8	OR9	OR10	OR11	OR12	OR13	OR14	OR16	B1	B2	L&D1	L&D2	AOS1	AOS2
Sun	OMF	URO	GS	GYNE	PEDIA	PVT1	STAFF	ER	GS	PLAS	ORTH	CAR	PVT2	NEUR	GS	OPTHA	OB	ER OB	ESWL	RAD/END
Mon	OMF	URO ONC	THOR	GYNE	HAEM	PVT1	ENT	ER	GS ONC	STAFF	ORTH	CAR	PVT2	NEUR	ORTH	OPTHA	OB	OB ER	END	CATH/MRI
Tuesday	OMF	URO	GS	GYNE	GS	PVT1	ENT	ER	ENT	GYNE	ORTH	CAR	PVT2	NEUR	PLAS	OPTHA		OB ER	IR	RAD
Wednesday	OMF	URO	GS	GYNE	PEDIA	PVT1	ENT ONC	ER	VASC	ENT	ORTH	CAR	PVT2	ORTH	PAIN	OPTHA	OB	OB ER	IR	RAD
Thursday	OMF	URO	GS	GYNE	PEDIA	PVT1	ENT	ER	GS	PLAS	ORTH	CAR	PVT2	NEUR	DENTAL	OPTHA		OB ER	ESWL	RAD/IR

Abbreviations: ER, Emergency surgery; END, endoscopy unit; ENT, Otolaryngology surgery; ESWL, Electronic shock wave lithotripsy unit; GS, general surgery; GYNE, gynaecology; HEAM, Haematology oncology; IR, Interventional radiology; NEURO, Neurosurgery; OB, Obstetrics. OMF, Oromaxillofacial; OPTHA, ORTHO; Orthopaedics; Podia, Paediatric Surgery; PLAS, Plastic surgery.

Table 2 Procedure Classification According to Risk of Aerosolization

Procedures that ARE Considered Aerosol Generating Procedures	Procedures That Might be Aerosol Generating Procedures
Cardiopulmonary Resuscitation	Nebulizer Administration
Endotracheal Intubation	High-Flow Oxygen Delivery
Endotracheal Extubation	Tracheostomy
Non-Invasive Positive Pressure Ventilation (EG, Bipap, CPAP)	Nasal Endoscopy Or Endoscopic Sinus Surgery
Bronchoscopy	Flexible Laryngoscopy
Manual Ventilation	Transsphenoidal Surgeries
Upper GI Endoscopy.

Table 3 The weekly Operating Room Schedule Prior to the COVID-19 Pandemic*

DAY	OR 1	OR 2	OR 3	EMER 1	EMER 2	AOS 1 0800–1530	AOS 2 0930–1200
SUN	NEURO	PLASTIC	GS	ER	OB ER	ESWL	RADIOTH 0930–1200H
		PEDIA
MON	THORACIC	HAEMA	CARDIAC	ER	OB ER	END	RADIOTH 0930–1200H
TUE	ENT	ORTHO	GS	ER	OB ER	VASCULAR/CARDIAC ELECTROPHYSIOLOGY-IR	RADIOTH 0930–1200H
WED	VASCULAR	GYNE	UROLOGY	ER	OB ER	IR (PEDIA)	RADIOTH 0930–1200H
THU	NEURO	ENT	CARDIAC	ER	OB ER	ESWL	RADIOTH 0930–1200H
		OMFS

Abbreviations: *CAR, Cardiac Surgery; CATH, cardiac catheterization lab; ER, Emergency surgery; END, endoscopy unit; ENT, Otolaryngology surgery; ESWL, Electronic shock wave lithotripsy unit; GS, general surgery; GYNE, gynaecology; HEAM, Haematology oncology; IR, Interventional radiology; MRI, magnetic resonance imaging; NEURO, Neurosurgery; OB, Obstetrics; OMF, Oromaxillofacial; ONC, oncology; OPTHA, Ophthalmology; ORTHO, Orthopaedics; PEDIA, Paediatric Surgery; PLAS, Plastic surgery; PVT, Patient from the Private Hospital; STAFF, surgery for hospital staff; THOR, Thoracic surgery; VASC, vascular surgery.

Figure 1 Airway Cart.

Figure 2 Anaesthesia for a COVID-19 patient. All equipment in the operating room were covered with a plastic drape to decrease contamination.

Figure 3 Doffing area in the operating room.

Figure 4 Carts placed outside the negative pressure room containing anaesthesia and PPE equipment.

Table 4 Anaesthesia team roles during surgery on a COVID-19 Patient

Primary anaesthesiologist	Team Leader Performs the tracheal intubation and all airway management. Take medical decisions.
Anaesthesia technician/Assistant:	Assist the primary anaesthetist with airway management. Assist with drawing up and administering medications. Assist with patient monitors and IV lines.
Outside Room anaesthesia technician (Runner)	Stands outside the operating room. Passes equipment to the anaesthesia team in the room.
Outside Room anaesthesiologist:	Coordinates with the multidisciplinary team and provides help if needed.

Figure 5 Protective hood would fog up with perspiration after a few minutes of being worn.