Table 2.

Anesthetic and PICU considerations for COVID‐19‐positive pediatric patients

Anesthesia considerations in the OR

Preoperative review, induction, and recovery to be done in the designated negative pressure OR. Only one parent to accompany the child to the OR for induction. PPE for all OT personnel. PAPR should be donned in addition to PPE for all aerosol generating procedures, for example, intubation, extubation by anesthesiologist and anesthesia nurse. Use of disposable equipment where available. Rapid sequence intubation to avoid bag mask ventilation. Most senior anesthetist should manage the airway. Closed breathing systems instead of an Ayre's T‐piece. HME filter, closed in‐line tracheal suctioning, and minimize circuit disconnections. Strict disinfection guidelines for OR, PAPR, and equipment.

Pediatric intensive care unit considerations

All suspected or confirmed cases should be admitted to negative pressure rooms with en suite toilets. One parent to accompany the child and wear a surgical facemask. PPE should be donned for all clinical work. PAPR should be donned in addition to PPE for all aerosol generating procedures, for example, intubation, suctioning, and bronchoscopy. Early intubation is recommended and should be carried out by the most senior physician. Avoid bagging where possible. If bagging is required, manual ventilation should be done with small tidal volumes using disposable BVM. HEPA filter to be attached to BVM. Hydrophobic mechanical filters should be attached to both inspiratory and expiratory limbs of mechanical ventilators. Simulation training to be held for emergency situations and airway management.

Abbreviations: BVM, bag valve mask; HEPA, high‐efficiency particulate air; OR, operating room; PAPR, powered air‐purifying respirator; PPE, personal protective equipment.