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Anesthetic Management of Neurosurgery Patients in COVID-19 Pandemic in an Emergency Setting

We read with interest the institutional protocol for anesthetic management of a patient undergoing neurosurgery during the COVID-19 pandemic. We concur with this protocol, which is similar to our hospital’s protocol, except for a few modifications appropriate for our institute. Perhaps this relates to conducting multiple neurosurgical emergency surgeries daily. When community transmission becomes widespread, every patient needs to be considered as a suspect. Anesthesiologists form a key group of healthcare workers who are susceptible to the COVID-19 infection, owing to airway management during surgical interventions and management of critically ill patients. Modifications in airway management are required to minimize aerosol generation. The protocols should have clear workflow guidelines which will help in facilitating multidisciplinary communication to implement effective isolation practices.[1] Ensuring training of healthcare workers regarding donning and doffing of personal protective equipment (PPE) and conducting simulation exercises are essential to ensure compliance to protocol, especially in emergencies like management of neurotrauma.[2] We believe the protocol is well made and may benefit from some modifications in institutions dealing with neurosurgical emergencies and trauma.

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Bharath Srinivasaiah (Department of Neuro-anesthesia and Neuro Critical Care, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India)

Harsh Deora (Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India)