SOAPC advisory on anaesthesia in COVID-19: What is lacking?

Abstract

Sir, We read with great interest the article by Solanki SL,et al., an advisory by the Society of Onco-Anaesthesia and Perioperative Care (SOAPC) regarding the perioperative management of onco-surgeries during the coronavirus disease (COVID)-19 pandemic.[1] It has inputs from various onco-anaesthesiologists of India and relevant guidelines from various national and international societies. We would like to congratulate the authors on bringing out this advisory at appropriate and challenging times. From the time COVID-19 was declared a pandemic by the World Health Organization (WHO), there have been various publications on the subject of anaesthesia for COVID-19 patients. Our Indian Society of Anaesthesiologists and its official publication, the Indian Journal of Anaesthesia (IJA), have tirelessly worked to impart the required information through various webinars and publications. There are two key issues of importance: planning for surgical intervention and prevention of the spread of infection amongst the healthcare workers. However, it is observed that some important documents and advisories have been released on these issues by two scientific organisations but have inadvertently been missed in the SOAPC advisory regarding perioperative management of onco-surgeries during the COVID-19 pandemic.[1] These are: COVID-19 Surgical Patient Checklist by the World Federation of Societies of Anaesthesiologists (WFSA)[2]The WFSA alongwith Lifebox and Smile Train have brought out a COVID-19 Surgical Patient Checklist,[2] [Annexure 1]. This checklist is a very relevant document in the current scenario and is available in English and Hindi. The COVID-19 Surgical Patient Checklist is a simple tool to promote teamwork and communication in the operating room, and it offers simple prompts to perform key infection prevention strategies when an operation is required for a COVID-positive or suspected patient. This is to be used in conjunction with the WHO Surgical Safety Checklist.Advisory by Indian Council of Medical Research (ICMR) on hydroxychloroquine (HCQ) prophylaxis for COVID-19 (March 23,2020 and revised on May 22, 2020)[34]The ICMR, the policy-making organisation in India, has issued the advisory on the use of HCQ for COVID-19 prophylaxis, especially for healthcare workers (HCW). It reinforces the use of HCQ in India, overruling the WHO decision to not use HCQ. Consequent to ICMR advisories, a large number of anaesthesiologists and frontline HCWs have consumed HCQ. In Mumbai, India, even police personnel were advised HCQ prophylaxis. Although inconclusive, it has still been recommended by ICMR. The SOAPC advisory does talk of care of staff but misses out on ICMR advice on HCQ. Both these documents have been released by scientific organisations of standing and repute. It is, therefore, suggested that the practising anaesthesiologists be made aware by publication in the journal. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.