Abstract
When preparing for the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the coronavirus infection disease (COVID-19) questions arose regarding various aspects concerning the anaesthetist. When reviewing the literature it became obvious that keeping up-to-date with all relevant publications is almost impossible. We searched for and summarised clinically relevant topics that could help making clinical decisions. This is a subjective analysis of literature concerning specific topics raised in our daily practice (e.g., clinical features of COVID-19 patients; ventilation of the critically ill COVID-19 patient; diagnostic of infection with SARS-CoV-2; stability of the virus; Covid-19 in specific patient populations, e.g., paediatrics, immunosuppressed patients, patients with hypertension, diabetes mellitus, kidney or liver disease; co-medication with non-steroidal anti-inflammatory drugs (NSAIDs); antiviral treatment) and we believe that these answers help colleagues in clinical decision-making. With ongoing treatment of severely ill COVID-19 patients other questions will come up. While respective guidelines on these topics will serve clinicians in clinical practice, regularly updating all guidelines concerning COVID-19 will be a necessary, although challenging task in the upcoming weeks and months. All recommendations during the current extremely rapid development of knowledge must be evaluated on a daily basis, as suggestions made today may be out-dated with the new evidence available tomorrow.
Highlights
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak emerged in Wuhan, China on 31 December 2019 and the resulting coronavirus infection disease (COVID-19) has been declared a pandemic by the World Health Organization on 11 March 2020
Lungs of COVID-19 patients are characterised by the coexistence of severely affected lung areas with atelectasis that are not, or hardly, recruitable and adjacent to areas that are unaffected and remain remarkably compliant, which are at risk of over-distension
In China, the origin of the majority of available data today, researchers reported a prevalence of diabetes mellitus (DM) as high as 20% in COVID-19 patients [72,74], while the prevalence in the general population is estimated at 6.6% [80]
Summary
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak emerged in Wuhan, China on 31 December 2019 and the resulting coronavirus infection disease (COVID-19) has been declared a pandemic by the World Health Organization on 11 March 2020. Detection of virus RNA by real-time reverse transcriptase polymerase chain reaction (RT-PCR)-based methods is a keystone in diagnosing current infection with SAS-CoV-2, while detection of immunoglobulins helps to test for previous infections and immunity. The latter can in the future hopefully be achieved by adequate vaccination, and different strategies are currently explored to find a respective vaccine, e.g., live attenuated vaccines, viral vector-based vaccines, recombinant protein-based vaccines, DNA or messenger RNA vaccines. Dexmedetomidine, remifentanil or fentanyl are other options to reduce coughing, which are at least effective, but with haemodynamic and respiratory side effects [9]
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