Royal Alexandra Hospital Department of Anaesthetics
  • Home
  • Meet our staff
    • Permanent staff
    • Junior staff
  • Rotas
    • Big rota 31 Aug-6 Sept 2020
    • Big rota 24-30 August 2020
    • Big rota 17-22 August 2020
    • Big rota 10-16 August
    • Big rota 3-9 August
    • Big rota 20 - 26 July
    • Big rota 13 - 19 July
    • Big rota 29 June - 5 July
    • Old rotas >
      • Big rota 22-28 June
      • Big rota 15 - 21 June 2020
      • Big rota 8 - 14 June 2020
      • Big rota 1 - 7 June 2020
      • Big rota 25 May-31 May
      • Big rota 18 - 24 May
      • Big rota 11-17 May
      • ICU 20 Apr- 17 May rota
      • Big rota 4-10 May
      • Big rota 27 Apr-3 May
      • Maternity 23 Mar-3 May rota
      • All 20-26 April (rota)
      • COVID 19 >
        • PPE (COVID 19) >
          • Droplets and aerosols (COVID 19)
          • PPE-What to wear and when (HPS/PHE)
          • FFP3 or surgical mask?
          • Donning and doffing PPE (COVID 19)
        • Thromboprophylaxis (COVID 19)
        • Staff support (COVID 19)
        • Human factors in a crisis
        • Obstetrics >
          • PPE in obstetrics (COVID 19)
          • Avoiding category 1 caesarean section (suspected COVID 19)
        • Critical care/ICU >
          • ICM West of Scotland Trainee Website
          • Thromboprophylaxis critical care (ICU)COVID 19
          • ICM / ICU website
          • Death Certificate (COVID 19)
          • Phillips Trilogy 2 ventilator setup (COVID 19)
          • Phillips Trilogy ventilator info (COVID 19)
          • ICU room checklist (COVID 19)
        • Theatres >
          • Intercollegiate General surgery guidance (PPE/AGP/COVID 19)
          • Fragility fractures patient management (COVID 19)
          • Theatre brief checklist (COVID 19)
          • Theatre personnel PPE advice (COVID 19)
          • Theatre equipment checklist (COVID 19)
          • Anaesthesia SOP (COVID 19)
        • Trakcare alerts guide
        • COVID FAQs March 2020
  • Induction
    • New Start Resources >
      • Before you start
      • RCoA Novice Guide
      • Anaesthetic machine instruction
      • Tutorials for new starts
      • Structured training for novices (STAN)
    • General
    • Obstetrics
    • ICU
  • Education
    • General Tutorials
    • ICU Tutorials >
      • Renal videos
    • FRCA Resources >
      • Primary
      • Final
    • RCoA Anaesthetists As Educators
  • Guidelines
    • Antibiotics >
      • Gentamicin prescribing (antibiotics)
      • Gentamicin surgical prophylaxis (antibiotics)
    • Quick reference handbook (QRH)
    • Anaphylaxis >
      • Anaphylaxis service referral
      • Anaphylaxis blood tests
    • Colorectal surgery >
      • ERAS (Enhanced recovery after surgery)
    • Dental referrals
    • Gynaecology >
      • Analgesia for hysterectomy (open)
    • ICM (ICU)
    • Obstetrics >
      • Maternity handbook
      • Gentamicin (obstetric prophylaxis)
      • Epidurals >
        • Epidural pump setup
        • Epidural top ups
        • PCEA info
      • Thromboembolic disease in pregnancy
      • Eclampsia
      • Preeclampsia
      • Post dural puncture headache
      • Tranexamic acid in PPH (obstetrics)
      • Post partum haemorrhage (PPH)
      • Antibiotics for caesarean section/assisted delivery (obstetrics)
      • Caesarean section analgesia (obstetrics)
      • Syntocinon for caesarean section (oxytocin)
      • Remifentanil PCA (obstetrics)
    • Orthopaedics >
      • Tranexamic acid for hip and knee replacement
      • Analgesia for hip and knee replacement
  • Useful stuff
    • Phone numbers >
      • All phone numbers
      • Maternity unit phone numbers
  • Contact us
  • Pumps (Baxter/Alaris)
    • Baxter volumetric pump
  • Trauma July-Oct 2020
PLEASE NOTE UPDATED GUIDELINES. ALL PATIENTS HAVING GA SHOULD BE TREATED AS IF THEY ARE COVID +VE.
Some of the other advice below remains relevant, however.

Updated Intercollegiate General Surgery Guidance on COVID-19               25th March 2020

Picture

Surgeons will continue to care for patients in the current crisis, especially emergencies. Patient care will be affected if surgeons become sick and leave work. This current document updates recent guidance as further information has now emerged from government, Italy and China. We must follow guidelines and also apply common sense to at risk clinical environments. Consider COVID-19 infection possible in every patient. While priorities may change as rapid testing becomes available, these are our combined updated guidelines:


  1. Acute patients are our priority. COVID-19 should be sought in any patient needing emergency surgery by history, COVID-19 testing, recent CT chest (last 24h) or failing that CXR. Any patient undergoing abdominal CT scan must also have CT chest.
 
  1. Any patient currently prioritised to undergo urgent planned surgery must be assessed for COVID-19 as above and the current greater risks of adverse outcomes factored into planning and consent. Consider stoma formation rather than anastomosis to reduce need for unplanned post-operative critical care for complications.
 
  1. Full Personal Protective Equipment (PPE) should be used for laparotomy except perhaps when the patient is convincingly negative for COVID-19, but note that current tests maybe false negative. Full PPE includes wearing visors or eye protection. It is imperative to practise donning and doffing PPE in advance.
 
  1. Laparoscopy should generally not be used as it risks aerosol formation and infection. Chinese and Italian experience reflects this. SAGES have offered guidance. Advocated safety mechanisms (filters, traps, careful deflating) are difficult to implement. Consider laparoscopy only in extremely selected cases where the mortality benefit is substantially beyond doubt in the current situation.
  • Use appropriate non-operative treatment of appendicitis or open appendicectomy.
  • Treat acute biliary disease conservatively for now or with cholecystostomy.
  1. In theatre:
  • Minimum number of staff in theatre
  • Full protective PPE including visors for all staff in theatre
  • Stop positive ventilation in theatre during procedure and for at least 20 minutes after the patient has left theatre
  • Smoke evacuation for diathermy / other energy sources
  • Patients are intubated and extubated in theatre – staff immediately present should be at a minimum.
  1. Risk situations in surgery also include:
  • Approaching a coughing patient, for example, even if COVID-19 has not been diagnosed. Protection including eye shield is needed.
  • Naso-gastric tube placement is an aerosol generating procedure (AGP). AGPSs are high risk. Full PPE is needed. Consider carrying out in a specified location.
  1. Only emergency endoscopic procedures should be performed . No diagnostic work to be done and BSG guidance followed. Upper GI procedures are high risk AGPs and full PPE must be used.


Association of Surgeons of Great Britain & Ireland
Association of Coloproctology of Great Britain & Ireland
Association of Upper Gastrointestinal Surgeons
Royal College of Surgeons of Edinburgh
Royal College of Surgeons of England
Royal College of Physicians and Surgeons of Glasgow
Royal College of Surgeons in Ireland






We acknowledge the help of Professor Iain Anderson, Miss Nicola Fearnhead and Professor Giles Toogood in the production of this guidance.