FAQs for patients who are having a procedure requiring an anaesthetic
26 May 2020
Is it safe to go to hospital for an operation during this pandemic?
NHS staff, including doctors in anaesthesia and critical care throughout the UK, will make sure that the care of patients requiring procedures under anaesthetic is as safe as possible at this time, that the right levels of staffing and equipment are in place and the risk of passing on infection is minimised.
Patients will where possible be prioritised based on the urgency of surgery. If the hospital offers you a date for an operation you should discuss the risks and any concerns you have with the surgeon and/or anaesthetist, who will help you decide whether receiving treatment now is the right thing for you. They may talk to you about different options, including non-surgical treatments, or may suggest that waiting a little longer may be better in your case.
However if your case is urgent and surgery is the only option, you may be advised to go ahead with the operation and you should not delay going to hospital for treatment if that is the advice of your doctors.
Detailed information for patients is available from the Centre for Perioperative Care here.
What is the risk that I will catch COVID-19 if I go to my local hospital for a procedure?
Your hospital will be doing everything possible to ensure that the risk of you getting an infection while you are in hospital is as low as possible.
Additional measures to reduce risk of infection while you are in hospital during the pandemic include:
Ensuring that wards, operating theatres and equipment undergo regular deep cleaning
Ensuring good hand hygiene
Staff using the appropriate personal protective equipment (PPE), which may include gloves, mask, eye protection and a gown,
Reducing the risk of patients being COVID-19 positive at admission for planned / elective surgery by requiring patients to isolate for 14 days and testing patients prior to admission
Identifying positive and at risk patients and looking after them in separate areas within the hospital
Using separate sites for COVID-19 positive patients, COVID-19 free cancer hubs or private hospitals to minimise the risk of infection when providing cancer treatment and surgical procedures.
What will be different when having an operation during the COVID-19 pandemic?
To maintain social distancing and reduce travelling to hospitals, you may be offered online consultations with the surgeon and the preoperative assessment clinic, rather than be asked to attend appointments in person.
It is likely that the hospital will ask you to take tests for COVID-19 and to self-isolate for up to 14 days ahead of the operation. Some hospitals may arrange a CT scan of the chest for you.
If you have any underlying medical conditions, such as diabetes or heart disease, you should tell the preoperative assessment clinic so that the anaesthetist will take this into account in planning your care and assessing your risk.
If you are suspected of having COVID-19, your operation will only take place if it is an urgent or emergency procedure and you consent to it, after discussing the risks with the healthcare team. This is for your safety and for that of other patients and the staff.
Is there a risk I could catch COVID-19 from anaesthetic equipment?
The risk of catching the virus specifically from anaesthetic equipment is very low. Most equipment used is disposable and so is used only for one patient. The ventilator is protected by very fine filters that can filter out virus particles. There is a new one of these for every patient. All the monitoring equipment used during your anaesthetic is cleaned according to infection control guidelines between patients, as are the theatre trolley and table. The air in the operating theatre is controlled and filtered with a minimum of 20 air changes per hour.
Should I tell the hospital, before I come in for my procedure, if I have had contact with a person with COVID-19 or suspected COVID-19?
Yes. It is important to contact the hospital so that further details can be taken and a decision can be made based on the urgency of the procedure that is planned.
If I am suspected to have COVID-19, what are the risks of having a procedure under anaesthetic?
If you are suspected of having COVID-19, your procedure under anaesthetic will only take place if it is an urgent or emergency procedure that needs to be carried out within a short period of time.
In this circumstance your risk will depend upon how unwell you are with the COVID-19 and the severity of the condition requiring the procedure under anaesthetic. This will be different for each patient. Your particular risks will be discussed in detail with you before you decide whether to go ahead. The anaesthetist and the team will do all they can to minimise the risk to your health.
Can I have visitors if I’m in hospital for a procedure during the pandemic?
Many hospitals are now discouraging or limiting visitors to patients in hospital in order to reduce the risk of spreading COVID-19. You should follow the local advice and guidance, as it will depend on your circumstances and that of the hospital at the time. If, however, you are known or suspected to have COVID-19, then hospitals will want to reduce the risk of anyone else catching it. Any visitors then allowed will have to wear extra protection.
Is it safe for me to come to hospital to deliver my baby, to have an epidural for pain relief in labour or if I need an emergency Caesarean Section?
Your maternity unit will be doing everything possible to ensure that the risk of you getting an infection while you are in hospital is as low as possible.
They will take additional measures during the pandemic including:
Ensuring that wards, operating theatres and equipment undergo regular deep cleaning.
Staff will use necessary personal protective equipment (PPE) that includes gloves, mask, eye protection and a gown, where there is a significant risk of infection.
Identifying COVID-19 positive pregnant women and looking after them in separate areas, ensuring good hand hygiene and additional regular deep cleaning.
Detailed information for pregnant women and their families has been produced by our colleagues at the Royal College of Obstetricians and Gynaecologists, which is available here.
What happens if I have COVID-19 and need to go to an intensive care unit (ICU)?
Most patients with COVID-19 have mild disease and will not need hospital care. However, some patients develop more severe disease and will need care in hospital. Of these patients, some may need to go to the ICU for extra support with their breathing. This usually happens at the stage when giving oxygen through a facemask on the ward does not keep their oxygen levels high enough. On the ICU there are more options for support including ventilators.
Helpful information about what patients and relatives can expect if they go to ICU can be found here. Note that ICUs are also sometimes called critical care units (CCUs) or intensive therapy units (ITUs).
A small proportion of patients with COVID-19 may need to have their breathing supported by a ventilator. The following FAQs explain what this means.
What is a ventilator?
A ventilator is a machine that takes over a person’s normal breathing by pushing oxygen and air into the lungs and allowing carbon dioxide to be removed. Ventilators are used in critical care units if a patient has lung disease or another condition that means their breathing has to be controlled. Ventilators are also used in operating theatres during some operations when patient are anaesthetised.
A tube is placed into the person’s trachea (windpipe) and connected to the ventilator. This tube is usually passed through the patient’s mouth, but could instead be passed through the nose or throat (a tracheostomy) if necessary.
Ventilators can vary how many breaths a minute are given (the respiratory rate) and the percentage of oxygen that is given as well as controlling the maximum pressure in the lungs and how quickly the breaths are given.
Are you anaesthetised if connected to a ventilator?
Patients needing to go on a ventilator are given an anaesthetic before the tube is placed in their trachea, so they do not feel any pain and are not aware while the procedure takes place. In the ICU, once ventilation is started most patients are sedated at first to keep them comfortable so that they are usually not aware of what is happening around them. Sometimes patients on the ICU will be given more anaesthetic to keep them fully unconscious if they have more serious difficulties or need drugs to relax their muscles.
What if I don’t want to be ventilated?
It is best if you have had the opportunity to think about your wishes before you become unwell. Then you can discuss your thoughts with your family and perhaps your usual doctors, including your GP. There are different ways that you can make your wishes clear to healthcare teams who may treat you in the future and the NHS website has more information about this here.
In the event that you become severely unwell with COVID-19, wherever possible, doctors will talk to you about the options for your care and treatment in critical care, including ventilation. If you have made an advanced decision about your care and treatment, they will respect this. If you are unable to make a decision about your care and treatment because you are too unwell, the doctor in charge of your care will make a decision in your best interests. The doctor will consult with colleagues and carefully consider your condition and the options for treatment. Wherever possible they will talk to your family to find out about your views on your care and treatment before you became critically ill.
How do you decide if I need ventilating?
If you are unwell, doctors will check the amount of oxygen and carbon dioxide in your blood. If your oxygen levels become too low or your carbon dioxide levels rise too high, they will know that you need extra support with your breathing.
This may start with ‘non-invasive ventilation’; this is when oxygen and air is given through a mask that is fixed tightly to form a seal over the patient’s nose and mouth. This system will deliver a larger amount of air and oxygen and help keep your breathing passages open.
Sometimes patients become exhausted if they are having to breathe too much and can no longer cough well enough to clear their sputum (phlegm). Being on a ventilator means the nurse can help remove their sputum with suction equipment and the breathing can be controlled whilst the lungs recover.