Corona and surgeries: The 7-week rule

A corona infection that has gone through still poses a considerable risk for planned surgeries weeks later. But it becomes really dangerous if the patient hides this infection.

Concealing an infection with Covid is slowly becoming socially acceptable. You don’t want to spoil your vacation, graduation party or whatever. It’s “just a cold”, some don’t even feel really sick.

We still have very effective vaccines to thank for this, but also a whim of nature – the current one SARS-CoV-2-Variante has become less life-threatening in the acute course. Therefore, many no longer take it seriously; Parts of the population have declared the pandemic over. You can still get really sick from it. And above all, we see after-effects of the disease in the clinic, which go far beyond the acute course of 1-2 weeks. Concealing the infection is therefore, at best, only selfish or negligent.

collapse in the operating room

At least in the case of planned surgeries, it can be really dangerous. I’m also happy to explain why. Before each operation, we not only ask about the vaccination status, but also whether and when an infection with SARS-CoV-2 was experienced. It is relatively irrelevant whether you had a mild course. In the body, the disease seems to have much longer consequences – even if you no longer notice it in everyday life. Although Covid is very mild and the body appears to have fully recovered, there seems to be a lot more to do at the cellular level.

“Sensitive bronchi” – I deliberately keep it simple – are part of it. In the last four months alone, at our location alone, we had three patients from whom we had a hard time rescuing the patients. Electrical OPs (Hammer toe, bile, something like that…) and during the anesthesia suddenly a complete collapse of the oxygen values. Similar to a severe asthma attack, it was only possible to get oxygen into the body at all with the help of several medications and very high ventilation pressures. Unlike an asthma attack, however, these patients did not respond to typical medication. We turned these patients upside down diagnostically. Nothing to find. They all had in common that they had had Covid on average 2-4 months beforehand.

Everything seems normal

Of course, this is all just empirical and we still lack the necessary evidence. If you talk to other anesthesiologists, the scheme is similar. For about a year we have been seeing patients who are completely normal in the preliminary examination. We have not only been measuring the saturation under room air in all patients since Corona. Values ​​above 97% are normal – and a little less for smokers.

Although everything is normal in the preliminary anesthesia consultation and in the preliminary examination, there are always the case that healthy, young people suddenly can hardly be ventilated under the anesthesia and in some cases a considerable drop in the oxygen concentration in the blood can be observed. You can then usually only aspirate clear secretion, but sometimes not even that.

In such an acutely life-threatening situation, several teams of experienced senior physicians and nursing staff are quickly there. We do bronchoscopy, recruit, inhale, do sonography… but usually nothing is found. So nothing that would explain this condition – other than a Covid history.

Seven weeks safety buffer

Don’t worry – I won’t be too quick to make the mistake of confusing correlation and causation. Many people are currently or were ill with Covid. Since it would be dubious to conclude directly from one to the other. At the beginning of an increase in knowledge there is always a theory, a presumed connection. It would be the task of future research to find out by comparing larger data or a reporting system whether there is a causal connection between a previous Covid infection and this form of severe anesthetic incidents.

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What we already know today: In the first few weeks after a corona infection, there is a measurably increased risk of anesthetic incidents. Therefore, there was a joint recommendation of the “Professional Association of German Surgeons” and the “Professional Association of German Anesthesiologists” for the termination of elective surgical interventions after COVID-19 infection. in the original wording it says: “An elective intervention should therefore, if possible, take place at the earliest seven weeks after the onset of symptoms of a previous COVID-19 infection and no persistent symptoms.” Important: these seven-week safety buffer only begin after the last symptoms have subsided!

You can read the paper and the original work in which the increased risk was proven in the original here read.

Urges honest communication!

By the way: You should also wait after a vaccination. But one week is enough here. It’s all about being able to clearly separate any symptoms such as fever, flu-like symptoms or chills – which can occur after a vaccination – from complications such as bacterial inflammation after an operation. This is something completely different than the safety interval after an infection has gone through.

During these seven weeks, an operation should only be carried out after careful consideration and, if possible, ideally under regional anesthesia. This expressly applies only to plannable, i.e. elective operations. Of course, this does not apply to emergency surgeries or urgent operations. If an operation is carried out shortly after or even while you are ill with COVID-19, we do it with the greatest possible safety precautions.

And even if there are complications, don’t worry, we’re prepared for that. That’s our job. If there is a problem, we have a plan or plans for it. We can do it, that’s what we’re trained for. However, it’s important to tell your patients to communicate honestly if they’ve recently had an infection. It doesn’t matter whether the patient wants to have the metal removed from the upper ankle fracture before the holiday and has been feeling fit for 5 weeks. He should leave it out of his own interest.

You don’t play with health.

We always have a plan B, but it’s better for the patient and for us if we don’t need it.

Image source: Waldemar Brandtunsplash

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