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 Subject : Elective T&A in children.. 05/07/2020 12:40:36 PM 
anna penna
Posts: 49
Location: manassas virginia
Hello, It's Dr Penna once again. We have a couple of T&A to be done at the surgery center next week. I'm wondering how to test these patients. Does the order come from the ENT? Should I write the order? We don't have accessible testing nearby. Its a struggle. The best we can do is to have very tight triage and temp testing.
anna m penna
 Subject : Re:Elective T&A in children.. 05/07/2020 01:37:20 PM 
Steven Butz MD, SAMBA-F
Posts: 7
Location: 
Anna,

If you don't have testing, these patients represent one of your highest risk for transmission with aerosol-generating procedure. The negative test gives some reassurance and lets you decrease PPE requirements. Without it, you fall into our highest precautions with CAPR use, limiting people present during intubation, and letting the room settle after extubation as well as likely recovering the patient in the OR if you cannot isolate in PACU. I am becoming more and more wary of asymptomatic carriers that would be putting the medical staff at risk for issues.

Best practice at this time is getting a PCR nasal swab. I wish I could give you better news or a solution!
 Subject : Re:Elective T&A in children.. 05/07/2020 01:45:38 PM 
Niraja Rajan MD, SAMBA-F
Posts: 6
Location: 
Hi Anna,

T and As fall in the high risk AGP group. These procedures should be done ideally in a negative pressure OR with the highest level of precautions. I strongly recommend a SARS-CoV-2 test pre procedure. However, with the current test having a 30% false negative rate, I would not forgo any of the PPE/other precautions. If you see the epidemiology of SARS-CoV-2 in kids you will notice a lot more asymptomatic infections.
Niraja
 Subject : Re:Elective T&A in children.. 05/07/2020 07:45:10 PM 
Chhaya Patel, MD, SAMBA-F
Posts: 4
Location: 
Every child undergoing anesthesia is at risk of aerosolizing! Every intubation and extubation is aerosolizing so we need to have proper PPE including N95s. ASA guidelines are also recommending universal testing. The elective outpatient AGPs such as T &A, sinus surgery, EGD, and dental procedures should minimally be tested for covid. I know Pre op covid testing is a logistical nightmare for families, but we need to enforce it contain the spread.
 
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