PROSPECT guidelines for oncological breast surgery: the role of non-opioid analgesics, a reply.

The SARS-CoV-2 (COVID-19) pandemic has dramatically changed everyday clinical practice Debate surrounding personal protective equipment (PPE) has been a prominent discussion point, and guidelines have differed nationally and globally [1] Following the peak of the pandemic, we wanted to assess anaesthetists' perception of risk and PPE use and how they felt their own practices had changed Methods We conducted an anonymous online survey of anaesthetists of all grades within our department Questions related to risk perception, current practice of PPE use, reducing levels of PPE in COVID-19 negative patients, and changes to anaesthetic practice for elective and emergency surgery Results Forty-three responses were received Almost a quarter of respondents would treat all theatre patients as having COVID-19 regardless of their swab result Eighty-four per cent would feel most reassured by a patient having two negative swabs Normal radiological findings gave little reassurance;however, more than half of respondents considered positive radiological findings as diagnostic for the purpose of PPE selection regardless of symptoms and swab results Key workers, frontline healthcare workers and nursing home residents were treated as having COVID-19 regardless of swab status by over three quarters of respondents For aerosol-generating procedures, almost all reported using an FFP3 mask for suspected COVID-19 cases, and almost three quarters when COVID-19 was not suspected For regional anaesthesia, these figures were 50% and 15%, respectively For emergency cases, respondents favoured regional anaesthesia or supraglottic airways If intubation was performed, almost all would prefer a rapid sequence induction over a standard technique involving bag-mask ventilation Discussion With the re-introduction of elective theatre work as the burden of COVID-19 on hospitals continues to fall, we have assessed our departments' perception of ongoing risk and how both their anaesthetic practice and PPE use has changed There appears to be a conscious move towards minimising aerosol-generating procedures with increased adoption of regional anaesthetic techniques Understandably, there remains concern about transmission of COVID-19, with a significant proportion feeling more comfortable wearing an FFP3 mask regardless of the nature of the anaesthetic or the patient's COVID-19 status This may reflect lack of confidence in current testing and patient-reported self-isolation practices