COVID-19 Infection: Implications for Perioperative and Critical Care Physicians

John R. Greenland, M.D., Ph.D.; Marilyn D. Michelow, M.D.; Linlin Wang, M.D., Ph.D.; Martin J. London, M.D.


Anesthesiology. 2020;132(6):1346-1361. 

In This Article

Abstract and Introduction


Healthcare systems worldwide are responding to Coronavirus Disease 2019 (COVID-19), an emerging infectious syndrome caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus. Patients with COVID-19 can progress from asymptomatic or mild illness to hypoxemic respiratory failure or multisystem organ failure, necessitating intubation and intensive care management. Healthcare providers, and particularly anesthesiologists, are at the frontline of this epidemic, and they need to be aware of the best available evidence to guide therapeutic management of patients with COVID-19 and to keep themselves safe while doing so. Here, the authors review COVID-19 pathogenesis, presentation, diagnosis, and potential therapeutics, with a focus on management of COVID-19–associated respiratory failure. The authors draw on literature from other viral epidemics, treatment of acute respiratory distress syndrome, and recent publications on COVID-19, as well as guidelines from major health organizations. This review provides a comprehensive summary of the evidence currently available to guide management of critically ill patients with COVID-19.


In December 2019, a novel pneumonia syndrome was identified in patients clustered around the Huanan Seafood Market in Wuhan, China.[1,2] Next generation sequencing was used to identify a novel coronavirus, now known as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), in bronchoalveolar lavage fluid from three of these patients. Infection with SARS-CoV-2 leads to the syndrome of Coronavirus Disease 2019 (COVID-19). Rapid international spread of this potentially lethal virus has caused global concern, with 110,000 cases and 3,800 deaths reported to date.[2,3] Here, we will summarize the latest insights into the biology of SARS-CoV-2 and their implications for anesthesiologists in perioperative and intensive care settings.