POST-ACUTE sequelae of COVID (PASC), commonly known as long COVID, continues to affect millions globally, with over 18 million Americans impacted. Despite its widespread prevalence, clinical guidelines specific to the perioperative management of PASC remain lacking. This condition, which can persist for months after SARS-CoV-2 infection, encompasses a wide range of neurological, respiratory, and endocrine complications, necessitating tailored perioperative care to ensure patient safety.
The complex, multisystemic nature of long COVID presents unique challenges for anesthesiologists and surgical teams. It is crucial to assess each patient thoroughly before surgery, with a focus on a detailed patient history and an understanding of off-label medications, such as those used to manage conditions like Postural Orthostatic Tachycardia Syndrome (POTS) and Mast Cell Activation Syndrome (MCAS). Additionally, many long COVID patients experience cognitive impairments such as brain fog, which may complicate the assessment and anesthetic planning process.
Managing anesthesia in these patients requires special consideration, particularly in those with neurological and cardiovascular complications. For example, careful monitoring and adjustment of anesthetic agents are advised to prevent exacerbating any pre-existing neurological or cardiovascular instability. Furthermore, lung-protective ventilation strategies and non-invasive post-operative respiratory support are essential in mitigating perioperative pulmonary complications, which are common in patients with long COVID.
The authors advocate for a personalized, multidisciplinary approach in managing these patients undergoing surgery. As research on long COVID progresses, the development of evidence-based guidelines will be crucial in improving outcomes for this growing patient population. Until then, vigilance in preoperative assessments, tailored anesthetic plans, and interdisciplinary collaboration remain key to successful perioperative management.
Reference:
Yogendra R et al. Perioperative and anesthetic considerations for post-acute sequelae of COVID (PASC)/long COVID. Perioper Med (Lond). 2025;28;14(1):80.
