In patients having general anesthesia for emergency surgery or medical procedures, you can take anesthesia irrespective of when you had the COVID vaccine. If the risk of complications outweighs the benefit of protection from COVID, an informed decision involving the anesthesiologist, surgeon, proceduralist, and the patient is critical to ascertain the risks vs. benefits of when to time the COVID vaccine around anesthesia.
There are three scenarios and let’s jump to explore them:
- You had COVID Vaccine and now need elective general anesthesia
- You had general anesthesia and now decide to get COVID Vaccine
- You had COVID Vaccine and now have an emergency that requires anesthesia
By Dr. Rajeev Iyer MBBS, MD, FASA – Anesthesiologist
Can I take General Anesthesia after COVID Vaccine?
I did an analysis of three major national societies around the world (USA, UK, and India) regarding the effect of the COVID vaccine and general anesthesia.
This is what I found:
|1.||American Society of Anesthesiologists||No evidence that COVID vaccine interferes with anesthesia.
Elective surgery 2 weeks after last vaccine dose
|2.||Association of Anaesthetists, Centre for Perioperative Care, Federation of Surgical Specialty Associations, Royal College of Anaesthetists, Royal College of Surgeons of England||Vaccine at least 2 weeks before anesthesia. This is to ensure protection.|
|3.||Indian Society of Anesthesiologists||Elective surgery can be done after resolution of COVID-19 vaccine symptoms if any - usually within a week.|
I asked a few people about their experience of symptoms after COVID vaccination. Here are some of them:
- Pain at the injection site
- Tenderness at the injection site
- Staying away from work
There may be other symptoms reported with COVID Vaccine, however, I did not come across them. These symptoms lasted for a day or two and nothing beyond. There are approximately 100 symptoms reported with COVID-19 infection – short-term and long-term.
The US FDA website is a great resource for all information related to the COVID-19 Vaccine.
Now let’s say you take anesthesia immediately after COVID-19 vaccination. Then it would be difficult to say if these symptoms are because of the vaccine or because of anesthesia/surgery. Hence, for elective surgeries, it is reasonable to wait for a few days after receiving a vaccine. If any of these symptoms develop, then you can wait until they are better prior to take anesthesia.
From a patient perspective, it is better to wait 2 weeks after vaccination prior to taking elective anesthesia. This is because of the time for adequate protection and not because of anything related to anesthesia.
What if I had General Anesthesia and now I decide to take COVID Vaccine?
This is the easy part. COVID Vaccine is something that is not taken on an emergency basis. At least not at the moment to my knowledge.
After you have had anesthesia for either surgery or medical procedures, you can take COVID Vaccine, after you have recovered from the procedure. This may take a day or a few days or sometimes weeks depending on the procedure and your underlying medical problem. Discuss with your anesthesia doctor, surgeon, or proceduralist to ensure you make the right choice.
Can I take Emergency Anesthesia after COVID Vaccine?
Emergency anesthesia is required for either emergency surgeries or medical procedures. This could happen anytime after receiving a COVID vaccine shot maybe 1 hour after or many days after.
Emergency surgery by definition supersedes everything. It is fine to have emergency anesthesia anytime after COVID Vaccination. There is a possibility we might run into the same issue mentioned above, i.e., what if there are symptoms after anesthesia and how to differentiate them from COVID-19 and anesthesia? The answer to this will depend on the patient’s status and the underlying procedure.
Should I be fully Vaccinated for COVID-19 before Elective Surgery?
Ok, so this is an elective surgery which means you can wait until most other business is taken care of. If you are eligible to get a vaccine, then why not get it and be fully protected before elective surgery. It is a good idea to be fully vaccinated for COVID before having elective surgery.
Do I need to discontinue my medications after receiving the COVID-19 vaccine before having anesthesia?
Generally, all pre-anesthesia medications should be continued after receiving the COVID-19 vaccine. Your anesthesia doctor may ask you to stop taking certain medicines prior to having anesthesia. Here are some examples of the medicines stopped before general anesthesia
- Herbal medicines
- Blood pressure medicines that belong to the angiotensin-converting enzyme inhibitors (ACE-I) category
- Examples are Captopril, Enalapril, Lisinopril, etc.
- Blood pressure medicines that belong to the angiotensin II receptor blocker (ARBs) category
- Examples are Losartan, Candasetron, Valsartan, etc.
- Blood thinners like warfarin depending on the procedure and underlying medical problems
- Metformin due to risk of lactic acidosis
This is no different from whether you receive the COVID vaccine before anesthesia or not.
What anesthesia medications should be avoided before the COVID-19 vaccine?
To my knowledge, there is no anesthesia medicine that has been reported to interfere with the COVID-19 vaccine. For this reason, at present no special considerations exist indicating certain anesthesia medicines have to be included or excluded during the care of patients. Anesthesia should be administered based on the present recommended standard of care for that particular patient and the scenario.
Can I take Local Anesthesia after COVID Vaccine?
If someone can receive general anesthesia which is a lot more involved, then local anesthesia which is a little more straightforward should be fine. Since local anesthesia is administered by many doctors who are not anesthesiologists, they may have certain levels of thresholds based on which decision is made regarding local anesthesia.
The information mentioned above is applicable to both general anesthesia and local anesthesia equally. If local anesthesia is administered by an anesthesia doctor, suggestions similar to general anesthesia will be followed.
What pain medications can I take after the COVID-19 Vaccine if I have anesthesia?
There are no specific changes required to treat pain after having anesthesia and the COVID-19 vaccine. The commonly used pain medicines after anesthesia like over-the-counter acetaminophen or paracetamol (Tylenol) and ibuprofen (Advil, Motrin, Brufen) can be continued, of course depending on the procedure and underlying patient condition. There may be additional pain medicines ordered by your doctor like opioids which can be taken irrespective of the COVID-19 vaccination status.
How can you reduce the pain of the COVID-19 vaccine and surgery?
If you are in a situation where you have had surgery and the COVID-19 vaccine at a shorter time interval, you will be having pain at two different locations – pain at the injection site and pain at the surgical site. As I mentioned above, you can continue your regular pain medicines after surgery which in turn will also help with the pain at the vaccination site.
To help with COVID-19 injection site pain, you can additionally apply something cool or move your arm to a more comfortable position (assuming this does not affect your surgical position).
|1.||COVID Vaccinated and need elective general anesthesia||Take anesthesia 2 weeks after vaccination or whenever the vaccination symptoms resolve, whichever occurs later.|
|2.||COVID Vaccinated and needs emergency general anesthesia||Anytime after vaccination. |
Emergency nature generally super cedes other requirements.
|3.||Had general anesthesia and needs vaccination||After recovery from anesthesia, surgery or medical procedure.|
|4.||Having local anesthesia||Similar suggestions as above for general anesthesia|
|5.||Thinking of vaccination before elective anesthesia||If eligible, it is a good idea to get vaccinated.|
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