There should be a dedicated room for COVID patient care, preferably an easily accessible area, with a minimal contact possible with other rooms, to prevent contamination of large extension the^11-13.

The patient should arrive through an exclusive door (when possible), located next to the dedicated room for the Covid-19 patient. The patient must leave through the same access^11,12.

The dedicated room for the Covid-19 patient should have an anteroom^11,14.

The room temperature should be kept adequate to ensure neutral or negative pressure^11-16. When there is no negative pressure option, it is important to allow at least 30 minutes between cases for complete exchange of the ambient air¹⁵.

Doors should remain closed during the procedure^13,16.

There should be a sign at the room’s door regarding the recommended precaution (contact and aerosol).

Only equipment, furniture and necessary medicines should be taken to the procedure room, to reduce the number of items that need to be cleaned or discarded^12,13.

The use of disposable equipment / materials should be prioritized^11-14.

The anesthesia machines, monitors, ultrasound devices and such should be protected with disposable plastic to reduce equipment contamination¹².

High-Efficiency Particulate Air (HEPA) filters should be used in the anesthesia circuit, with the capnography system set between the circuit and the filter¹².

Wash hands before and after placing and removing the PPE^11-13,16-18.

No use of adornments¹⁸.

No entering the OR with personal effects.

Use of appropriate Personal Protective Equipment (PPE) (cap, waterproof apron, glasses, face shield, N95 mask, gloves with long cuffs, closed and waterproof shoes that can be disinfected) - according to the PPE use guidelines in COVID 19 suspected cases^13,19.

Any transport of a suspected or confirmed COVID-19 patient to the OR must be previously communicated in order for the team to gear up.

Put a surgical mask on the patient during transfer between areas^12,13,19.

Professionals who perform patient transport to the OR and vice versa should use PPE (N95 masks, face shield/goggles, aprons and gloves)^11,13,16,19.

Ensure there is no obstruction in the patient’s way¹¹.

Reserve the elevator next to the OR to carry the patient and block its use for hygiene after transport^11,13.

The OR staff should wait for the the patient properly vested^11,16,19.

The patient should not remain in the reception or preoperative area, being taken directly to the OR^11,13.

The team participating in the surgery should be as small as possible^{12-14,16,17,20}.

During airways manipulation (intubation and extubation), the team not involved in the procedure should stay out of the room^13,21.

A support professional should be available outside the room, ensuring compliance to precaution techniques^11,13,15,17.

Surgeons and assistants should wear an N95 mask with a surgical mask on top, complete face shield, apron, gloves and shoe protection^13,19.

Anesthetic blockades should be preferred whenever possible, avoiding handling airways^11,12,16,17.

Intubated patients from intensive care units should have their endotracheal tubes occluded by grasping forceps in the need of ventilator change, to prevent aerosols leakage^11,12.

Reduce the production of aerosols, with the judicious use of electrocautery, maintaining continuous suction and care during laparoscopy; whenever possible, use a filter to deflate the pneumoperitoneum^13,20,21.

The postoperative recovery should be performed inside the room and the patient should remain with a surgical mask; if there is need for complementary oxygen, the oxygen catheter should be placed under the mask^{11,12,14,16,17}.

Non-invasive airway support with positive pressure should be avoided to the maximum, since it can cause aerosolization of the virus¹².

The patient in conditions of discharge from anesthesia should wear a surgical mask for transportation, and the transport professionals should use PPEs, as recommended for handling suspected COVID-19 cases^12,19.

All PPEs, including N95 masks, but excluding goggles, face masks, and waterproof shoes, should be discarded (preferably in the anteroom) after use in procedures that generate aerosolization (ie: intubation, extubation, aspiration, cardiopulmonary resuscitation, non invasive ventilation, and bronchoscopy) or in the presence of contamination by blood or other body fluids¹¹.

Preferably remove the PPEs in the anteroom^11,19.

No touching the face before sanitizing the hands¹⁹.

Sprinkling shower in the locker room^11,12.

Cleaning of goggles with soap and water, applying 70% alcohol after drying¹⁹.

Provide one hour between procedures for patient transfer and cleaning and decontamination of all surfaces, screens, keyboard, computers, cables, monitors, anesthesia machines, and furniture^11,15.

Leave the room prepared for the next procedure^11,15.

Change the whole circuit, the filter, the soda lime, and disinfect the anesthesia machine, as well as the soda lime compartment after each surgery¹¹.

Thorough cleaning of the equipment and furniture of the operating room, using PPE (n95 masks, faceshield / goggles, aprons and gloves)^11,13.

Discard all PPEs in the infectious waste^11,12.

Discard all unused items from the medicine tray and airways car, since they should be considered contaminated^11,12.

All materials and instruments should be sent to the purge inside large plastic boxes with the lid completely closed and with written identification that is easy to be seen by the team of the Material and Sterilization Center (MSC).