**6. General versus regional anesthesia**

Under the current information, the type of anesthesia that we should use during this pandemic in the various clinical settings described is still controversial. Although general anesthesia is now safer than at the beginning of this crisis, the current trend is to use regional anesthesia whenever possible, ensuring the possibility that conversion to general anesthesia is not necessary.


During this time of COVID-19, we have two major scenarios in the practice of anesthesia: 1) Hospitals where there are well-established care programs for COVID-19 patients and people without this infection. These hospitals have personnel resources and supplies that vary according to each country and geographic region of the planet. The surgery programs have been gradually normalized according to their capacity and the level of infections by SARS-Cov-2. 2) On the other hand, outpatient and short-stay surgery units suspended their activities for short periods of time, but quickly resumed their activities during the pandemic due to the high demand for surgical patients referred from hospitals that limited their usual operating capacity due to being collapsed by COVID-19 patients [75, 76].

General anesthesia leads to the generation of aerosols, increasing the risk of COVID-19 contamination in operating rooms and recovery areas, significantly exposing healthcare teams to COVID-19 infection during tracheal intubation, extubation, and in the immediate period of recovery from anesthesia. The risk of transmission of acute respiratory infections to HCWs during aerosol-generating procedures, such as tracheal intubation, has been reported to be high. On the other hand, it is well known that general anesthesia decreases the immune response which could negatively interfere with the evolution of COVID-19 patients [77, 78]. Furthermore, general anesthesia has a higher risk of perioperative lung complications than regional anesthesia.
