810 www.anesthesia-analgesia.org September 2015 • Volume 121 • Number 3 Copyright © 2014 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000000573 T he 2014 Ebola epidemic is unprecedented in the 38-year history of the disease. As of mid-October 2014, the epidemic has affected approximately 10,000 patients, approached a 50% mortality rate, and crossed polit- ical and geographic borders without precedent (Fig. 1). The disease has spread throughout Liberia, Guinea, and Sierra Leone in Western Africa. Isolated cases have arrived in urban centers in Europe and North America. The unabated exponential growth, and possibility of a patient requiring admission after travel to Western Africa, highlights the urgent need for effective management protocols for the various health care subspecialties that may care for patients with Ebola virus disease (EVD). As recently as October 7, 2014, the American College of Surgeons (ACS) published the frst “Surgical Protocol for Possible or Confrmed Ebola Cases,” which is adapted from the treatment guidelines set forth by the Center for Disease Control and Prevention (CDC) and currently under review by the same organiza- tion. 1,2 This brief protocol presents a series of recommenda- tions focused on the perioperative care of patients with EVD in the context of infection control and health care personnel (HCP) protection. In an effort to develop a similar set of guidelines for anesthesiologists caring for patients with EVD in the inpatient hospital setting, we conducted a comprehensive review of the literature to identify key areas of anesthetic care affected by this disease. The serious potential for “high- risk exposure” and “direct contact” (as defned by the CDC) of anesthesiologists caring for patients with EVD prompted this urgent investigation. On the basis of the available data, research, and public health policies, we present available evidence-based recommendations for the anesthetic man- agement of this patient population and identify areas of future research where data are lacking. As of mid-October 2014, the ongoing Ebola epidemic in Western Africa has affected approxi- mately 10,000 patients, approached a 50% mortality rate, and crossed political and geo- graphic borders without precedent. The disease has spread throughout Liberia, Guinea, and Sierra Leone. Isolated cases have arrived in urban centers in Europe and North America. The exponential growth, currently unabated, highlights the urgent need for effective and immedi- ate management protocols for the various health care subspecialties that may care for Ebola virus disease patients. We conducted a comprehensive review of the literature to identify key areas of anesthetic care affected by this disease. The serious potential for “high-risk expo- sure” and “direct contact” (as defned by the Centers for Disease Control and Prevention) of anesthesiologists caring for Ebola patients prompted this urgent investigation. A search was conducted using MEDLINE/PubMed, MeSH, Cochrane Review, and Google Scholar. Key words included “anesthesia” and/or “ebola” combined with “surgery,” “intubation,” “laryn- goscopy,” “bronchoscopy,” “stethoscope,” “ventilation,” “ventilator,” “phlebotomy,” “venous cannulation,” “operating room,” “personal protection,” “equipment,” “aerosol,” “respira- tory failure,” or “needle stick.” No language or date limits were applied. We also included secondary-source data from government organizations and scientifc societies such as the Centers for Disease Control and Prevention, World Health Organization, American Society of Anesthesiologists, and American College of Surgeons. Articles were reviewed for primary- source data related to inpatient management of Ebola cases as well as evidence-based management guidelines and protocols for the care of Ebola patients in the operative room, infection control, and health care worker personal protection. Two hundred thirty-six arti- cles were identifed using the aforementioned terminology in the scientifc database search engines. Twenty articles met search criteria for information related to inpatient Ebola virus disease management or animal virology studies as primary or secondary sources. In addi- tion, 9 articles met search criteria as tertiary sources, representing published guidelines. The recommendations developed in this article are based on these 29 source documents. Anesthesia-specifc literature regarding the care of Ebola patients is very limited. Secondary- source guidelines and policies represent the majority of available information. Data from controlled animal experiments and tuberculosis patient research provide some evidence for the existing recommendations and identify future guideline considerations. (Anesth Analg 2015;121:810–21) Anesthetic Implications of Ebola Patient Management: A Review of the Literature and Policies Andres Missair, MD, EDRA,* Michael J. Marino, MD,* Catherine N. Vu, MD,* Juan Gutierrez, MD,* Alfredo Missair, MA,† Brian Osman, MD,‡ and Ralf E. Gebhard, MD* From the *Department of Anesthesiology, Perioperative Medicine, and Pain, University of Miami, Miller School of Medicine, Miami, Florida; †United Nations Development Programme, New York, New York; and ‡Beth Israel Deaconess Medical Center, Boston, Massachusetts. Accepted for publication October 29, 2014. Funding: None. The authors declare no conficts of interest. Reprints will not be available from the authors. Address correspondence to Andres Missair, MD, EDRA, Department of An- esthesiology, Perioperative Medicine, and Acute Pain, University of Miami, Miller School of Medicine, 193 N. Shore Dr., #602, Miami Beach, FL 33141. Address e-mail to amissair@med.miami.edu. REVIEW ARTICLE E