Aerosol generation during general anesthesia is comparable to coughing: An observational clinical study

Oksanen, Lotta‐Maria; Sanmark, Enni; Sofieva, Svetlana; Rantanen, Noora; Lahelma, Mari; Anttila, Veli‐Jukka; Lehtonen, Lasse; Atanasova, Nina S.; Pesonen, Eero; Geneid, Ahmed; Hyvärinen, Antti

doi:10.1111/aas.14022

Cited by 8 publications

(8 citation statements)

References 42 publications

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“…Coughing produced the greatest number of aerosol particles among six respiratory activities, including quiet breathing, talking, exercise, shouting, and forced expirations, particularly increasing the particle count 370.8-fold compared with quiet breathing. 16 Recent studies that quantified the amount of aerosol generation during general anesthesia have shown that patient coughing during extubation increased the amount of aerosol generation, [10][11][12] which is consistent with our study result that all positive bacterial exposure belonged to extubation cases with patients coughing, and the CFU count was correlated with the number of coughing episodes. According to previous studies, 9,11,12 endotracheal extubation produces aerosols, but the amount was comparable to or less than that of coughing.…”

Section: Discussionsupporting

confidence: 91%

“…8 In previous studies that quantified aerosol generation during general anesthesia, aerosols were detected during endotracheal extubation; however, the results were conflicting during endotracheal intubation. [9][10][11][12] There have been no studies on bacterial exposure to anesthesiologists' faces during endotracheal intubation, extubation, and airway suction. Therefore, this prospective study aimed to determine bacterial exposure to anesthesiologists' face shields during endotracheal intubation and extubation by comparing pre-and post-procedural samples from face shields.…”

Section: Introductionmentioning

confidence: 99%

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Risk of Bacterial Exposure to the Anesthesiologist’s Face During Intubation and Extubation

Song¹,

Choi²,

Park³

et al. 2023

IDR

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Anesthesiologists are exposed to the risk of infection from various secretions or droplets from the respiratory tract of patients. We aimed to determine bacterial exposure to anesthesiologists' faces during endotracheal intubation and extubation. Methods: Six resident anesthesiologists performed 66 intubation and 66 extubation procedures in patients undergoing elective otorhinolaryngology surgeries. Sampling was performed by swabbing the face shields twice in an overlapping slalom pattern, before and after each procedure. Samples for pre-intubation and pre-extubation were collected immediately after wearing the face shield at the time of anesthesia induction and at the end of the surgery, respectively. Post-intubation samples were collected after the injection of anesthetic drugs, positive pressure mask ventilation, endotracheal intubation, and confirmation of intubation success. Post-extubation samples were collected after endotracheal tube suction, oral suction, extubation, and confirmation of spontaneous breathing and stable vital signs. All swabs were cultured for 48 h, and bacterial growth was confirmed by colony forming unit (CFU) count. Results: There was no bacterial growth in either pre-or post-intubation bacterial cultures. In contrast, while there was no bacterial growth in pre-extubation samples, 15.2% of post-extubation samples were CFU+ (0/66 [0%] vs 10/66 [15.2%], p=0.001). All the CFU+ samples belonged to 47 patients with post-extubation coughing, and the CFU count was correlated with the number of coughing episodes during the process of extubation (P < 0.01, correlation coefficient= 0.403). Conclusion:The current study shows the actual chance of bacterial exposure to the anesthesiologist's face during the patient awakening process after general anesthesia. Given the correlation between the CFU count and the number of coughing episodes, we recommend anesthesiologists to use appropriate facial protection equipment during this procedure.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Risk of Bacterial Exposure to the Anesthesiologist’s Face During Intubation and Extubation

Song¹,

Choi²,

Park³

et al. 2023

IDR

View full text Add to dashboard Cite

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“… 10 However, in the absence of better understanding, coughing is still commonly used as a limit value for high-risk aerosol output during medical procedures. 15 , 25 , 26 Coughing is an activity that, for example, in the case of ENT diseases, healthcare workers encounter in their work daily, but for a relatively short time.…”

Section: Discussionmentioning

confidence: 99%

Aerosol generation during coughing: an observational study

et al. 2022

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Objective Coronavirus disease 2019 has highlighted the lack of knowledge on aerosol exposure during respiratory activity and aerosol-generating procedures. This study sought to determine the aerosol concentrations generated by coughing to better understand, and to set a standard for studying, aerosols generated in medical procedures. Methods Aerosol exposure during coughing was measured in 37 healthy volunteers in the operating theatre with an optical particle sizer, from 40 cm, 70 cm and 100 cm distances. Results Altogether, 306 volitional and 15 involuntary coughs were measured. No differences between groups were observed. Conclusion Many medical procedures are expected to generate aerosols; it is unclear whether they are higher risk than normal respiratory activity. The measured aerosol exposure can be used to determine the risk for significant aerosol generation during medical procedures. Considerable variation of aerosol generation during cough was observed between individuals, but whether cough was volitional or involuntary made no difference to aerosol production.

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“…Thus, most intubation and extubation procedures should not be defined as AGPs and do not warrant pre-procedure asymptomatic screening for infection prevention purposes. 25,26 Similar studies examining aerosol generation from procedures such as nasal endoscopy, flexible laryngoscopy, airway suctioning, and various forms of high-flow oxygen delivery have similarly questioned the classification of these procedures as AGPs. 27,28 In an operative environment, with specific ventilatory parameters and baseline use of personal protective equipment, the addition of preprocedure screening may have very limited benefit, if any.…”

Section: Using An Infection Prevention Risk Assessment To Guide Asymp...mentioning

confidence: 99%

Asymptomatic screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) as an infection prevention measure in healthcare facilities: Challenges and considerations

Talbot

Hayden

Yokoe

et al. 2022

Infect. Control Hosp. Epidemiol.

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Executive summary Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, “asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls. In addition, the logistic challenges and costs related to screening program implementation, data noting the lack of substantial aerosol generation with elective controlled intubation, extubation, and other procedures, and the adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention. Consequently, the Society for Healthcare Epidemiology of America (SHEA) recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities. Specifically, preprocedure asymptomatic screening is unlikely to provide incremental benefit in preventing SARS-CoV-2 transmission in the procedural and perioperative environment when other infection prevention strategies are in place, and it should not be considered a requirement for all patients. Admission screening may be beneficial during times of increased virus transmission in some settings where other layers of controls are limited (eg, behavioral health, congregate care, or shared patient rooms), but widespread routine use of admission asymptomatic screening is not recommended over strengthening other infection prevention controls. In this commentary, we outline the challenges surrounding the use of asymptomatic screening, including logistics and costs of implementing a screening program, and adverse patient and facility consequences. We review data pertaining to the lack of substantial aerosol generation during elective controlled intubation, extubation, and other procedures, and we provide guidance for when asymptomatic screening for SARS-CoV-2 may be considered in a limited scope.

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Aerosol generation during general anesthesia is comparable to coughing: An observational clinical study

Cited by 8 publications

References 42 publications

Risk of Bacterial Exposure to the Anesthesiologist’s Face During Intubation and Extubation

Risk of Bacterial Exposure to the Anesthesiologist’s Face During Intubation and Extubation

Aerosol generation during coughing: an observational study

Asymptomatic screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) as an infection prevention measure in healthcare facilities: Challenges and considerations

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