Airway Management in the Operating Room and Interventional Suites in Known or Suspected COVID-19 Adult Patients: A Practical Review

Abstract

Coronavirus disease 2019 (COVID-19) mainly transmits via droplets and contact Airborne precautions are required for aerosol-generating procedures such as manual ventilation, intubation, extubation, non-invasive ventilation (NIV) and cardiopulmonary resuscitation (CPR) Modifications in airway management are required to minimise aerosol generation Regional anaesthesia should be considered where possible Disease transmission can be minimised when perioperative care is thoroughly planned BACKGROUND The virus SARS-CoV-2 is an enveloped, single stranded RNA virus that is 50-200nm in diameter(3). Though genetically 85% similar to SARS-CoV, which was the culprit of the SARS epidemic in 2003, SARS-CoV-2 is a distinctly new coronavirus (see Table 1). An online test is available for self-directed continuous medical education (CME). It is estimated to take 1 hour to complete. Please record time spent and report this to your accrediting body if you wish to claim CME points. A certificate will be awarded upon passing the test. Please refer to the accreditation policy here.

Airway Management Considerations for Upper Gastrointestinal Endoscopic Procedures in COVID-19 Era

“…When used with a superimposed surgical mask, High flow nasal cannula (HFNC) may be a reasonable option in hypoxemic patients to avoid intubation [11]. Its use has been described during intubation for critically ill COVID-19 patients, though highly debated [12]. Nonetheless, HFNC therapy assisted sedation is not employed during endoscopy in many centers (anecdotal evidence) regardless of the prevalence rate, due to concerns with aerosolization of viral particles [13].…”

“…Due to the sustained reduction in infection rate in the late phase of the pandemic, according to the recent international guidelines [7] we resumed elective endoscopic [12] activities in outpatients, administering a symptom questionnaire and performing a temperature check on the day of the procedure.…”

“…Breathing circuit with filter (blue arrow), dedicated airway channel (light green arrow), endoscope (orange arrow) inserted through the endoscopy channel (red arrow). [Published with permission from the British Journal of Anaesthesia [ 12 ] …”

Anesthesiologists’ Attitude and Approach Regarding Personal Usage of Protective Equipment During the Covid-19 Pandemic

“…Hastanın solunum aktivitesinin yanı sıra tıbbi girişimlerde aerosol üretebilir. Bu aerosoller, uzun mesafeler kat edebilen ve havada daha uzun süre kalabilen partiküller içerir, ancak enfektif potansiyelleri belirsizdir (3) . Temas hava yolu manevraları sırasında, özellikle trakeal entübasyon sırasında önemlidir.…”

Institutional Review of Laparoscopic Surgery during Coronavirus Disease - 2019: Recommendations for Developing Countries

“…[2][3] Laparoscopic procedures were avoided in all cases due to the risk of viral transmission from aerosol-generating products (AGP) during procedures performed under general anesthesia (GA) during intubation and ventilation and smoke generation from insu ated gas. [4][5][6] Gradually, surgical societies adopted newer guidelines that allowed laparoscopy-provided protective measures to be strictly implemented. 7 Some of these measures were limited due to the cost of devices and systems to support procedures.…”