All India difficult airway association (AIDAA) consensus guidelines for airway management in the operating room during the COVID-19 pandemic

Abstract

Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) which causes coronavirus disease (COVID-19) is a highly contagious virus. The closed environment of the operation room (OR) with aerosol generating airway management procedures increases the risk of transmission of infection among the anaesthesiologists and other OR personnel. Wearing complete, fluid impermeable personal protective equipment (PPE) for airway related procedures is recommended. Team preparation, clear methods of communication and appropriate donning and doffing of PPEs are essential to prevent spread of the infection. Optimal pre oxygenation, rapid sequence induction and video laryngoscope aided tracheal intubation (TI) are recommended. Supraglottic airways (SGA) and surgical cricothyroidotomy should be preferred for airway rescue. High flow nasal oxygen, face mask ventilation, nebulisation, small bore cannula cricothyroidotomy with jet ventilation should be avoided. Tracheal extubation should be conducted with the same levels of precaution as TI. The All India Difficult Airway Association (AIDAA) aims to provide consensus guidelines for safe airway management in the OR, while attempting to prevent transmission of infection to the OR personnel during the COVID-19 pandemic.

Pediatric ophthalmology, strabismus and neuro-ophthalmology practice in the COVID-19 era: All India Ophthalmological Society guidelines

“…The major concern here is the spread of virus during airway management which is mandatory for children who are to be taken up for these procedures. [ 23 ] Where possible, a procedure under sedation should be preferred over one under general anesthesia.…”

“…Importantly, they should be specifically told that donning and doffing should be very carefully done and disposal of these is of utmost importance. [ 23 26 27 ] Explaining to the attendants and conducting various tests on the patients preoperatively: Investigations which may be indicated include complete blood count, chest X-ray and viral markers. A COVID-19 test should be done if possible, however it is not mandatory in the current scenario.…”

“…It is best to avoid mask ventilation to prevent any aerosol generation unless O2 saturation goes below 95%. [ 23 ] Extubation: There should be a closed suction system. Suction should be done only if it is required as it is also an aerosol generating procedure.…”

“…A face mask can be threaded over the endotracheal tube prior to doing the intubation to prevent any further spread of aerosols. [ 23 ] Postoperative: The patient should be wearing this face mask before transferring to the postoperative area PPE for the Anesthetist/Surgeon: A full level PPE consisting of Reusable N95 mask, face shield/goggles, gown and double gloves should be used by all personnel present in the operating room. Have a dedicated Doffing and Donning area, if possible.…”

Heat and moisture exchanger filter in a paediatric patient: A dilemma for anaesthesiologists- to use or not to use?

“…[ 1 ] Adding a filter to the breathing system reduces the transmission of microbes and other particulate matter (together HMEF). [ 2 ]…”