Managing Aerodigestive Emergencies During the COVID-19 Pandemic: Challenges for Healthcare Workers

Optimizing Airway Surgery in COVID 19 Era

“…There have been innumerable evidence based data and research on the proper use PPE. We cannot ignore the aspect of false negative RT PCR, and how it depends on several factors [ 17 , 18 ]. Hence, though a pre-operative negative RT-PCR provides some amount of mental relaxation, there should be no difference in maintaining the protocols or precautions.…”

“…Tracheotomy/Tracheostomy [5,15,16,27,29] -Under General Anaesthesia with complete paralysis in elective cases where orotracheal intubation is possible -Metallic tracheostomy tubes are to be avoided to prevent mucosal injury -A cuffed silicon (Bivona) tracheostomy set is considered to be the best of its kind during tracheotomy; subsequently the tube can be deflated and can be left unchanged for 1 month unless indicated [8] The semi-urgent airway cases, which can be planned electively Example: repeat or staged airway procedure like second dilatation of tracheotomised case of subglottic tracheal stenosis, Benign vocal fold lesion like polyp, Early vocal fold malignancy -A relatively larger sized tube is used, to avoid frequent changing due to blockage -Adequate pre-oxygenation prior to tracheostomy -The skin incision should be generous to avoid unnecessary delay in the procedure -Procedure should be as fast as possible, performed by well-trained hands -There should be limited use of suction and electrocautery -Holding the ventilation just before making the tracheal incision will prevent the sudden burst of aerosols -The tracheostomy hub should be connected immediately to ventilator, preferably with a closed suction system -Connection with Viral filter or a heat and moisture exchanger (HME) is always recommended -Training and optimising tracheostomy tube self care at home and video-teleconsultation -In cases where orotracheal intubation is unfavourable, TIVA or IV deep sedation with HFNC can be preferred [7] Foreign Body Airway Removal [2,11,17] -Use of video-endoscopy for maintaining distance -Use of optical forceps for an expeditious procedure -Use of glass slide for blocking the vents of the bronchoscope -Side endoscope port oxygenation -Good communication with anaesthesiology team for avoiding unnecessary delay and minimisation of PPV -Swift execution of the procedure when intermittent apnea technique with complete neuromuscular blockade was used as anesthesia -TIVA or deep IV sedation is a good alternative to PPV -Plastic drape barrier [26] Subglottic Tracheal Stenosis [12,19,24,25] -Preference of repeated Coblation excision and dilatation -Intralesional steroid instillation -Relook procedure with balloon dilatation, wherever applicable -Aerosol minimalisation by closed ventilation via cuffed tracheostomy tube -CTR and anastomosis is another surgical option, but as…”

Challenges and Adaptation in Otorhinolaryngology Practice During Pandemic Lockdown: Experience from a Malaysian COVID-19 Hospital

“…During MCO, all hospitals in Malaysia comprehensively adapted a number of changes according to the guidelines drafted by the Ministry of Health Malaysia ( 20 – 22 ). As the ORL-HNS health care workers are heavily involved in the examinations and interventions of problems of the upper aerodigestive tract, the challenges are distinctly different from other specialties ( 23 ).…”