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2020 ; 131
(3
): 677-689
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Airway Management in the Operating Room and Interventional Suites in Known or
Suspected COVID-19 Adult Patients: A Practical Review
#MMPMID32502132
Thiruvenkatarajan V
; Wong DT
; Kothandan H
; Sekhar V
; Adhikary SD
; Currie J
; Van Wijk RM
Anesth Analg
2020[Sep]; 131
(3
): 677-689
PMID32502132
show ga
Current evidence suggests that coronavirus disease 2019 (COVID-19) spread occurs
via respiratory droplets (particles >5 µm) and possibly through aerosol. The rate
of transmission remains high during airway management. This was evident during
the 2003 severe acute respiratory syndrome epidemic where those who were involved
in tracheal intubation had a higher risk of infection than those who were not
involved (odds ratio 6.6). We describe specific airway management principles for
patients with known or suspected COVID-19 disease for an array of critical care
and procedural settings. We conducted a thorough search of the available
literature of airway management of COVID-19 across a variety of international
settings. In addition, we have analyzed various medical professional body
recommendations for common procedural practices such as interventional
cardiology, gastroenterology, and pulmonology. A systematic process that aims to
protect the operators involved via appropriate personal protective equipment,
avoidance of unnecessary patient contact and minimalization of periprocedural
aerosol generation are key components to successful airway management. For
operating room cases requiring general anesthesia or complex interventional
procedures, tracheal intubation should be the preferred option. For
interventional procedures, when tracheal intubation is not indicated, cautious
conscious sedation appears to be a reasonable approach. Awake intubation should
be avoided unless it is absolutely necessary. Extubation is a high-risk procedure
for aerosol and droplet spread and needs thorough planning and preparation. As
updates and modifications in the management of COVID-19 are still evolving, local
guidelines, appraised at regular intervals, are vital in optimizing clinical
management.