Preoperative Airway assessment practices in COVID-19 pandemic- SAFE PAC Survey

For the safe practice of anesthesia, the anesthesiologist must examine the mouth cavity, nose, jaws, and neck from the front and sides of the patient before to administering anesthesia. The sensitivity and specificity of airway evaluation tests range between 24 and 51% and 87 and 93%, respectively. The test with the greatest sensitivity was the modified Mallampati test, which involves complete mouth openness with the examiner's eyes at the level of the oral cavity. During this pandemic, the process of assessing the airway exposes the examiner to the possibility of infection from asymptomatic individuals. A patient experiencing an adverse airway event owing to the avoidance of pre-anesthetic airway evaluation constitutes a breach of duty of care. Comparing the present practice of pre anesthetic airway evaluation during the pandemic to the pre-pandemic era, a survey was done recently. An email questionnaire survey of practicing anesthesiologists is the most secure and appropriate technique of research during this epidemic. We may be able to establish a framework for best practice during this pandemic based on the findings of the survey, which may have a significant impact on current procedures.

A survey was done utilizing a questionnaire including 35 pre-validated items. The questionnaire was sent through Google Forms to 4,676 members of the Indian Society of Anaesthesiologists (ISA). 470 email messages sent to 4676 members were returned as undelivered. The response percentage for the remaining 4206 questionnaire recipients was 10.8 percent, with 456 replies received. Using EZR software, percentage, mean, and standard deviation were determined. During the pandemic, the rate of pre-anesthetic airway screening declined by 31.7%, resulting in 5.2% of individuals experiencing unexpectedly difficult airways. Eight percent of the respondents were afflicted.

This is the first study to demonstrate that a drop in preoperative airway evaluation during the pandemic has resulted in a significant decline in the safety of airway management for patients scheduled for elective surgery. During the pandemic, there was a statistically significant decrease in pre-anesthetic airway examination, leading to adverse airway events. Case-by-case evaluation of the risk of contamination aids in the selection of suitable PPE, hence lowering the danger of transmission. In the evolution of virtual pre-anesthetic airway examination, innovative approaches play a critical role. Eight percent of responders tested positive for COVID-19. During the pandemic, a methodology for safe pre-anesthetic airway evaluation is proposed.

Reference –

Girijanandan, Menon D.; Manjit, George,; Sunitha, Zachariah K.; Lintu, George; Linby, Chacko; Sruthy, Victor Study on airway assessment practices for elective procedures during pre-anesthetic evaluation in COVID-19 pandemic- A national online survey (SAFE PAC Survey), Journal of Anaesthesiology Clinical Pharmacology: Volume 38 - Issue Suppl 1 - p S79-S88

doi: 10.4103/joacp.joacp_138_21