Guidelines for anesthetists for intubation or GA in COVID 19 patients

The current outbreak of COVID-19 has rapidly expanded over a short time. The confirmed cases have crossed 1.2 million globally and continue to increase despite austere measures taken by all concerned. Up to one-third of affected patients may require a higher level of care in hospitals, including mechanical ventilation in the early report.

The anaesthesiologists are experts in airway management and will be on the frontlines of managing critically ill patients. Learning from previous experiences with SARS and understanding the current epidemiological factors of the COVID-19, anaesthesiologists are much better prepared to protect themselves during aerosol-generating medical procedures. Good knowledge of infection prevention and control, vigilance in protective measures, strict adhesion of donning and doffing of PPE, and preparedness for the care of infected patients are of utmost importance.

An article published in the British Journal of Anaesthesia has outlined how anaesthesiologists have to address the problem of COVID-19 including precautions they need to observe while dealing with such patients.

Preparing the patient and procedure room

Transfer of a suspected or infected COVID-19 patient to the room for aerosol-generating medical procedures requires planning. Considerations include:

(i)The room should be adequately ventilated; for aerosol-generating medical procedures performed outside the operating theatre, a negative pressure/airborne isolation room with a minimum of 12 air changes h−1 is preferred.

(ii)The patient should wear a face mask during transport to the procedure room.

(iii)The staff involved in the care of the patient should don PPE as required by their hospital's policy for the management of COVID-19.

(iv)Hand hygiene must be performed by staff before and after all patient contact, particularly before putting on and after removing PPE.

(v)The number of individual staff members involved in the resuscitation should be kept to a minimum with no or minimal exchange of staff for the duration of the case, if possible.

PPE considerations

(i)Specific PPE components selected for aerosol-generating medical procedures may vary slightly by hospitals. However, the underlying principles are the same: to protect the healthcare provider from inhalation and contact with aerosols and droplets that may be generated during the procedure. PPE components that may be used to accomplish this level of protection include:

(a)A particulate respirator (US National Institute for Occupational Safety and Health-certified N95, EU standard FFP2, or equivalent); all healthcare workers should have an updated respirator fit test;

(b)Eye protection, through the use of goggles or a disposable face shield;

(c)Gown with fluid resistance, and

(d)Gloves.

(ii)Any PPE component that becomes heavily soiled during aerosol-generating medical procedures should be replaced immediately.

(iii)Careful attention must be paid to donning and doffing of PPE to avoid potential exposure and self-contamination, which is highest during the removal of PPE. All healthcare workers attending to aerosol-generating medical procedures should be trained and comfortable with PPE use, including safe donning and doffing.

(iv)After removing protective equipment, the healthcare worker should avoid touching the hair or face before cleaning hands.

(v)PPE should be disposed of carefully in touch-free disposal or laundering bin.

Minimization of the aerosol generation

To minimize the aerosols generated during airway instrumentation, some factors to consider include the following:

For further reference log on to:

https://doi.org/10.1016/j.bja.2020.02.008

airway management, coronavirus, COVID-19, infection prevention, and control, MERS, 2019-nCoV, SARS