Airway management in patients with COVID-19

Abstract

SARS-CoV-2 virus causes COVID-19, which is characterized by a high level of aerosol spreading of viral particles. Aerosol generating procedures are high-risk procedures for anesthesiologists and necessities expensive high level protective personal equipment (PPE) (level 3). The problem with COVID-19 is the high number of patients, which presents an economic burden for the health care system and country, and causes issues with human and equipment resources. Airway protocols vary among hospitals like three gloves technique, videolaryngoscope, FFP3 masks, eye protection, and additional shield. All parts of the anesthesiologist's body need to be covered with protective equipment. Extubation is also considered as high risk from the point of aerosol production, and PPE level 3 is required. Patient monitoring for early warning signs leads to intubation, which is predicted and planned. The patient is preoxygenated, fully relaxed, without mask ventilation as rapid sequence intubation. The suggested time for intubation is 30 s, immediate cuff inflation, followed by a tube connecting with the machine for mechanical ventilation. Capnography serves for the tracheal intubation confirmation. Supraglottic devices and cryccothyteothomy are reserved for situation can't intubate-can't oxygenate. Airway procedures are considered as high-risk procedure, and the most experienced anesthesiologist should perform them in the shortest possible time. The best solution is to have an airway dedicated team, educated in simulation center for this specifiec type of intubation, proper planning, prepared and checked medications and equipment.

Keywords

• airway
• covid-19