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Archive November 2020 XXI, No. 11

Anesthesia Alert: Safe Anesthesia Care During COVID-19

Take precautions to reduce exposure risks to airborne droplets.

Roxanne McMurray

Roxanne McMurray, DNP, APRN, CRNA

BIO

PROCESS IMPROVEMENT
Pamela Bevelhymer, RN, BSN, CNOR
PROCESS IMPROVEMENT Now is the time to refine airway management practices that may not have been applied in the early months of the pandemic.

Anesthesia providers have been forced to alter the way they work in order to deliver safe and efficient care during the COVID-19 pandemic. Because of their close proximity to patients and the types of procedures they perform, anesthesia professionals are among the providers most at risk of exposure to the coronavirus. Fortunately, several straight-forward interventions can reduce transmission risks.

The latest recommendations

The science continues to evolve, but experts believe COVID-19 is predominantly transmitted by droplet spread and through direct contact. Early research indicates that the highest viral load appears in sputum and upper airway secretions. Anesthesia providers are positioned near the patient's head, and many procedures they perform are aerosol-generating. High-flow oxygen delivery, endotracheal intubation and extubation, non-invasive ventilation and open suctioning of airways all can generate droplets. Not surprisingly, guidance to help mitigate risk associated with airway management centers on avoiding aerosol-generating procedures whenever possible. Current professional society recommendations include:

  • Focus on "safe, accurate and swift" airway management techniques. Multiple attempts to secure an airway can increase exposure. Ensure airway devices are easy to use, so endotracheal tubes can be placed on the first try.
  • Use suitable alternatives to aerosol-generating procedures, whenever possible.
  • Keep as safe a distance as possible from the patient's airway while maintaining appropriate technique.
  • Use airway management tools and techniques that lessen the need for prolonged direct patient contact, which can occur with chin lift and jaw thrust maneuvers.
  • Opt for single-use equipment instead of reusable devices, when feasible.

Placing (intubating) or removing (extubating) an endotracheal tube can cause patients to cough. Research indicates these aerosol-generating procedures increase the odds of transmitting an acute respiratory infection to the surgical team by six-fold.

The Anesthesia Patient Safety Foundation (APSF) recommends distancing in the post-anesthesia care unit from patients who are coughing or sneezing repeatedly due to airway irritation. These patients might require an enclosed room with limited personnel who practice full airborne precautions, according to the APSF. Of course, many outpatient surgery facilities have limited space available to allocate for this kind of use. The recommendation, though, underscores the importance of reducing patient coughing to the extent possible. A practice that may help stem patient coughing in the OR or recovery unit is pulling the endotracheal tube or extubating while the patient is still asleep in the OR. By replacing the endotracheal tube with a less invasive device, coughing can be limited as the patient emerges from anesthesia. One such option is a pharyngeal airway device with tubing long enough to stent open the airway, but short enough that coughing and gagging are reduced when it is removed from a waking patient. This type of airway management tool also can maintain a patient airway without the need for a chin lift or jaw thrust, reducing prolonged patient-provider contact.

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