COVID-19 Info

Safe Anesthesia Care During COVID-19
Read full article in Outpatient Surgery Magazine

Airway management of patients with COVID-19 (SARS-CoV-2) presents high risk to staff and patients.[1] Professional anesthesia societies have developed many COVID-related recommendations to protect healthcare staff and patients including:

  • Using regional anesthesia (RA) rather than general anesthesia (GA) given the high risk of
    aerosol generation during GA.[1] RA with deep sedation (RA-DS) provides patient comfort
    and depression of consciousness while preserving spontaneous ventilation.

  • Considering the anesthesia provider’s proximity to the patient if maneuvers like jaw life
    are required.[2] “Stay as distant from the airway as is practical to enable optimal
    technique, whatever device is used.”[3]

    • Transmission is thought to be predominantly by droplet spread and through
      direct contact with the patient or contaminated surfaces (fomites).[4]

    • The highest viral load of SARS-CoV-2 appears in the sputum and upper airway secretions.[4]

  • Avoiding aerosol-generating procedures wherever possible—“If a suitable alternative is
    available, use it.”[3] Both intubation and extubation can result in respiratory droplet
    exposure.[5-6]

  • Focusing on “safe, accurate and swift” airway management techniques.[3] Multiple
    attempts to place an airway can increase exposure for staff and patients.[3]

  • When practical, using single-use equipment vs. reusable.[3]

 

A New Airway Management Solution
Adequate ventilation and oxygenation are always critical goals for anesthetized patients. The
McMurray Enhanced Airway (MEA) provides a hands-free method for maintaining patency in
patients who experience airway obstruction during deep sedation. The MEA is designed to:
 

  • Displace pharyngeal tissue via longer, flexible tubing that stents open the airway unlike
    currently available oral airways, which are shorter than the MEA.

  • Alleviate airway obstruction, reducing the need for hands-on chin lift/jaw thrust
    maneuvers—and the extended, close patient-provider contact they require.

  • Bridge deep extubation and LMA removal to help decrease patient coughing post-
    procedure. Extubation often results in more aerosolization than intubation.[7]

  • Be easy and intuitive to use.

 

The MEA also can be connected to the anesthesia circuit with an HME or used with an oxygen
mask to decrease viral exposure. The MEA is available now to relieve upper airway obstruction while helping reduce
aerosolization exposure.

 

 

References

​

  1. Uppal V, Sondekoppam RV, Lobo CA, Kolli S, Kalagara KP. Practice Recommendations on Neuraxial Anesthesia and Peripheral Nerve Blocks during the COVID-19 Pandemic. American Society of Regional Anesthesia and Pain Medicine. (n.d.) Retrieved June 12, 2020 from: https://www.asra.com/page/2905/practice-recommendations-on-neuraxial-anesthesia-and-peripheral-nerve-blocks-dur. Published March 31, 2020.

  2. American Society of Anesthesiology. (n.d.). COVID-19 FAQs. Clinical FAQs Coronavirus (2019-CoV) COVID-19.  from: https://www.asahq.org/about-asa/governance-and-committees/asa-committees/committee-on-occupational-health/coronavirus/clinical-faqs Accessed June 12, 2020

  3. Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19. Anaesthesia. 2020;75(6):785-799.

  4. Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA. 2020;323(18):1843–1844. doi:10.1001/jama.2020.3786

  5. Rowlands J, Yeager MP, Beach M, et al. Video observation to map hand contact and bacterial transmission in operating rooms. Am J Infect Control. 2014;42:698–701.

  6. Loftus RW, Koff MD, Birnbach DJ. The dynamics and implications of bacterial transmission events arising from the anesthesia work area. Anesth Analg. 2015;120:853–860.

  7. Zucco L, Levy N,, Ketchandji D, Aziz M, D; Ramachandran SR. An Update on the Perioperative Considerations for COVID-19 Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). APSF Newsletter. 2020;35(2):33-29.