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Intubation strategy in COVID-19 era: An observational study
Aparna Sinha, Dinesh Punhani, Abhishek Sharma, Kumar Gaurav Dhakate, Nivedita Garg, Sangeeta Patro
Department of Anesthesia, Max Institute of Laparoscopy, Endoscopy and Bariatric Surgery, Max Super Speciality Hospital, New Delhi, India
Correspondence Address:
Aparna Sinha,
Max Institute of Laparoscopy, Endoscopy and Bariatric Surgery, Max Super Speciality Hospital, Saket, New Delhi - 110 017
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/jmas.jmas_11_22 PMID: 35915524
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Background and Aims: Aerosol protection equipment aim at protecting the anaesthesiologist, from aerosol-borne infections, namely, severe acute respiratory syndrome corona virus-2.
Methods: We improvised the first-generation intubation box (IB) by increasing its dimensions, including heat and moisture exchanger with filter, suction catheter, and attaching arm sleeves to make a modified intubation box (MIB). The impact of IB, MIB and transparent sheets (TS) on the patient outcomes during airway management was evaluated.
Results: A significant difference in median (interquartile range in minutes) was observed in time to intubate between IB (4 [4–5]); TS (0.5 [0.3–0.5]) and MIB (0.3 [0.3–1.5]): P = 0.004); and airway devices; McCoy (0.5 [0.3–2]), CMac (0.5 [0.3–1.5]): P = 0.004. First-pass success was 100% with the TS, whereas more than three attempts were required with IB 66.7% and 5.2% with MIB. Video laryngoscope was associated with less airway-related adverse events (ARAEs). The need for mask ventilation (and hence possible aerosolisation) was maximum with IB. All the ARAEs resolved uneventfully. No breach of personal protective equipment was observed; none of the health-care professionals involved in patient care developed any symptoms suggestive of COVID-19.
Conclusion: Video laryngoscope is favourable for managing airway in COVID-19 times. In view of the ongoing pandemic and added protection that it offers, it is worthwhile to include the MIB in the armamentarium for managing the airway of patients with COVID-19.
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