key: cord-0811242-euh55i56
authors: Kapoor, Indu; Prabhakar, Hemanshu; Mahajan, Charu
title: Avoiding Aerosol Generation During Tracheostomy in COVID-19 Patients
date: 2020-09-11
journal: J Am Coll Surg
DOI: 10.1016/j.jamcollsurg.2020.08.730
sha: 4d475f635e1e2ecee857165e5e98b6bc4f13700b
doc_id: 811242
cord_uid: euh55i56

nan

We read with interest the article by Foster and colleagues. 1 The authors discussed a novel approach to reducing the transmission of novel coronavirus disease (COVID-19) during tracheostomy. In this scenario, an anesthesiologist plays a very important role in incorporating various methods that can reduce aerosolization of secretion during tracheostomy. We would like to add some maneuvers by which aerosol formation and transmission can be further reduced: intravenous glycopyrrolate before tracheostomy for suspected or confirmed COVID-19 patients facilitates drying of secretion and decreases the risk of exposure to aerosols, 2 and to facilitate tracheostomy, opioids should be given after muscle relaxant in order to avoid opioid-induced cough, which may generate a large amount of aerosol containing virus. 3 An appropriate size tracheostomy tube should be kept handy to avoid delay in insertion of the tracheostomy tube.

The authors also mentioned that they connected the Buffalo Filter smoke evacuator tubing to 2 heat moisture exchange (HME) filters and placed them under the drape to provide further air filtration. Connecting 2 HME filters will make the breathing circuit more bulky, and therefore will increase the risk of accidental extubation. Rather, one can use a high efficiency particulate air (HEPA) filter, which would be less bulky than 2 HME filters, and it will provide bacterial and viral filtration exceeding 99.995%, which assures a very high level of protection against them. We are completely in agreement with the authors that one can also use a large transparent plastic sheet to cover the patient to decrease the risk of viral exposure to health care providers. We also agree with the authors that to mitigate risk during tracheostomy, meticulous planning of each procedural step, along with strict adherence to institutional guidelines, is very important.

Novel approach to reduce transmission of COVID-19 during tracheostomy

Can glycopyrrolate come to the airway rescue in Covid-19 patients?

Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl-induced cough

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2020 by the American College of Surgeons