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Table of Contents
LETTER TO EDITOR
Year : 2021  |  Volume : 5  |  Issue : 2  |  Page : 141-142

Surgical drape as a protective barrier during airway management in a COVID-19-positive pediatric patient


Department of Anaesthesiology, Critical Care and Pain, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission17-Sep-2020
Date of Decision07-Oct-2020
Date of Acceptance12-Oct-2020
Date of Web Publication16-Apr-2021

Correspondence Address:
Dr. Amiya Kumar Barik
Department of Anaesthesiology, Critical Care and Pain, All India Institute of Medical Sciences, Rishikesh - 249 203, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/BJOA.BJOA_211_20

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How to cite this article:
Pathak S, Gupta P, Barik AK, Andleeb R. Surgical drape as a protective barrier during airway management in a COVID-19-positive pediatric patient. Bali J Anaesthesiol 2021;5:141-2

How to cite this URL:
Pathak S, Gupta P, Barik AK, Andleeb R. Surgical drape as a protective barrier during airway management in a COVID-19-positive pediatric patient. Bali J Anaesthesiol [serial online] 2021 [cited 2021 Jun 23];5:141-2. Available from: https://www.bjoaonline.com/text.asp?2021/5/2/141/313883



Sir,

Coronavirus disease (COVID-19) has been bringing new challenges for health-care workers with each passing day. More and more positive patients are undergoing anesthesia for various emergent and semi-urgent, life/limb/vision-saving procedures. Due to increase in the number of cases, the available resources are rapidly declining. Anesthesiologists have been at the forefront as expert airway managers.[1] It has been documented that intubation carries the highest risk of exposure to the novel COVID-19.[2] Airway management procedures such as mask ventilation, intubation, and extubation are associated with generation of highly infectious aerosol, potentially infecting the operating room (OR).[3],[4] However, this has not discouraged them from administering anesthesia to surgical patients. These procedures become even more challenging in a pediatric patient. The use of barrier enclosures has proven to be effective in minimizing the spread of aerosols to health-care providers.[5] In a resource-limited country like ours, we have to improvise our existing practice using the available resources. This case highlights the utility of a transparent surgical drape as a protective barrier for the anesthesia team during airway management in a COVID-19-positive pediatric patient.

An 8-year-old female patient with raised intracranial pressure due to tubercular meningitis with COVID-19-positive status was referred to our center. She was planned for emergency ventriculoperitoneal shunt placement. The call was received by the anesthesia team at 1 am. Immediately, the OR was prepared, including functional anesthesia workstation with monitor, anesthetic drugs, and airway equipment. A mock drill was carried out by the anesthesia team for better coordination and to avoid confusion during patient management. Unfortunately, we did not have any barrier such as intubation box, aerosol box, or intubation tent. Hence, we used a transparent drape sheet which was available inside the OR at that point of time. Isolation surgical drape is routinely used in robotic surgery and urology OR. Transparency of this drape becomes advantageous when used as a barrier providing complete patient visibility while performing a procedure. We attached the two ends of the drape to intravenous (IV) fluid stands kept on either side of the operating table and laid the rest of the drape onto the table [Figure 1]a. Two holes of the size of the intubator's arms were made in the drape for providing access to the patient without exposing the airway manager directly to the patient's airway. The two IV stands were kept fairly apart such that the drug administrator and the airway equipment provider were also standing behind the barrier. All the team members were briefed again about their roles before the patient was wheeled in. After proper donning with personal protective equipment, the patient was taken inside OR. All American Society of Anesthesiologists (ASA) monitors were attached, the intubator stood at the head end behind the barrier, and anesthesia was induced according to an institutional protocol for COVID-19 intubations [Figure 1]b. The circuit with the attached high-efficiency particulate air filter and mask was placed on the patient's face through one of the two holes made in the drape. The patient was intubated using videolaryngoscope, while the intubator stayed behind this barrier throughout the procedure, thus limiting the exposure to the patient's secretion [Figure 1]c. The barrier did not impair the visibility during intubation and also the transparency aided in complete patient visibility throughout. Intraoperative period was uneventful. During extubation also, the airway manager stayed behind the barrier, thus limiting the exposure, and extubated the patient successfully. After completion of the surgery, the plastic sheet was folded upon itself and disposed carefully, thus limiting OR exposure to aerosols. The COVID-19 pandemic has started to reach its peak in many countries, resulting in a decline in the availability of resources. This simple yet useful method can be used in place of the intubation box effectively to limit the aerosol exposure during airway management.
Figure 1: (a) Surgical drape sheet as a protective barrier, (b and c) airway manipulations behind the barrier

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Acknowledgment

We would like to thank the Department of Anaesthesiology, Critical Care and Pain, AIIMS, Rishikesh.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient (s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gupta B, Bajwa SJ, Malhotra N, Mehdiratta L, Kakkar K. Tough times and miles to go before we sleep-corona warriors. India J Anaesth 2020;64 Suppl 2:120-4.  Back to cited text no. 1
    
2.
Harding H, Broom A, Broom J. Aerosol-generating procedures and infective risk to healthcare workers from SARS-CoV-2: the limits of the evidence. J Hosp Infect 2020;105:717-25.  Back to cited text no. 2
    
3.
Orser BA. Recommendations for endotracheal intubation of COVID-19 patients. Anesth Analg 2020;130:1109-10.  Back to cited text no. 3
    
4.
Lai YY, Chang CM. A carton-made protective shield for suspicious/confirmed COVID-19 intubation and extubation during surgery. Anesth Analg 2020;131:e31-3.  Back to cited text no. 4
    
5.
Canelli R, Connor CW, Gonzalez M, Nozari A, Ortega R. Barrier enclosure during endotracheal intubation. N Engl J Med 2020;382:1957-8.  Back to cited text no. 5
    


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