INTUBATION OUTSIDE OPERATING THEATRE DURING PANDEMIC COVID 19
Ridha Surya Nugraha, Erwin Pradian, Iwan Fuadi, Suwarman, Reza W. Sudjud

Anesthesiology Departement & Intensive Therapy, Medical Faculty of Univercity Padjajaran, General Hospital Dr. Hasan Sadikin, Bandung, Indonesia

Abstract

Airway management in patients outside the operating room in COVID 19 Pandemic is associated with increased difficulties and risks since the virus is highly contagious via aerosol, droplets, or direct contact. Around 10% of positive COVID-19 cases requiring urgent tracheal intubation for profound and sudden hypoxia. A 55 years old man has suspected for COVID 19 cases had impending respiratory failure. He had a history of hypertension and DM. Physical examination revealed he was alert, GCS 15, the airway is patent, with respiration rate 35x/m, SpO2 was 88% with 10L/m NRM with pulse rate 120x/m, BP 135/80mmHg, the temperature was 38.5 C. He was intubated with a rapid sequence intubation technique facilitated with a video laryngoscope (Mc Grath) using fentanyl (200mcg), propofol (150 mg), and rocuronium (60 mg). Intubating suspected or confirm COVID 19 patients need awareness about the aerosol potential source in airway management, especially in an emergency condition outside the operating room. Thorough preparation and PPE should be done. Rapid sequence intubation and disposable tools are preferable. The two-person technique was done to minimize the risk of aerosolization of airway secretions, vice (V-E) grip is recommended to maximize the face mask seal. The procedure should be done by the most experienced physician. Video laryngoscope with disposable blades can help better visualization, successful first attempt, and reduce risk of aerosolization. Managing the airway in this situation should combine principles from guidelines, and some modifications as a strategy.

Keywords: Aiway management, COVID 19, Intubation, Rapid Sequence intubation, videolaryngoscope,

Topic: Clinical Practice in Pandemic Era