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Case Reports
. 2020 Jun;47(3):472-476.
doi: 10.1016/j.anl.2020.04.002. Epub 2020 Apr 18.

Anesthetic and surgical management of tracheostomy in a patient with COVID-19

Mariko Hiramatsu  1 , Naoki Nishio  2 , Masayuki Ozaki  3 , Yuichiro Shindo  4 , Katsunao Suzuki  2 , Takanori Yamamoto  3 , Yasushi Fujimoto  2 , Michihiko Sone  2
Affiliations
Case Reports

Anesthetic and surgical management of tracheostomy in a patient with COVID-19

Mariko Hiramatsu et al. Auris Nasus Larynx. 2020 Jun.

Abstract

Objective: The ongoing pandemic coronavirus disease-2019 (COVID-19) infection causes severe respiratory dysfunction and has become an emergent issue for worldwide healthcare. Since COVID-19 spreads through contact and droplet infection routes, careful attention to infection control and surgical management is important to prevent cross-contamination of patients and medical staff. Tracheostomy is an effective method to treat severe respiratory dysfunction with prolonged respiratory management and should be performed as a high-risk procedure METHOD: The anesthetic and surgical considerations in this case involved difficult goals of the patient safety and the management of infection among health care workers. Our surgical procedure was developed based on the previous experiences of severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV).

Results: We described the management procedures for tracheostomy in a patient with COVID-19, including the anesthesia preparation, surgical procedures, required medical supplies (a N95 mask or powered air purifying respirator, goggles, face shield, cap, double gloves, and a water-resistant disposable gown), and appropriate consultation with an infection prevention team.

Conclusion: Appropriate contact, airborne precautions, and sufficient use of muscle relaxants are essential for performing tracheostomy in a patient with COVID-19.

Keywords: COVID-2019; SARS-COV-2; Surgical management; Tracheostomy.

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Conflict of interest statement

Declaration of Competing Interest The authors have no financial conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Clinical history and chest images of X-ray and computed tomography.
Fig. 2
Fig. 2
Typical PPE during tracheostomy in a patient with COVID-19 a: powered air-purifying respirator, b: Clinical care nurse with PPE who assisted the tracheostomy outside the surgical field, c: Tracheostomy performed by two otolaryngologists and one anesthesiologist. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
See this image and copyright information in PMC

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