Thoracic Anesthesia of Patients With Suspected or Confirmed 2019 Novel Coronavirus Infection: Preliminary Recommendations for Airway Management by the European Association of Cardiothoracic Anaesthesiology Thoracic Subspecialty Committee

Abstract

The novel coronavirus has caused a pandemic around the world. Management of patients with suspected or confirmed coronavirus infection who have to undergo thoracic surgery will be a challenge for the anesthesiologists. The thoracic subspecialty committee of European Association of Cardiothoracic Anaesthesiology (EACTA) has conducted a survey of opinion in order to create recommendations for the anesthetic approach to these challenging patients. It should be emphasized that both the management of the infected patient with COVID-19 and the self-protection of the anesthesia team constitute a complicated challenge. The text focuses therefore on both important topics.

Keywords: COVID-19; coronavirus; lung separation; personal protective equipment; thoracic anesthesia.

Fig 1

Systematic approach for (A) tracheal intubation and (B) lung separation for COVID-19 patients scheduled for thoracic surgery. BB, bronchial blocker; CPAP, continuous positive airway pressure; DLT, double-lumen tube; ETT, endotracheal tube; FiO₂, fraction of inspired oxygen; FNAC, front of neck access; OLV, one lung ventilation; PEEP, positive end-expiratory pressure; PPE, personal protective equipment; PSV, pressure support ventilation; RSI, rapid sequence induction; SGD, 2nd generation supraglottic device; TLV, two lung ventilation.

Fig 1

Systematic approach for (A) tracheal intubation and (B) lung separation for COVID-19 patients scheduled for thoracic surgery. BB, bronchial blocker; CPAP, continuous positive airway pressure; DLT, double-lumen tube; ETT, endotracheal tube; FiO₂, fraction of inspired oxygen; FNAC, front of neck access; OLV, one lung ventilation; PEEP, positive end-expiratory pressure; PPE, personal protective equipment; PSV, pressure support ventilation; RSI, rapid sequence induction; SGD, 2nd generation supraglottic device; TLV, two lung ventilation.

Fig 2

The lung separation tools preferably used by the respondents for COVID-19 patients. Respondents would use only either a bronchial blocker (52.4%) or double-lumen tube (4.7%). The remaining 47.6% chose to use a bronchial blocker or double-lumen tube according to the intubation status (intubated v nonintubated), airway difficulty, and duration of the surgical procedure. BB, bronchial blockers; DLT, double-lumen tubes.

Fig 3

The most common indications for using bronchial blockers or double-lumen tubes. The use of bronchial blockers in all patients is advocated by 52.4%; 33.3% would use bronchial blockers in already intubated patients and 9.5% in patients with difficult airway. On the other and, 28.6% would use double-lumen tubes in all cases and 19% only in nonintubated cases. BB, bronchial blockers; DLT, double-lumen tubes.

Fig 4

An antiviral filter connected to the double-lumen tube. (A permission to use was obtained from Dr. Domenico Massullo, Rome, Italy.)

Fig 5

Systematic approach for tracheal extubation plans for COVID-19 patients scheduled for thoracic surgery. BB, bronchial blockers; DLT, double lumen tubes; ETT, endotracheal tube; HFNO, high-flow nasal oxygen; ICU, intensive care unit; NIV, noninvasive ventilation; PPE, personal protective equipment.