All India difficult airway association (AIDAA) consensus guidelines for airway management in the operating room during the COVID-19 pandemic

Abstract

Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) which causes coronavirus disease (COVID-19) is a highly contagious virus. The closed environment of the operation room (OR) with aerosol generating airway management procedures increases the risk of transmission of infection among the anaesthesiologists and other OR personnel. Wearing complete, fluid impermeable personal protective equipment (PPE) for airway related procedures is recommended. Team preparation, clear methods of communication and appropriate donning and doffing of PPEs are essential to prevent spread of the infection. Optimal pre oxygenation, rapid sequence induction and video laryngoscope aided tracheal intubation (TI) are recommended. Supraglottic airways (SGA) and surgical cricothyroidotomy should be preferred for airway rescue. High flow nasal oxygen, face mask ventilation, nebulisation, small bore cannula cricothyroidotomy with jet ventilation should be avoided. Tracheal extubation should be conducted with the same levels of precaution as TI. The All India Difficult Airway Association (AIDAA) aims to provide consensus guidelines for safe airway management in the OR, while attempting to prevent transmission of infection to the OR personnel during the COVID-19 pandemic.

Keywords: Airway; COVID-19; Coronavirus; SARS-CoV-2; operation room; pandemic; personal protective equipment.

Figure 1

AIDAA consensus guidelines for airway management in operating room during the COVID-19 pandemic

Figure 2

Tracheal intubation using a customised intubation tent

Figure 3

Patient's face covered with a transparent plastic sheet during preoxygenation

Figure 4

Management of unanticipated difficult tracheal intubation in adults during the COVID-19 pandemic -Algorithm