Optimizing Airway Surgery in COVID 19 Era

Abstract

Otorhinolaryngologists, particularly dealing with airway cases, are subjected to highest risk of COVID 19 aerosolisation, self infection and transmission. Moreover, airway cases, which mostly present as emergency, cannot be deferred. Being a tertiary airway centre and having received a number of airway cases, most of them requiring prompt surgical intervention, our airway surgery and anaesthesiology team had to work in conjunction to adapt and readapt the practice over the past few months, striving to achieve effective airway surgery protocols, to minimize exposure and prevent transmission of COVID 19. To enlist the encountered airway cases during COVID 19 pandemic and to highlight the important inclusions and adaptations in executing the airway surgeries. A retrospective observational study of 7 months duration was carried out. This is a single institutional study, where the sample included the primary as well the referred airway cases. Apart from Tracheotomy, Foreign body bronchus removal, Dilatation of Laryngotracheal Stenosis (LTS) and excision of Recurrent Respiratory Papillomatosis (RRP), we also have had the experience to deal with congenital Laryngo-tracheo-oesophageal Cleft (LTOC) Type III b, Thyroid surgery to relieve tracheal compression and Bilateral Choanal Atresia repair during the last 7 months. Routine 2 weeks follow up of the patients have been favourable, as there has not been any report or clinical features of transmission of COVID 19. As the airway surgeries could be executed with the incorporation of certain change in practice and as the follow up revealed no evidence of transmission, we attempt to contribute to airway best practice guideline for maintaining the safety of patients and health professionals.

Keywords: Aerosols; Airway surgery; Covid 19; Guidelines; Safety.