PMC:7113162 / 2371-5770 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/7113162","sourcedb":"PMC","sourceid":"7113162","source_url":"https://www.ncbi.nlm.nih.gov/pmc/7113162","text":"Anesthesia Process\n\n1. Preparation of manpower\n• Assign the most experienced anesthesia professionals to practitioners performing endotracheal intubations. Inexperienced trainees should not perform endotracheal intubation for training purposes.\n• Assign experienced assistants who can perform techniques such as cricoid pressure when performing rapid sequence induction (RSI).\n• Consider allowing anesthesia teams to be replaced at least every 2 hours, to prevent fatigue.\n\n2. Preparation before anesthesia and use of personal protective equipment\n• Allow sufficient time for all staff involved to don PPE. It may take more than 5 minutes to properly wear PPE.\n• Early planning and implementation of endotracheal intubation should be considered. In the event of an unexpected emergency endotracheal intubation, PPE cannot be adequately donned; therefore, early implementation should be performed when possible.\n• Protective coverall/body suits, N95 masks, disposable goggles/face shields, disposable shoe covers, and disposable gloves must be worn. Use the double glove technique on both hands to reduce contact.\n• A powered air-purifying respirator should be worn by healthcare workers who are involved in endotracheal intubation or extubation processes.\n\n3. Selection of intubation technique\n• Awake fiberoptic intubation should not be performed unless it is a necessary indication. Spraying local anesthetics can aerosolize the virus, and should be avoided.\n• Consider using video laryngoscopes to increase the likelihood of successful endotracheal intubation.\n• Consider using disposable devices for intubation.\n\n4. Endotracheal intubation\n• A high-efficiency hydrophobic filter must be applied between the face mask and the breathing circuit, or between the face mask and the reservoir bag.\n• Preoxygenation for 5 minutes with 100% oxygen should be performed.\n• RSI should be performed to limit procedures such as manual ventilation, which can spread aerosolized virus into the room.\n• The method of RSI can be modified to suit the clinical situation. If manual ventilation is required, a small tidal volume may be considered, or a supraglottic airway may be inserted to provide ventilation instead of manual ventilation using a face mask.\n• Do not use high-flow oxygen, such as high-flow nasal cannula devices, as these can aerosolize the virus.\n\n5. Equipment management after endotracheal intubation\n• All used airway equipment should be placed in double zip-locked plastic bags and removed for disposal or disinfection.\n• Used laryngoscopes should be sealed in double zip-locked plastic bags as soon as the endotracheal intubation is complete, to prevent further contamination of the surroundings.\n• End-tidal carbon dioxide sample lines and traps should be replaced.\n• Take care to avoid contaminating various instruments in the operating room, such as stethoscopes, pens, and telephones.\n\n6. Undressing and hand washing after endotracheal intubation\n• Consider preparing additional isolation rooms as contaminated areas next to the operating room to remove and dispose of PPE in accordance with protocol. If it is difficult to obtain an additional isolation room, use the space inside or immediately outside the operating room to remove PPE according to the protocol.\n• Wash your hands after removing PPE.\n• Avoid body contact, including touching your hair or face, until hands are 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