ABSTRACT
Introduction: The airway management of patients with COVID-19 is a high risk task for anaesthesiologists. Several innovations have been born as a result of this problem, including aerosol boxes and clear plastic sheets. Aim: To compare the timing and attempt of direct laryngoscopy with and without aerosol box for intubation in patients undergoing general anaesthesia during the COVID-19 pandemic. Materials and Methods: This was a randomised controlled study was conducted in Parul Sevashram Hospital, Parul University, Vadodara, Gujrat, India from April 2021 to September 2021. A total of 50 patients were randomly divided into two equal groups as group A was intubated with an aerosol box and a macintosh laryngoscope, while group B was intubated with a clear plastic sheet and macintosh laryngoscope. With proper airway precautions and Personal Protective Equipments (PPE) comparative assessment of patients undergoing surgery in general anaesthesia was done. Time to intubate, number of attempts, ease of Endotracheal Tube (ETT) tube insertion, quality of Laryngoscopy view and Cormack Lehane scores were assessed in both the groups. Results: The mean time for intubation was high at 29.72 seconds in group A, while it was 23.16 seconds in group B;the difference was significant. Overall, 20 out of 25 (80%) patients could be intubated in 1st attempt in group B as compared to 15 out of 25 (60%) in group A. Airway visualisation using Percentage of Glottic Opening (POGO) scoring and Cormack Lehane staging were suggestive of better visualisation in group B than group A. Difficulties encountered during intubation like laryngoscopy, glottic visualisation, arm movement restriction, ETT negotiation, and stylet removal were lesser in group A as compared to group B. The incidence of complications like sore throat and airway bleeding were lower in group B as compared to group A. Conclusion: In the COVID-19 era, aerosol box and clear plastic sheets are effective barrier measures for airway management to prevent the anaesthesiologists from the aerosol transmission. But airway management with clear plastic sheet is technically easier than aerosol box.
ABSTRACT
Introduction: Anaesthesiologists are at constant risk of contracting Corona Virus Disease 2019 (COVID-19) disease. They are constantly conducting surgical procedures despite being surrounded by pandemic. Patients requiring Nasotracheal Intubation (NTI) for oromaxillofacial surgery expose anaesthesiologists to aerosol-risk. Video laryngoscope simplifies NTI with diminished aerosol exposure, decreased time and difficulty for intubation in patients undergoing oromaxillofacial surgery. Aim: This study was intended to compare the effectiveness of King Vision Video Laryngoscope (KVVL) and Macintosh laryngoscope in patients requiring NTI for oromaxillofacial procedures. Materials and Methods: This prospective randomised controlled study was conducted on total of 40 patients undergoing oromaxillofacial surgery under general anaesthesia with NTI in Parul Sevashram Hospital, Vadodara, India, from September 2020 to February 2021. Patients were randomly allocated into group KL and group ML of 20 patients each. Laryngoscopy in group KL was performed with KVVL (non-channelled blade), while in group ML patients were intubated using Macintosh laryngoscope. Intubation time, Modified Nasointubation Difficulty Scale (MNIDS), haemodynamic parameters, and complications were noted. Student t-test and chi-square test were used respectively for continuous and categorical variables. Results: There was no significant difference in the mean age, weight and gender between the groups KL and ML (p-value>0.05). The mean age of the group KL patients were 32.65 years and group ML was 33.95 years which was not statistically significant. Time required for passing tube from glottic opening to trachea (T3) was significantly less (13.5 seconds) in group KL than (17.4 seconds) in group ML (p-value <0.001). A total of 16 patients (80%) and 12 (60%) patients respectively, in group KL and group ML had MNIDS of 0. Increase in Heart Rate (HR) and Mean Arterial Pressure (MAP) was significantly higher in group ML than group KL. Also, a video laryngoscope increases the distance between the operator and airway and hence reduces aerosol exposure. Conclusion: Intubation time, assist manoeuvre, and change of head position were less in group KL than group ML. KVVL reduces distance between patient and anaesthesiologist. Video laryngoscopes reduce aerosol transmission better than macintosh laryngoscopes. Thus, the video laryngoscopes were found better than macintosh laryngoscopes.
ABSTRACT
Background: Usage of personal protective equipment, which includes N95 filtering face piece respirators (FFRs), was the major preventive measure for healthcare workers to control COVID-19 transmission. However, a global shortage of N95 FFRs was observed worldwide during initial phase of pandemic. Reusing mask was the only strategy and various decontamination methods were suggested. The main objective of the study was to evaluate the compliance rate of limited reuse and extended use policy implemented in hospital. Methods: Limited reuse and extended use policy of N95 FFRs was implemented for one month in lower risk areas. Compliance to policy was checked by questionnaires asked to 100 healthcare workers verbally and challenges faced by them were noted. Results: It was observed that overall compliance to policy was 80%. Major reasons of non-compliance were suffocation, followed by smell from mask and loosened strips. Conclusion: Limited reuse and extended use method was successfully used as a bridge until sufficient N95 FFRs were not available although effective decontamination method must be established in hospitals to prepare ourselves for the future pandemics. © 2021 Occupational Health and Safety Society of Nepal. All rights reserved.