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A simple combined nasal mask-face tent provided CPAP Pre-and continuous apnoeic oxygenation and reduced aerosol/droplet spread in an agitated/combative elderly patient with SBO/perforation during RSI/intubation for emergency exploratory laparotomy
Anesthesia and Analgesia ; 133(3 SUPPL 2):1944-1945, 2021.
Article in English | EMBASE | ID: covidwho-1444826
ABSTRACT

Background:

Intubation/extubation are aerosol/droplet-generating procedures. A combined paediatric facemask-face tent provided pre/apnoeic nasal oxygenation and reduced aerosol/droplet spread during RSI, intubation, and extubation in a COVID-19 positive patient.1-2 It was used to avoid severe desaturation and reduce aerosol/droplet spread during difficult intubation/extubation in a morbidly obese patient.1,3 We used it in a combative patient with SBO/perforation during RSI/intubation. Case Report A lethargic 87-year-old female ex-smoker with HTN, CVA, CAD s/p MI, uterine cancer s/p TAH/BSO, hiatal hernia, recent URI, worsening abdominal pain, sinus tachycardia and respiratory distress, presented for emergency exploratory laparotomy for SBO. Following NGT suctioning 150 cc biliary fluid, she was transferred to OR table. She became agitated/combative, requiring 3 providers to hold her on the table. She was tachycardic, hypertensive, cold with undetectable SpO2. A nasal mask-face tent was secured over her nose and NGT for pre-oxygenation and reducing aerosol/ droplet spread (Fig.1). With cricoid pressure, RSI was induced with fentanyl/lidocaine/propofol/ etomidate/succinylcholine. Video-laryngoscopy assisted intubation was quickly accomplished under face tent while nasal mask delivered apnoeic oxygenation (Fig.2) with co-occurring NGT suction. Nasal oximetry revealed 99%SpO2 immediately post-intubation. Arterial and additional IV catheters were inserted to manage suspected septic shock. She tolerated ileocectomy with ileostomy well with 98-100%SpO2 throughout with stable yet critical hemodynamics. She remained intubated for managing septic shock which was resolved in one week.

Discussion:

This simple combined nasal mask-face tent provided CPAP pre- and continuous apnoeic oxygenation and reduced aerosol/droplet spread in an agitated/combative patient with SBO/perforation during RSI/intubation. It avoided desaturation and provided additional provider protection amid the ongoing COVID pandemic at no extra costs. (Figure Presented).
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Collection: Databases of international organizations Database: EMBASE Language: English Journal: Anesthesia and Analgesia Year: 2021 Document Type: Article

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Collection: Databases of international organizations Database: EMBASE Language: English Journal: Anesthesia and Analgesia Year: 2021 Document Type: Article