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  Table of Contents  
LETTER TO THE EDITOR
Year : 2020  |  Volume : 57  |  Issue : 4  |  Page : 500-501
 

Use of protective partition during extubation in the COVID-19 pandemic


Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Submission06-May-2020
Date of Decision10-Jun-2020
Date of Acceptance17-Jun-2020
Date of Web Publication02-Oct-2020

Correspondence Address:
Sumitra G Bakshi
Department of Anesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijc.IJC_453_20

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How to cite this article:
Bakshi SG, Trivedi B, Patil VP. Use of protective partition during extubation in the COVID-19 pandemic. Indian J Cancer 2020;57:500-1

How to cite this URL:
Bakshi SG, Trivedi B, Patil VP. Use of protective partition during extubation in the COVID-19 pandemic. Indian J Cancer [serial online] 2020 [cited 2020 Oct 24];57:500-1. Available from: https://www.indianjcancer.com/text.asp?2020/57/4/500/297023




The COVID- 19 pandemic has unfolded many challenges in delivering optimum cancer care, and despite many odds, cancer surgeries are continuing at major centers.[1],[2] It is equally essential to ensure that the health-care workers remain protected. Of special mention is the need for the anesthesiologists to be well covered as they work in and around the airway and are at increased risk of infection.[3] We describe the use of in-house disposable protective partition made by equipment readily available in nearly all operating rooms.

Cough and its resultant aerosol remains a major way of transmission of COVID-19 infection among humans.[3] In the operating room, the chance of aerosol generation remains high at intubation and at extubation.[3] Pharmacological intervention to reduce the incidence of cough has been described.[3] However, there always remains a possibility of the patient coughing during extubation and thereby the chance that the operating room personnel are exposed to a shower of aerosol remains high. It is essential that the anesthesiologist and support staff are well-covered using adequate personal protective equipment. In addition, the use of additional barriers like the aerosol box has been reported.[4] It has been shown that in the absence of the aerosol box, contamination of the laryngoscopist face shield, monitors, and floor is a high possibility.[4]

With the aim of creating a protective partition between the patient and caretaker, the following equipment readily available in the operating room was used. Two surgical screenholders were attached to the head end of the operating table [Figure 1] and a green transparent plastic drape was spread over to create a fairly enclosed area. The anesthesiologist can approach the airway beneath the drape. This protective partition limits the spread of any cough or blast beyond the inner surface of the drape. Also the visualization of the airway remains unhampered. The protective partition can also be used during intubation; however, visibility of glottis through the plastic sheet may be affected. The same can be easily taken care by use of video laryngoscopes, which aids in intubation by looking at a distant monitor.[5]
Figure 1: Photo showing the use of surgical screenholders and green transparent plastic drape to form a protective partition between the anesthesiologist and patient during extubation. Note the anesthesiologist's hands are beneath the drape

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Simulated experiments have shown that low-cost barriers like plastic sheets do help in limiting aerosolization.[6] We accept that there has been no lab-based experiment comparing the aerosol box versus plastic drapes; nevertheless, in this time of medical crisis, we certainly advocate its use in the absence of proper aerosol box that is described for airway manipulation. Also, this technique is a feasible alternative in limited resource centers where the intubation box is not available or cannot be purchased. The transparent drapes used by us is a part of routine surgical draping. The same drape at the end of the surgery is used as a part of the protective partition, thus avoiding excess plastic burden. An important point to remember is that while discarding the drape, the outer side is handled and folded in such a way that the inner surface in contact with the patient remains inwards and is not exposed to the environment. The limitation of the protective partition is that it is limited to the operating room. However, during transfer it can be used over the trolley railings to offer some protection. But unlike the aerosol box, the protective partition cannot be used in the recovery room.

In conclusion, in the absence of an aerosol box, we recommend the use of protective partition in the operating room during every extubation in the COVID-19 medical crisis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
The Tata Memorial Centre COVID-19 Working Group. The COVID-19 pandemic and the Tata Memorial Centre response. Indian J Cancer 2020;57:123-8.  Back to cited text no. 1
[PUBMED]  [Full text]  
2.
Pramesh CS, Badwe RA. Cancer management in India during Covid-19. N Engl J Med 2020;382:e61.  Back to cited text no. 2
    
3.
Aminnejad R, Salimi A, Saeidi M. Lidocaine during intubation and extubation in patients with coronavirus disease (COVID-19). Can J Anaesth 2020;67:759.  Back to cited text no. 3
    
4.
Canelli R, Connor CW, Gonzalez M, Nozari A, Ortega R. Barrier enclosure during endotracheal intubation. N Engl J Med 2020;382:1957-8.  Back to cited text no. 4
    
5.
Chemsian R, Bhananker S, Ramaiah R. Videolaryngoscopy. Int J Crit Illn Inj Sci 2014;4:35-41.  Back to cited text no. 5
[PUBMED]  [Full text]  
6.
Matava CT, Yu J, Denning S. Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: Implications for COVID-19. Can J Anaesth 2020;67:902-4.  Back to cited text no. 6
    


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