Avoiding Aerosol Generation During Tracheostomy in COVID-19 Patients

Abstract

We read with interest the article by Foster and colleagues.¹ Foster P. Cheung T. Craft P. et al. Novel approach to reduce transmission of COVID-19 during tracheostomy. J Am Coll Surg. 2020; 230 : 1102-1104 Abstract Full Text Full Text PDF PubMed Scopus (13) Google Scholar The authors discussed a novel approach to reducing the transmission of novel coronavirus disease (COVID-19) during tracheostomy. In this scenario, an anesthesiologist plays a very important role in incorporating various methods that can reduce aerosolization of secretion during tracheostomy. We would like to add some maneuvers by which aerosol formation and transmission can be further reduced: intravenous glycopyrrolate before tracheostomy for suspected or confirmed COVID-19 patients facilitates drying of secretion and decreases the risk of exposure to aerosols,² Garg H. Can glycopyrrolate come to the airway rescue in Covid-19 patients?. J Clin Anesth. 2020; 64 : 109843 Crossref PubMed Scopus (0) Google Scholar and to facilitate tracheostomy, opioids should be given after muscle relaxant in order to avoid opioid-induced cough, which may generate a large amount of aerosol containing virus.³ Lin C.S. Sun W.Z. Chan W.H. et al. Intravenous lidocaine and ephedrine, but not propofol, suppress fentanyl-induced cough. Can J Anaesth. 2004; 51 : 654-659 Crossref PubMed Google Scholar An appropriate size tracheostomy tube should be kept handy to avoid delay in insertion of the tracheostomy tube.