Safety Protocols for Videolaryngoscopy During the COVID-19 Pandemic: A Prospective Review of 196 Cases
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ORIGINAL ARTICLE
Safety Protocols for Videolaryngoscopy During the COVID-19 Pandemic: A Prospective Review of 196 Cases Sachin Gandhi1 • Subash Bhatta1
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Shraddha Jayant Saindani1 • Dushyanth Ganesuni1 • Asheesh Dora Ghanpur1
Received: 23 July 2020 / Accepted: 27 August 2020 Ó Association of Otolaryngologists of India 2020
Abstract To prepare safety protocols for performing videolaryngoscopy (VLS) during COVID-19 pandemic, that would be feasible for patients, hospital and the health care providers. This was a prospective study performed from March 01, 2020 to June 30, 2020. It analyzed the precautions adapted for VLS initially and subsequently describes modifications with the time. The safety protocols are developed considering the safety aspect, the feasibility aspect (due to increase in number of the VLS), and the financial aspect. The VLS was performed with the personal protective equipment (PPE), including the face shield mask and head cover. The PPE was re-used after sterilization with ethylene oxide. For local anesthesia, the oropharynx was sprayed with 15% xylocaine and nose packed with 4% xylocaine soaked pledget. Following the VLS, the scope was wiped three times with 80% alcohol and then immersed in 5.25% sodium hypochlorite and 0.55% orthophthalaldehyde for 10 min each. Each VLS was spaced by at least 15 min gap. The endoscopy suite maintained with laminar air flow. It can be concluded that during the COVID-19 pandemic, the VLS must be performed using PPE with proper sterilization of the scope and the endoscopy suite after the procedure. The use of face shield mask and 15% xylocaine spray into the oropharynx were also highlighted. The financial burden should be minimized by reusing the materials whenever possible.
& Subash Bhatta [email protected] 1
Department of Laryngology, Deenanath Mangeshkar Hospital and Research Centre, Erandwane, Pune 411004, India
Keywords Videolaryngoscopy COVID-19 Safety protocols
Introduction In December of 2019, in Wuhan, China, the Novel Corona virus (COVID-19) epidemic originated and thereafter rapidly spread throughout the world [1–4]. The World Health Organization (WHO) declared the disease as a pandemic on March 11, 2020 [5, 6]. The COVID-19 infection primarily involves the respiratory system, including both the upper and the lower airways [2, 3, 7]. Subsequently, the viral load is found to be the highest in the nasal cavities, nasopharynx, oropharynx, hypopharynx, larynx and the lower airways [7, 8]. The characteristics of the virus and its transmission route makes the videolaryngoscopy (VLS) a potential medium for spread of the infection. The involvement of the transmucosal upper airway further increases the generation of the aerosols during the VLS [5, 9–11]. The provision has been suggested to perform the VLS only when it is dire emergency, with all the necessary precautions [12–16]. There are studies in the literature conducted to update the knowledge and formulate guidelines to carry out upper and lower gastrointestinal endoscopy safely during the C
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