**(Best Practice Recommendations) Airway Management in Patient with Suspected Novel Coronavirus (COVID19): Permission from Qatar Difficult Airway Society (QMAD) (Figure 6)**

Keep in your mind YOUR personal protection is the priority.


6.Avoid awake fiberoptic intubation unless highly indicated. Atomized local anesthetic will aerosolize the virus. Consider disposable videolaryngoscopes.

*Qatar difficult airway society (QMAD)airway management in COVOD 19 patients.*

*Airway Management in COVID-19 as Aerosol Generating Procedure*

*DOI: http://dx.doi.org/10.5772/intechopen.96889*

**Figure 6.**

**17**

7.Plan for rapid sequence intubation and intubation (RSII) and ensure skilled assistant able to perform cricoid pressure if needed. RSI may need to be modified, if patient has very high alveolar-arterial gradient and is unable to tolerate short period of apnea or has a contraindication to succinylcholine. If manual ventilation is predicted, small tidal volumes should be applied.


patient and health care provider safety as well. Actually, this fact utmost true

• As a general rule any non-invasive equipment contaminated with patient secretions (blood, urine, vomit, or faces) or has been used with contact in suspected or confirmed COVID 19 patients must decontaminated with,1,000

• The real concern in single use equipment is shortage of these devices, and in

• If re-usable equipment has been used special consideration should be taken in decontamination process following local and manufacture recommendation is

when invasive equipment is used [52, 53].

*Special Considerations in Human Airway Management*

a must.

**12. Conclusion**

**Airway Society (QMAD) (Figure 6)**

to avoid self-contamination.

equipment, drugs, ventilator and suction.

intact skin.

**16**

parts per million available chlorine (ppm av. cl) [54]

highly demand situation replacement will be quite difficult.

Managing the airway in a patient who is potentially infective with a droplet infection needs thorough understanding of the disease process and the modifications to airway management technique, that have been seen to reduce harm to the patients and reduce spread to the airway operators. The COVID 19 pandemic has taught us better ways to manage the airway, which can be used in all aerosol generating procedures. Formulating a plan early with good preparation and using checklists, meticulous patient assessment, personal protection for staff, modification of technique and good after care are the cornerstones to achiev-

ing safe airway management in COVID19 patients and all AGPs in general. **(Best Practice Recommendations) Airway Management in Patient with Suspected Novel Coronavirus (COVID19): Permission from Qatar Difficult**

1.Please review the material and use droplet/contact isolation precautions (PPE – face mask, long-sleeved gown, gloves, overhead, overshoes with eye protection and fit-tested particulate respirators (N95 or

equivalent, or higher level of protection) when interacting with patients' blood, body fluids, secretions (including respiratory secretions) and non-

2. Standard precautions should always be routinely applied in all areas of health care facilities. Standard precautions include: hand hygiene; prevention of needle-stick or sharps injury; safe waste management; cleaning and disinfection of equipment; and cleaning of the environment.

3.Before intubation, review and practice wearing and removing the protective barrier mask, gloves and clothing of the infected patient. Pay close attention

4.Most skilled anesthetists available to perform suitable airway management

technique, if possible. Avoid junior intubation for sick patients.

5.Check carefully the followings; standard ASA monitoring, I.V. access,

Keep in your mind YOUR personal protection is the priority.




## **Figure 6.**

*Qatar difficult airway society (QMAD)airway management in COVOD 19 patients.*


8.Three to five minutes of preoxygenation with oxygen 100% and RSI in order to avoid manual ventilation of patient's lungs and potential aerosolization of virus from airways.

**References**

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*DOI: http://dx.doi.org/10.5772/intechopen.96889*

*Airway Management in COVID-19 as Aerosol Generating Procedure*

1564–67 <https://doi.org/10.1056/

[8] B. A. McGrath, S. Wallace, and J. Goswamy, 'Laryngeal Oedema

[9] Jeffrey L. Apfelbaum and others, 'Practice Guidelines for Management of the Difficult Airway: An Updated Report by the American Society of Anesthesiologists Task Force on Management of the Difficult Airway', *Anesthesiology* (The American Society of Anesthesiologists, 2013), 251–70 <https://doi.org/10.1097/ALN.0b013e

[10] James M. Rich, 'Recognition and Management of the Difficult Airway with Special Emphasis on the Intubating Lma-Fastrach/Whistle Technique: A Brief Review with Case Reports', *Baylor University Medical Center Proceedings*, 18.3 (2005), 220–27 <https://doi.org/ 10.1080/08998280.2005.11928072>.

[11] Rich, James M., 'Recognition and Management of the Difficult Airway with Special Emphasis on the Intubating Lma-Fastrach/Whistle Technique: A Brief Review with Case Reports', Baylor University Medical Center Proceedings, 18.3 (2005), 220–27 <https://doi.org/ 10.1080/08998280.2005.11928072>

[12] Sunanda Gupta, Rajesh Sharma, and Dimpel Jain, 'Airway Assessment: Predictors of Difficult Airway', *Indian J*

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[3] 'COVID-19 Map - Johns Hopkins Coronavirus Resource Center' <https://

[4] WHO, 'Novel Coronavirus ( 2019- NCoV ) 22 January 2020', *WHO*

*Bulletin*, JANUARY, 2020, 1–7 <https:// www.who.int/docs/default-source/ coronaviruse/situation-reports/ 20200122-sitrep-2-2019-ncov.pdf>.

[5] Jasper Fuk Woo Chan and others, 'A

[6] 'Modes of Transmission of Virus Causing COVID-19: Implications for IPC Precaution Recommendations' <https://www.who.int/news-room/ commentaries/detail/modes-oftransmission-of-virus-causing-covid-19-implications-for-ipc-precautionrecommendations> [accessed 17 June

[7] Neeltje Van Doremalen and others, 'Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1',

(Massachussetts Medical Society, 2020),

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Familial Cluster of Pneumonia Associated with the 2019 Novel Coronavirus Indicating Person-to-Person Transmission: A Study of a Family Cluster',*The Lancet*, 2020, 514–23 <https://doi.org/10.1016/ S0140-6736(20)30154-9>.

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