Double clear plastic screens to minimize droplet spread and aerosolization at extubation in COVID-19 patient

Abstract

The droplets of novel coronavirus disease 2019 (COVID-19) can be transmitted during aerosol-generating procedures involving tracheal intubation.¹ Anesthesiologists are exposed to a higher risk than other specialty healthcare workers because they manage the airway and ventilation.² Extubation is as high a risk for aerosolization of respiratory secretions as is intubation. Additional barriers have been described for intubation like using intubation box or clear plastic drapes but limited options have been explored for extubation.³ Some experts suggest placing wet gauze over the patient’s mouth and nose just prior to extubation if the patient starts to cough, and/or covering the patient's face with a clear plastic drape.⁴

Recently, a confirmed COVID-19 patient came for appendectomy in which we have used an alternative approach to protect against aerosolized droplets during extubation. Before induction of anesthesia, we put a large clear plastic sheet (120 x 200 cm), which is routinely used in pediatric surgery. The screen is adjusted in height and width with two infusion poles (drip stands) to the head end. We intubated with a videolaryngoscope, making sure that the plastic screen acted as a barrier between us and the patient.