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Answer: collaboration by Dr. J Lichtor and Leo Rodriguez MD
The problem with MAC anesthesia is that it can quickly end up being a general anesthetic and in the process of changing from using sedation to general anesthesia, aerosol contamination can result that cannot be well controlled.( Sharma D, Rasmussen M, Han R, et al. Anesthetic Management of Endovascular Treatment of Acute Ischemic Stroke During COVID-19 Pandemic: Consensus Statement from Society for Neuroscience in Anesthesiology & Critical Care (SNACC)_Endorsed by Society of Vascular & Interventional Neurology (SVIN), Society of NeuroInterventional Surgery (SNIS), Neurocritical Care Society (NCS), and European Society of Minimally Invasive Neurological Therapy (ESMINT). J Neurosurg Anesthesiol. 2020). Of course, the use of either MAC or mask anesthesia depends on the type of procedure and whether your institution is performing that procedure. Some institutions, for example, currently are only doing emergent cases. If the patient is COVID-19 (suspected or known) the patient should be intubated for their procedure by the dedicated airway team (2 senior airway proceduralists in full PAPR). If the patient is not suspected of having COVID-19, and whether or not a patient’s trachea is intubated for the procedure, the airway provider should have an N95 mask and face shield for full airborne precautions, in case the patient should become positive. For MAC cases that involve the esophagus (i.e. EGD, TEE), in some institutions, all participants are using full PPE. Furthermore, for those procedures, no endotracheal is used, because it can increase the risk of coughing.
In addition:
We are trying to do as much possible regional anesthesia with no or mild sedation to avoid airway manipulation.
We have also been applying a level 3 mask to the patient’s face, we then place an oxygen mask on top of the surgical mask to supplement oxygen (though there’s no evidence). Also, we are avoiding nasal cannula, to prevent aerosolization. |
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Last Edited On: 04/22/2020 11:06:04 AM By Leopoldo Rodriguez, MD, MBA, FAAAP, FASA, SAMBA-F |
