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 Subject : Nasal intubation in Pediatric Outpatient Dental Surgery.. 05/11/2020 08:36:17 AM 
Dr. Adrian Hawaleshka l
Posts: 3
Location: 
We are instituting newCovid-19 related policies at our outpatient surgical center that deals only with pediatric dentals. Are nasal intubations to be avoided with Covid19? At first my conclusion was yes but with a literature search , i am not so sure. Thoughts?
 Subject : Re:Nasal intubation in Pediatric Outpatient Dental Surgery.. 05/11/2020 09:05:55 AM 
Chhaya Patel, MD, SAMBA-F
Posts: 4
Location: 
Hi there

We do tons of pediatric dental at our Surgery center too. The oral intubation may cause slightly less aerosol generation during intubation. We have been doing pre op covid 19 testing for all these patients. In the hands of experienced anesthesia providers and good dose of IV propofol, nasal intubation is fast and most convenient for the dentist. It also saves time required to switch ETT intraoperatively. We are also wearing PPE for this AGP that includes gown, N95, gloves, and eye shield for the intubation and procedure.
 Subject : Re:Nasal intubation in Pediatric Outpatient Dental Surgery.. 05/11/2020 09:19:24 AM 
Dr. Adrian Hawaleshka l
Posts: 3
Location: 
Thanks Dr. Patel! Unfortunately pre-op covid-19 testing is not yet an option for us. I agree completely... i think the aerosol generation in the hands of an experienced provider would be no different and therefore eliminating any concern re. increasing risk to provider. I know there is no data on it, but any concern on your end that anesthesia may be delivering a 'viral load' to a patient by doing a nasal intubation (if a covid positive patient slips through)?
 Subject : Re:Nasal intubation in Pediatric Outpatient Dental Surgery.. 05/11/2020 10:38:35 AM 
Constance Hale
Posts: 6
Location: 
Is anyone decolonizing patients with dilute Betadine intranasal or chlorhexidine orally? Children not likely to cooperate preop, but could have benefit to decrease shedding intraop and on extubation once patient is intubated. I haven’t read anything about this since the initial APSF rec. https://www.apsf.org/news-updates/optimizing-infection-control-and-or-management-during-the-covid-pandemic/
 Subject : Re:Nasal intubation in Pediatric Outpatient Dental Surgery.. 05/11/2020 12:02:29 PM 
anna penna
Posts: 49
Location: manassas virginia
Hello,
I think all elective GA cases should be avoided in a covid positive child. The only way to assure safety is to test. We are also finding it hard to get these kids tested, but I DO think this is a high risk procedure with large amounts of aerosol generated during extubation. Plus this population is by definition HIGH RISK. These dental cases are elective. I urge you to work on finding a testing site and arranging preop testing. The dentist should be involved in the process as well. Remember, these cases are elective
anna m penna
 Subject : Re:Nasal intubation in Pediatric Outpatient Dental Surgery.. 05/11/2020 12:53:05 PM 
Dr. Adrian Hawaleshka l
Posts: 3
Location: 
Thank you Dr. Penna. we are definitely working on it. We are not doing elective cases. Only emergent cases that have not responded to medical therapy.
 
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