Surgical Considerations for an Awake Tracheotomy During the COVID-19 Pandemic

• Published in: Journal of laparoendoscopic & advanced surgical techniques. Part A Vol. 30; no. 5; p. 477
• Main Authors: Crossley, Jason, Clark, Christine, Brody, Fredrick, Maxwell, Jessica H
• Format: Journal Article
• Language: English
• Published: United States 01.05.2020
• Subjects: Aerosols - adverse effects; Airway Obstruction - etiology; Airway Obstruction - surgery; Betacoronavirus - isolation & purification; Carcinoma, Squamous Cell - complications; Coronavirus Infections - complications; Coronavirus Infections - diagnosis; Coronavirus Infections - virology; COVID-19; Glottis; Humans; Infection Control - methods; Infection Control - standards; Infectious Disease Transmission, Patient-to-Professional - prevention & control; Laryngeal Neoplasms - complications; Male; Middle Aged; Pandemics; Pneumonia, Viral - complications; Pneumonia, Viral - diagnosis; Pneumonia, Viral - virology; Respiratory Insufficiency - etiology; Respiratory Insufficiency - surgery; SARS-CoV-2; Tracheotomy - adverse effects; Tracheotomy - methods; Wakefulness; COVID-19; pandemic; tracheotomy
• ISSN: 1557-9034
• DOI: 10.1089/lap.2020.0239

The current global COVID-19 pandemic is caused by the novel coronavirus Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Given that SARS-CoV-2 is highly transmissible, surgical societies have recommended that procedures with a high risk of aerosolization be avoided or delayed. However, some high-risk procedures, such as those related to head and neck malignancies, cannot always be delayed. Care must be taken during aerosol-generating procedures to minimize viral transmission as much as possible. Preoperative testing for COVID-19, limited operating room personnel, adequate personal protective equipment, and surgical technique are factors to consider for high-risk procedures. This article presents the case of an awake tracheotomy performed for a transglottic mass causing airway obstruction. With detailed planning and specific techniques, the amount of aerosolization was reduced, and the procedure was performed as safely as possible. This case provides a template for future aerosol-generating procedures during respiratory pandemics.