Airway Management in the Operating Room and Interventional Suites in Known or Suspected COVID-19 Adult Patients

A Practical Review

Venkatesan Thiruvenkatarajan, MD, DA, DNB, FANZCA; David T. Wong, MD; Harikrishnan Kothandan, DNB, DA, FANZCA, MClinUS, FAMS; Vimal Sekhar, MBBS, MClinSci; Sanjib Das Adhikary, MD; John Currie, MBChB, FFARCSI; Roelof M. Van Wijk, MD, PhD, FANZCA, FFPMANZCA


Anesth Analg. 2020;131(3):677-689. 

In This Article


SARS-CoV-2 is likely to remain in many communities for the foreseeable future. Although the daily new cases had reduced in many countries, some regions are witnessing a second wave of infection. Airway management is one of the highest risk procedures for aerosol and droplet dispersion. Adhering to strict PPE practice is an essential approach in mitigating the infection risk. GETA should be the preferred option for known or suspected COVID-19 cases, and awake intubation should be avoided unless absolutely indicated. Extubation strategies should be planned in advance to attenuate the emergence response of airway irritation and agitation. Monitored anesthesia care with sedation may be an appropriate option if carefully performed. For interventional procedures performed outside the operating room setting, clear communication, appreciating the implications, and advanced planning will improve the outcome. Each and every adaptation based on available resources to limit aerosol generation should be followed throughout the periprocedural period. National/society guidelines have been published to guide safe approaches to airway management. However, the locally adapted guidelines that are updated regularly by a committed team are often the best sources that clinicians should rely on. Efforts tailored to the local environment will not only help overcome the current COVID-19 crisis but also help in the events of similar outbreaks in the future.