Facemask ventilation of patients for surgery does not increase the risk of spread of COVID-19

Transmission electron micrograph of SARS-CoV-2, the virus that causes COVID-19. It emerges from human cells. Credit: NIAID

New research published in anesthesia The Association of Anesthetists journal states that the use of face mask ventilation during routine surgery should not be classified as an aerosol-producing procedure and increases the risk of COVID-19 infection compared to normal breathing / coughing in patients. It says that it will not let you.

Therefore, this procedure is not risky and can be performed with confidence in both routine surgery and emergency airway management. Its use should not slow down operations or require the use of additional personal protective equipment for the medical team.

mask ventilation Is an important intervention used by anesthesiologists as part of the “life support” of most anesthetized patients undergoing surgery. Designation as’aerosolThe World Health Organization’s “Generation Procedure” (AGP) has had a significant impact on operating room efficiency and processes. However, there is no direct evidence that face mask ventilation is a high-risk procedure for aerosol production. Previous studies have not measured aerosols produced during face mask ventilation, and evidence of their AGP classification is primarily in one study of anesthesiologist infections dating back to the pre-2003 SARS-1 epidemic. It is based on.

As a result of this AGP designation, current guidance states that anesthesiologists who provide face mask ventilation to patients at risk of contracting COVID-19 will wear breathing masks, eye protection, and additional personal protection. need to do it. This also applies to nearby theater staff. In addition, extra time (up to 30 minutes per case) had to be added to each operation to allow sufficient air exchange in the theater to remove all presumed infectious aerosols. This significantly reduces the number of cases that can be performed daily, especially in the case of emergencies or emergency surgery, contributing to the backlog of the medical system.

In this new study, the authors deliberately generate air leaks to mimic aerosol monitoring of anesthetized patients under standard face mask ventilation and the worst-case scenarios in which aerosols can spread into the air. We carried out face mask ventilation. Records were performed in an ultra-clean operating room (South Mead Hospital, North Bristol NHS Trust, UK) and compared to aerosols produced by normal breathing and coughing in each patient.

Respiratory aerosols from normal breathing were reliably detected above very low background particle concentrations, with a median aerosol concentration of 191 particles per liter. The average aerosol concentration (3 particles per liter) detected during leak-free face mask ventilation was 1/64 of that for breathing. When the intentional leak was introduced, the aerosol count was one-seventeenth of the breath (11 particles per liter).

Looking at the peak particle concentration, the team found that the patient’s cough produced spikes of 1260 particles per liter, whereas normal face mask ventilation produced 60 (1/20) per liter of intentional leaks. When introduced, it turned out to be 120 per liter (10x).

Dr. Andrew Shrimpton, the lead author of this study, commented:

The author adds: “Low concentrations of aerosols detected during face mask ventilation, even with intentional leaks, are reassuring given that this is the worst scenario. Both normal breathing and spontaneous coughing are face mask ventilation. Produces many times more aerosols than …. Based on this, we believe mask Ventilation should not be considered an aerosol production procedure. Accumulated evidence is that many procedures currently defined as aerosol production are not inherently at high risk of producing aerosols, and that natural patient respiratory events often produce much higher amounts. Is shown. “

They conclude that: “New evidence from quantitative clinical aerosol studies has not yet been incorporated into clinical guidance for aerosol production procedures, which we believe requires urgent reassessment. One of these anesthesia-related procedures. It seems appropriate to declassify the part as aerosol production. Our findings also indicate that the term “aerosol production procedure” refers to anesthesia airway management in the prevention of SARS-CoV-2 or other airborne pathogens. It raises the broader question of whether it is still a useful concept for the practice of. “

Dr. Mike Nathanson, President of the Anesthesia Society, said: “This important study will help clinicians better understand the risks of general anesthesia in COVID patients. Surgical cases are increasing. Anesthesia wants to continue working for as many patients as possible. As the author suggests, this study will help us discuss how to work safely. “

This study is the result of a collaborative study between the Anesthesia Research Group and the Aerosol Research Group based in Bristol, England and Melbourne, Australia, as part of the NIHR-sponsored AERATOR study. This result supports the results of a similar study conducted by the AERATOR group and shows that many anesthesia procedures do not have a high risk of aerosol production.

New research may help clear untreated portion of surgery

Provided by AAGBI

Quote: Patient face mask ventilation for surgery was obtained from on October 27, 2021 COVID-19 (2021, 2021,) Does not increase the risk of epidemic (October 27)-covid-.html

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