Anesthetic Management in Tracheostomy for COVID-19 Patients and Patients under Investigation: A Review Article for Better and Safe Perioperative Care

Main Article Content

Sawita Kanavitoon


Objective: The rapidly, worldwide spreading of COVID-19
assaults the pulmonary system to acute respiratory
distress syndrome (ARDS) and prolonged intubation and
required tracheostomy. Various recommendations are
published with some debating points. This review aims to
provide data and suggestion for anesthetic personnel,
regarding tracheostomy in patients with positive or
unknown COVID-19 results.
Methods: All articles related evidences to this topic were
reviewed and compared. A practical guideline was
proposed base on the reviewed data.
Result: An organized, detailed recommendation is
presented concerning evidence-based and safety concerns.
Tracheostomy should be performed in patients with

COVID-19, after 14 days of intubation with non-fenestrated
tube. Practical steps for anesthesia personnel for
tracheostomy are fully paralyze the patient, preoxygenate
with 100% oxygen and positive end-expiratory pressure
(PEEP), advance the endotracheal tube before opening
the trachea, and stop the ventilation without unnecessary
disconnection of the circuit. Details of practical steps are
listed and integrated for better patients care.
Conclusions: Tracheostomy in patients with COVID-19
is a rare procedure. However, tracheostomy in the patient
under investigation (PUI) case seems to be more common.
Indication of tracheostomy must be fulfilled to balance the
infection risk of health care personnel.

Article Details

Review articles


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