Anesthesia for Emergency Open Reduction and Internal Fixation of the Unstable Cervical Spine Fracture during COVID-19 Pandemic

Abstract

Anesthetic management of a patient with an unstable
cervical spine fracture, presented with neurological
deficit, who has also been classified as a Patient Under
Investigation (PUI) for COVID-19 should be strictly
adhered to standard recommendations and guidelines in
the same manner of confirmed COVID-19 cases. In
addition to the use of appropriate personal protective
equipment (PPE) for anesthesia providers with direct
patient contact, tracheal intubation performed by
experienced personnel are highly suggested. In this case
report, awake tracheal intubation using video laryngoscope
with separate video monitor screen was successfully
performed. Viscous lidocaine gargles along with

intravenous lidocaine were previously administered in
order to reduce coughing during intubation. Proper
endotracheal tube position and placement were assessed
and confirmed by using vocal cord marker and
end-tidal capnography, respectively. Above all, providers
should always be aware of viral spreading caused by
contamination of patient’s secretion which can be
minimized by limiting the number of anesthetic equipment
and anesthesia personnel with clear role and responsibility,
providing appropriate zoning management plan. After the
operation, respiratory secretions should be collected for
detection of SARS-CoV-2 and appropriate equipment is
required during patient transport.