New Normal Practice in Thoracic Anesthesia in Central Chest Institute of Thailand

Abstract

During the COVID-19 pandemic, anesthesiologists
might be involved in the perioperative care of asymptomatic
COVID-19 patients undergoing thoracic surgery. There is
a higher exposure risk of thoracic anesthesiologist due to
the need to perform frequent aerosol-generating
procedures for thoracic surgery including bag-mask
ventilation, tracheal intubation, tracheal tube repositioning,
bronchoscopy, lung isolation, suction, correcting of hypoxia
during one-lung ventilation and tracheal extubation. The
modification in thoracic anesthesia practice in Central
Chest Institute of Thailand aims to minimize the risk to
healthcare professionals while providing effective
operative conditions and patient safety. The new normal
practice includes minimizing the number of staff present
in the operating room during aerosol-generating
procedures, preparation of personal protective equipment,
airway management plan and equipments with additional

acrylic box, closed-suction system and HEPA viral filter to
prevent spreading of droplets/aerosol. The choice of
tracheal tube for lung isolation depends on the indication,
difficulty of tracheal intubation and the need for
postoperative ventilation. The goals of safe aerosolgenerating
procedures during open airway are
pre-oxygenation, silent airway and no flow by reassuring
adequate neuromuscular blockade, discontinuation of
positive pressure ventilation at end-expiration, releasing
positive pressure by opening adjustable pressure limiting
valve, closed-suction and clamp the tube before
disconnection of breathing circuit and pass the flexible
bronchoscope through the valve of endotracheal tube
swivel connector and store in a designated area after use
to prevent contamination.