Aleksandar Dimitrovski, Marija Toleska, Andrijan Kartalov, Biljana Kuzmanovska
University Clinic for TOARILUC-KARIL, Medical Faculty Skopje, University “Ss Cyril and Methodius” Skopje, Macedonia
Correspondence: Aleksandar Dimitrovski, MD, Todor Aleksandrov 73-1/21 1000 Skopje, North Macedonia;
E-mail: dimitrovski777@gmail.com; Phone: +389 70250692
Citation: Dimitrovski A, Toleska M, Kartalov A, Kuzmanovska B. Aerosol box for peripheral nerve blocks. Anaesth. pain intensive care 2020;24(4):469-470.
DOI: 10.35975/apic.v24i4.1323
The COVID-19 pandemic has posed new challenges to the anesthesiologists the world over. Keeping in mind the way the virus was known to be spreading through aerosols and the global deficiency of personal protective equipment, medical workers embarked upon to create and develop devices and equipment to protect themselves from the virus during this pandemic period.
Taiwanese anesthesiologist Dr. Hsien Yung Lai has constructed an aerosol box,1 whose function is to offer an additional protection from aerosols produced during the induction and intubation of the patients needing surgery. The box is transparent made of plexiglass with dimensions of 50 x 50 x 40 cm. The box has two holes with diameters of 10 cm each, for insertion and manipulation of the hands of the intubating anesthesiologist.
Taking consideration of the recommendations for COVID-19 by The European Society of Regional Anaesthesia & Pain Therapy (ESRA) and The American Society of Regional Anesthesia and Pain Medicine (ASRA).2 the preference is given to peripheral nerve blocks as a main anesthesia technique, thus avoiding the need of intubation and general anesthesia.
We used the aerosol box as a protective shield for performing peripheral nerve blocks of brachial plexus, by infraclavicular and interscalene approach and cervical plexus block in patients who were suspected of CoViD-19 infection. Many studies
concluded that the potential aerosol spread of SARS-CoV-2 is not only through coughing and sneezing, but also through breathing.3 In a large number of these patients, a cough is a symptom which represents a high possibility of transmitting the virus through aerosols to the anesthesiologist, because of the close contact that they have during the performance of these blocks.
The box is positioned over the patient's head. Through the one hole, the anesthesiologist inserts one hand with the needle for applying the peripheral nerve block; through the other hole, the other hand holds the probe of the ultrasound. During the procedure, the anesthesiologist is using the recommended PPE.
Although the space is limited for manipulation, we successfully performed the blocks without much limitations.
We think that the use of aerosol box during manipulation and performing the peripheral nerve blocks in brachial and cervical region, in patients that are suspected of COVID-19, or are known to be infected, enhances the safety of the anesthesiologist as the chances of infection during the manipulation are extremely low.
References
University Clinic for TOARILUC-KARIL, Medical Faculty Skopje, University “Ss Cyril and Methodius” Skopje, Macedonia
Correspondence: Aleksandar Dimitrovski, MD, Todor Aleksandrov 73-1/21 1000 Skopje, North Macedonia;
E-mail: dimitrovski777@gmail.com; Phone: +389 70250692
Citation: Dimitrovski A, Toleska M, Kartalov A, Kuzmanovska B. Aerosol box for peripheral nerve blocks. Anaesth. pain intensive care 2020;24(4):469-470.
DOI: 10.35975/apic.v24i4.1323
The COVID-19 pandemic has posed new challenges to the anesthesiologists the world over. Keeping in mind the way the virus was known to be spreading through aerosols and the global deficiency of personal protective equipment, medical workers embarked upon to create and develop devices and equipment to protect themselves from the virus during this pandemic period.
Taiwanese anesthesiologist Dr. Hsien Yung Lai has constructed an aerosol box,1 whose function is to offer an additional protection from aerosols produced during the induction and intubation of the patients needing surgery. The box is transparent made of plexiglass with dimensions of 50 x 50 x 40 cm. The box has two holes with diameters of 10 cm each, for insertion and manipulation of the hands of the intubating anesthesiologist.
Taking consideration of the recommendations for COVID-19 by The European Society of Regional Anaesthesia & Pain Therapy (ESRA) and The American Society of Regional Anesthesia and Pain Medicine (ASRA).2 the preference is given to peripheral nerve blocks as a main anesthesia technique, thus avoiding the need of intubation and general anesthesia.
We used the aerosol box as a protective shield for performing peripheral nerve blocks of brachial plexus, by infraclavicular and interscalene approach and cervical plexus block in patients who were suspected of CoViD-19 infection. Many studies
concluded that the potential aerosol spread of SARS-CoV-2 is not only through coughing and sneezing, but also through breathing.3 In a large number of these patients, a cough is a symptom which represents a high possibility of transmitting the virus through aerosols to the anesthesiologist, because of the close contact that they have during the performance of these blocks.
The box is positioned over the patient's head. Through the one hole, the anesthesiologist inserts one hand with the needle for applying the peripheral nerve block; through the other hole, the other hand holds the probe of the ultrasound. During the procedure, the anesthesiologist is using the recommended PPE.
Although the space is limited for manipulation, we successfully performed the blocks without much limitations.
We think that the use of aerosol box during manipulation and performing the peripheral nerve blocks in brachial and cervical region, in patients that are suspected of COVID-19, or are known to be infected, enhances the safety of the anesthesiologist as the chances of infection during the manipulation are extremely low.
References
- Everington K. Taiwanese doctor invents device to protect US doctors against coronavirus. Taiwan News. March 23, 2020 [Internat}; Available from: https://www.taiwannews.com.tw/en/news/39024359. Accessed on 17 July 2020)
- Uppal V, Sondekoppam RV, Lobo CA, Kolli S, Kalagara HKP. Practice Recommendations on Neuraxial Anesthesia and Peripheral Blocks during the COVID-19 Pandemic [Internet]; Available on https://www.asra.com/covid-19/raguidance (Accessed 10 July 2020)
- National Academies of Sciences, Engineering, and Medicine. 2020. Rapid Expert Consultation on SARS-CoV-2 Viral Shedding and Antibody Response for the COVID-19 Pandemic (April 8, 2020). Washington, DC: The National Academies Press. DOI: 17226/25774