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Awake tracheal intubation during COVID-19 pandemic: An audit of 23 cases in a tertiary cancer centre

Background: Coronavirus disease 2019 (COVID-19) pandemic has significantly affected routine healthcare including cancer care across the world. Head and neck cancer (HNC) is the most common cancer in India and has a good prognosis if treated surgically in early stages. HNC patients often present with difficult airway with reduced mouth opening requiring awake tracheal intubation (ATI). Health professionals are at a risk of getting infected with COVID-19 during ATI, a potential aerosol-generating procedure. We aimed to evaluate the modifications of ATI techniques used during the COVID-19 pandemic in our institution. Methodology: This retrospective observational study was conducted in a tertiary cancer care centre. All patients who had ATI performed between 25th March 2020 and 31st May 2020 were included in the study. The type of barrier methods used to prevent aerosol spread and the methods used to provide topical anaesthesia of the airway were documented and analysed. Results: Twenty-three patients underwent ATI during that period. Barrier methods such as aerosol box or transparent plastic drapes to prevent aerosol spread were used in 48% of patients. Lignocaine nebulisation and transtracheal lignocaine injection were administered in 70% and 87% of patients, respectively, during the study period. Spray-as-you-go lignocaine topicalisation and oral lignocaine spray for airway topicalisation were used in 22% and 39% of patients, respectively, during this period. Five techniques were used for ATI – conventional, under aerosol box (single anaesthesiologist and two anaesthesiologists) and under transparent plastic drape (in one technique, both airway topicalisation and intubation were done under the drape; in another, only intubation was performed under the drape). Conclusions: With modifications of the routine technique, ATI can be performed safely during the COVID-19 pandemic.