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Issue link: http://outpatientsurgery.uberflip.com/i/1346819
4 8 • O U T P A T I E N T S U R G E R Y M A G A Z I N E • M A R C H 2 0 2 1 assist if they were need- ed. The CDC also rec- ommends using video laryngoscopes during intubations in order to maintain a safe distance between the anesthesia provider and patient. Providers are able to stand upright as they view the airway on a separate screen instead of crouching inches away from the patient's mouth to get a direct view of the glottis. Most of the newer video laryngoscopes employ disposable blades, so we've experi- enced a shortage of sup- plies during the pandemic. To combat this problem, we've had to use video laryngoscopes only on patients we thought could present more challenging intubations. We try to determine during a patient's pre-op airway evaluation if use of a video laryngo- scope might be necessary by looking at the size of their neck, considering their BMI, assessing their abilities to open their mouth and extend their neck, checking their dentition and reviewing their medical records for a history of difficult intubation. Use of these video laryngoscopes has increased during the pandemic. I think more anesthesia pro- fessionals will opt to use them during routine air- way management, but believe most providers will reserve them for difficult intubations. Added protection PPE protocols have been enhanced during the pan- demic. Our anesthesia providers double-glove and remove the outer layer after performing intubations and extubations, and before touching equipment, surfaces or patients. When intubations are being performed, everyone in the room wears an N95 mask with a standard surgical mask over top of it. They must also wear eye protection, including tight- fitting goggles or face shields, and disposable isola- tion gowns. We experienced a shortage of PPE and a backorder on disposable gowns, so we also relied on cloth gowns that were professionally laundered. I'll be interested to see how much protection anesthesia providers will employ during airway management after the pandemic. We've learned to adapt to wearing multiple layers, but I'm not sure the added protection will be needed moving for- ward. However, I'm fairly certain one aspect of PPE use will remain: The creative ways facilities have secured the protective gear they need. Before the pandemic, we didn't keep a large stock of face shields because our providers didn't wear them for every case. We also had only a cou- ple boxes of N95s left over from the Ebola crisis of 2014. During the first wave of the pandemic, before knowing the full extent of the impact it would have on PPE supply chains, I ordered as many items as I could. But when the first wave of the pandemic hit and supplies dwindled, we reached out to contacts at local surgical facilities. One day we'd have extra masks, but would be low on gloves, while another facility had the opposite problem. We'd help each other out if our vendors were unable to provide HIGH RISK COVID-19 has increased the importance of implementing safe practices during airway management.