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Anaesthesia simulation training during coronavirus pandemic: an experience to share
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  • Published on:
    Simulation For Clamping of The Endotracheal Tube In COVID 19
    • jyoti sharma, consultant anaesthesia all india institute of medical sciences, bathinda, india
    • Other Contributors:
      • prashant kumar, consultant anaesthesia

    We read with interest the article by Ahmed O et al1 regarding simulation training during the coronavirus pandemic. We would like to congratulate the authors for the same. The time since simulation training has been introduced for learning anaesthesia skills, it has increased the success rates when the procedures are performed on patients after practicing on simulators. We would like to stress on the point that although simulation training improves the success rate for all procedures, but special recommendations which have been specially added for anaesthesia management during the present pandemic needs extra attention like donning doffing of the PPE kit and clamping to unclamping of the ETT (points 17-20)
    It is a well known fact that clamping of the ETT increases airway resistance and changes the dynamic compliance of the lung.2 If the total process of clamping till unclamping is prolonged, it can lead to adverse effect on the lung dynamics, in an already compromised COVID 19 patient, showing ARDS type features. If the total time of clamping is increased the cuff needs to be deflated prevent the increase in airway resistance, thereby increasing the chances of secretion drooling and hampering the whole purpose of clamping. It is essentially important to complete the whole procedure within a short time span. In present COVID situation the results may not be as anticipated as number of assistants will be limited, and anxiety of operator will be high. Simulation will be...

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    Conflict of Interest:
    None declared.
  • Published on:
    Simulation COVID-19 Intubation Checklist
    • Ahed Ahed Zeidan, Anaesthesia Consultant Department of Anaesthesiology, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
    • Other Contributors:
      • Mohiidin Ali, Anaesthesia Consultant

    We read with interest the report by Ahmed et al1. "Anaesthesia simulation training during coronavirus pandemic: an experience to share". The authors developed A metric-based checklist steps of induction of GA, tracheal intubation, intraoperative management, tracheal extubation and patient recovery in the context of treating patient with covid-19. A supplemental video was used as learning method for the involved health workers. Although the investigators initiate that their clinicians improved their performance during simulation training, they could not consistently addressing all concerns. 1) it is not clear at what flow rate O2/min that preoxygenation should be delivered. Defining such flow is crucial to minimize viral transmission2. 2) the preparation/management between two cases of COVID19, ( e.g soda-lime canister changes; the necessary time pause between cases…),was not notified in their training sessions. Adding such guidance to the checklist would ensure more supplementary protective measures.
    On the other hand, the video showed nicely all training steps, including the using of the glidescope as videolarungoscope (GVL) tool for endotrachel intubation. It is well known that due to the curvature of the GVL blade, a stylet must be used to position the endotrachel tube (ETT) tip at the glottic opening especially in suspected difficult airway3,4. The using of stylet facilitate a quick-pass first-attempt tracheal instrumentation5 .However, in the record...

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    Conflict of Interest:
    None declared.