In pursuit of the right plan for airway management in gastrointestinal endoscopic procedures…the battle half won?

Endoscopic Endotracheal Intubation for ERCP In the Era of COVID: An Approach To Minimize Risk of Transmission of Infectious Diseases

“…Traditionally, ERCP patients are intubated in the supine position and moved semi-prone for the procedure, further exposing healthcare team members to possible infectious disease transmission. Hence, there is an opportunity to develop endoscopic procedure-specific best intubation practices, that enhance patient safety [3].…”

“…Elective asleep endoscopic intubations have been utilized for procedures in patients without known difficult airways for multiple patient and procedure-specific reasons and we have examined the use of this approach in patients undergoing ERCP [5]. There is a need for improved airway management in endoscopic procedures and an endoscopic endotracheal intubation for ERCP procedures carries several advantages and may fulfil this need, as described previously [3,11]. Intubation is accomplished briskly (<1 minute), the patient is anesthetized, muting the aerosol-generating cough reflex, the patient's mouth is directed down and away from the intubating physician, and distance between patient and physician can be maintained at four feet during the entire intubation process [5].…”

“…As discussed by Gowd et. al., airway management for gastrointestinal endoscopic procedures is an area of concern for patient safety, to prevent hypoxic injury and aspiration events [3]. At our academic medical center endoscopy unit, we have studied urgent endoscopic endotracheal tube (ETT) placement in safely accomplishing rescue intubation during endoscopic retrograde cholangiopancreatography (ERCP) procedures that failed Monitored Anesthesia Care (MAC).…”

Thrust on airway research – Exploring the publications

“…Much research is being published to improve airway management’s safety and success. [ 1 ] Authors have shared findings from clinical trials exploring diverse airway management methods and employing diagnostic tools/algorithms for airway assessment.…”