OSLI Retina

November 2020

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November 2020 · Vol. 51, No. 11 651 ■ T E C H N I Q U E ■ Use of a Modified Plastic Viewing System for Safer General Anesthesia Care in Pediatric Ophthalmic Surgery During the COVID-19 Pandemic Noy Ashkenazy, MD; Giuliana Orihuela, MD; Luis Ignacio Rodriguez, MD; Catherin Isabel Negron, MBA; J. William Harbour, MD; Audina M. Berrocal, MD ABSTRACT: Certain pediatric ophthalmology pro- cedures require time-sensitive surgical care to pre- vent long-term morbidity and mortality. In the era of the COVID-19 pandemic, it has become increas- ingly important for anesthesia and surgical care providers to protect themselves during medically necessary procedures requiring general anesthesia care. In this study, an intubating viewing system with plexiglass shield and drape was designed. The viewing system allowed effective and safe in- tubation of pediatric patients for ophthalmological surgery while minimizing the risk of disseminating aerosolized droplets. The authors concluded that this viewing system and modified intubation tech- nique may reduce the risk of transmitting SARS- CoV-2 and other highly transmissible pathogens to operating room personnel. The continued study of measures to protect operating room personnel is encouraged to provide more evidence-based rec- ommendations. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:651-652.] INTRODUCTION Urgent and emergent ophthalmological care con- tinues to be performed during the COVID-19 pan- demic era. 1 Pediatric eye surgery typically requires general anesthesia, even for rapid procedures. 2 Health care workers are at high risk for SARS-CoV-2 infection, especially when performing potentially droplet- and aerosol-generating procedures, such as intubation. 3 Asymptomatic or pre-symptomatic COVID-19 infection occurs in 5% to 80% of cases, and testing may be falsely negative up to 30% of the time. 4,5 We herein describe a technique that the sur- gical care team may utilize in order to reduce po- tential exposure to contaminated secretions during pediatric procedures requiring general anesthesia. TECHNIQUE We routinely perform preoperative rapid test- ing for COVID-19 at our institution. 5 All persons in our operating rooms wear a fitted N95 respirator, covered by a surgical mask. Anesthesia providers wear a face shield, gown, hair cover, and double gloves. We transformed a section of our surgical wing into a negative pressure space. 6 We fashioned an intubating shield design (Figure 1) with a clear acrylic viewing panel (Reverso Pumps, Davie, FL) for protection when intubating pediatric ophthal- mology patients. Steps for its use are outlined below. Steps 1 through 8 are also illustrated in a video (available at www.healio.com/OSLIRetina). From the Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida (NA, CIN, JWH, AMB); the Department of Anesthesiology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, Florida (GO, LIR); and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida (JWH). Originally submitted May 1, 2020. Revision received May 1, 2020. Accepted for publication August 20, 2020. Supported in part by the NIH Center Core Grant P30EY014801, Research to Prevent Blindness Unrestricted Grant. The authors report no relevant financial disclosures. Address correspondence to Audina M. Berrocal, MD, Bascom Palmer Eye Institute, 900 N.W. 17th Street, Miami, FL 33136; email: aberrocal@med.miami. edu. doi: 10.3928/23258160-20201104-08

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