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 Table of Contents  
Year : 2022  |  Volume : 9  |  Issue : 4  |  Page : 375-376

COVID-19 era: rethinking the approach to delivering airway training

1 Department of Trauma and Emergency, All India Institute of Medical Sciences, Patna, India
2 Department of Anaesthesiology, All India Institute of Medical Sciences, Patna, India

Date of Submission28-Aug-2021
Date of Decision30-Oct-2021
Date of Acceptance08-Dec-2021
Date of Web Publication29-Dec-2022

Correspondence Address:
MD Amarjeet Kumar
Department of Trauma and Emergency, Room No. 505, B-Block, OT Complex, All India Institute of Medical Sciences, Patna 801507, Bihar
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/roaic.roaic_58_21

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How to cite this article:
Kumar A, Sinha C, Singh K, Sagdeo GD. COVID-19 era: rethinking the approach to delivering airway training. Res Opin Anesth Intensive Care 2022;9:375-6

How to cite this URL:
Kumar A, Sinha C, Singh K, Sagdeo GD. COVID-19 era: rethinking the approach to delivering airway training. Res Opin Anesth Intensive Care [serial online] 2022 [cited 2023 Mar 26];9:375-6. Available from: http://www.roaic.eg.net/text.asp?2022/9/4/375/365796

Contributions: Dr. Amarjeet Kumar helped in conceptualization and write-up. Dr. Chandni Sinha helped in conceptualization and write-up. Dr. Kunal Singh helped in draft and revision. Dr. Gayatri D Sagdeo helped in data collection and data analysis

To the Editor

During COVID-19 era, many teaching hospitals are getting converted to dedicated COVID hospitals. This would mean admission of only COVID-proven/suspect patients with suspension of elective surgeries, preanesthetic clinics, chronic pain, and palliative clinics.

Newly joined anesthesia residents were redeployed to Intensive Care Units, this resulted in drastic reduction in opportunities for hands-on training of airway management in the operating room [1]. Several other factors (airway management by senior and experienced anesthesiologist as per several guidelines, cancelation of elective operations, preference of regional anesthesia over general anesthesia in view to avoid aerosol-generating procedures, use of personal protective equipment, which hampers proper communication between trainer and trainee, and widespread cancelation of airway-training courses, conferences, and workshops) are also responsible for decreased opportunities for learning airway training of anesthesia residents [1],[2],[3].

Therefore, this indirect impact of COVID-19 pandemic on medical education of the anesthesia residents cannot be ignored. Traditional methods of delivering hands-on training of airway management for anesthesia residents include out-of-theater airway workshops, with four stations (one station covering each of plans A, B, and D of the 2015 Difficult Airway Society guidelines) [4] and airway-simulation training sessions are now subject to COVID-19 infection prevention and control measures. The strategies to optimize airway training in the operating room include increased use of videolaryngoscopes to identify the relevant structures, allow the trainee to intubate the patient with minimal assistance, increase first-pass intubation success, reduce failures, increase the distance between the intubator and the patient’s airway, and to improve patient and intubating team safety [5]. Other COVID-19 adjustments to conduct workshops in COVID-19 era include use of empty operating theater (due to cancelation of elective surgeries in the COVID-19 pandemic) to improve ventilation, limiting group sizes, use of personal protective equipment, and cleaning training materials between teaching sessions, using an online booking system, rotating groups in a one-way manner, and using digital mode of registration, feedback, handouts, and certificate distribution to prevent infection [5]. For locally delivered out-of-theater training, we suggest flipped-classroom learning before attending workshops in person to reduce face-to-face training time, training for awake tracheal intubation by using bronchoscopy simulator, and use of video platforms for simulation-training session through remote link from distant safe sites. Hybrid workshops with centrally delivered lectures and demonstrations that were delivered by videoconferencing, followed by skill stations in hospitals, maximized the number of delegates while avoiding the risk of magnified COVID-19 transmission caused by multiple attendees from different hospitals. Encourage use of social-media platforms in rapid dissemination of newly published papers, protocols, and guidelines, and enable sharing of experiences, ideas, and learning among clinicians around the world. Although all these modalities appear impressive, implementing all this requires time, patience, adequate resources, and planning. It is time that the institutions and government make strategies at the local level to delivering airway training for anesthetic trainees, in view of any future pandemics.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Cook TM, McGuire B, Mushambi M, Misra U, Carey C, Lucas N et al. Airway management guidance for the endemic phase of COVID-19. Anaesthesia 2020; 76:251e60.  Back to cited text no. 1
Sneyd JR, Mathoulin SE, O’Sullivan EP, So VC, Roberts FR, Paul AA et al. Impact of the COVID-19 pandemic on anaesthesia trainees and their training. Br J Anaesth 2020; 125:450e5.  Back to cited text no. 2
Uppal V, Sondekoppam RV, Landau R, El-Boghdadly K, Narouze S, Kalagara HKP. Neuraxial anaesthesia and peripheral nerve blocks during the COVID-19 pandemic: a literature review and practice recommendations. Anaesthesia 2020; 75:1350e63.  Back to cited text no. 3
Frerk C, Mitchell VS, McNarry AF, Mendonca C, Bhagrath R, Patel A et al. Difficult Airway Society 2015 guidelines for management of unanticipated difficult intubation in adults. Br J Anaesth 2015; 115:827e48.  Back to cited text no. 4
Hickman J, McNarry AF, Kelly FE. Practical strategies for delivering airway training in the COVID-19 era. Br J Anaesth 2021; 127:188–191.  Back to cited text no. 5


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