Microlaryngoscopy, Bronchoscopy + Supraglottoplasty in COVID-19 Era

This video demonstrates microlaryngoscopy, bronchoscopy (MLB) + supraglottoplasty in a three-month old male with laryngomalacia, with a special focus on appropriate personal protection equipment (PPE) and safe surgical considerations in the setting of a COVID-19 status unknown patient.

The COVID-19 pandemic presents unique challenges for the Otolaryngologist given intervention is in areas of high viral loads thus exposure places the surgeons at greater risk of severe infection.  There have been reports of deaths of healthcare professionals  in several countries where the risk of transmission of SARS-CoV-2 during aerosol generating procedures (AGP) was possibly underappreciated.  Therefore appropriate PPE and altered techniques are paramount in reducing the risk of serious morbidity and mortality.
We present and demonstrate a common paediatric airway procedure for a patient with laryngomalacia of COVID-19-unknown status.  This video outlines the appropriate PPE attire and intra-operative approach according to recent North American and UK guidelines to provide a practical guide to protect the surgeon and theatre staff from potential infection during an AGP in the operating theatre.1-3  MLB and supraglottoplasty is one such procedure that places all healthcare workers and the patient at risk of infection. We demonstrate an approach to the COVID-unknown patient ensuring safety for all involved without compromising patient care.
In the setting of COVID-unknown patient care, optimal PPE and surgical approach is crucial to minimise the risk of transmission of disease.  It will be impossible to delay all surgery in patients not only of unknown COVID-19 status but also those who are COVID-19 positive. Knowledge of how to safely do so is of the upmost importance.
The authors report no conflicts of interest or disclosures and there was no funding received for this work.
1. Surgery AAoO-HaN. Coronavirus Disease 2019: Resources. https://www.entnet.org/content/coronavirus-disease-2019-resources. Published 2020. Updated 31/3/20. Accessed 31st March, 2020. 2. Surgery ASoOHaN. Further guidance for ENT surgeons during the COVID-19 pandemic. http://www.asohns.org.au/about-us/news-and-announcements/latest-news?article=80. Published 2020. Updated 22/2/20. Accessed 31st March, 2020. 3. Yaneza M. ENT UK Guidelines for changes in ENT during COVID-19 Pandemic. https://www.entuk.org/entuk-guidelines-changes-ent-during-covid-19-pandemic. Published 2020. Updated 20/3/20. Accessed 31st March, 2020.

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