key: cord-268135-77emtyen
authors: Moghadam, Vahid Damanpak; Shafiee, Hamed; Ghorbani, Maryam; Heidarifar, Reza
title: Letter to the Editor: Additional Recommendations before Intubation of COVID-19 Patients
date: 2020-06-30
journal: Chinese Medical Sciences Journal
DOI: 10.24920/003744
sha: 
doc_id: 268135
cord_uid: 77emtyen

nan

with SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2). For instance, in a review article published by Jiang et al., respiratory symptoms including cough and dyspnea, are the common initial findings in such patients after fever. [1] This Very contagious disease involves lower respiratory system and can lead to coronavirus pneumonia and rapidly progressive acute respiratory distress syndrome (ARDS), [2] and if the respiratory failure occurs, patients need intubation and protective mechanical ventilation. [3] We really appreciate Zuo patients infected with COVID-19 vlrus.'" But according to our observations and available evidence, we want to add some recommendations to valuable information of this article. Based on recommendation of this article, anesthesiologists can use injection of lidocaine through the working throat channels before intubation and lidocaine spray as a topical anesthesia in awake patients, but as we know, this type of administrating lidocaine can cause further irritation of airway and tracheal spasm. In addition, spraying lidocaine produces more aerosols and as a general result, chance of infecting medical staff increases.

Therefore, as a resolve of this problem and preventing cough in patients infected with COVID-19, we propose injecting intravenous lidocaine or dexmedetomidine before administrating tracheal intubation. The systematic review and meta-analysis articles published by Clivio et al. and Tung et al. confirmed our statement, because they declared that intravenous lidocaine dose dependently prevents intubation, extubation, and opioid-induced cough in adults, and the suggested dose by the authors for achieving this goal was 0.5-2.0 mgjkg lntravenously.P' In addition, dexmedetomidine is regarded as the most effective drug to prevent coughing. [6] 2) Not applying pulse oximeter probe on cold limbs.

3) Applying pulse oximeter probe on auricle can provide the most accuracy.

None.

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World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19)

StatPearls Publishing

Expert recommendations for tracheal intubation in critically ill patients with noval coronavirus disease 2019

Intravenous lidocaine for the prevention of cough: systematic review and meta-analysis of randomized controlled trials

Medications to reduce emergence coughing after general anaesthesia with tracheal intubation: a systematic review and network meta-analysis