Certain respirators used by anesthetists linked to increased airway complication risk

In a new study, use of filtering facepiece class 2 or 3 respirators was associated with an increased risk for airway complications, but most aerosol precautions during COVID-19 were not linked with the same risk.

Tom Potter, MD, from the department of anesthesia and perioperative medicine at Guy’s and St Thomas’ NHS Foundation Trust, London, and colleagues conducted a prospective cohort study that included 5,905 patients who were undergoing general anesthesia for elective or emergency procedures during a 96-hour period at 70 hospitals. Researchers collected data on use of aerosol precautions by the airway practitioner, airway complications and potential confounding variables.

The overall airway complication rate was 10%; 9% of complications occurred on induction and 1.2% on emergence.

Use of filtering facepiece class 2 or 3 respirators was associated with an increased risk for airway complications (OR = 1.38; 95% CI, 1.04-1.83) after adjusting for patient BMI, SARS-CoV-2 status, surgical urgency and grade of first person to intubate the trachea. This increased risk was mainly due to associations with difficult facemask ventilation (OR = 1.68; 95% CI, 1.09-2.61) and desaturation on pulse oximetry (OR = 2.39; 95% CI, 1.26-4.54).

Researchers reported no association with change in risk for airway complications with the use of goggles, powered air-purifying respirators, long-sleeved gowns, double gloves and video laryngoscopy.

According to the researchers, limitations of this study include its observational study, insufficient granularity to detect the sequence of events and reliance upon anesthetists to report airway complications, which may have resulted in inaccurate reporting.

“In conclusion, in our study of anesthetic airway management in the context of use of aerosol precaution PPE, minor airway complications were common and no major airway complications were observed. The use of [filtering facepiece class 2 or 3 respirators] was associated with a small but significantly increased risk of airway complications, and no other components of the aerosol precaution bundle were plausibly associated with airway complications,” the researchers wrote. “These findings should serve as reassurance that anesthetists have continued to deliver safe care for patients requiring general anesthesia, even in the wake of significant changes to airway management. Further research will be needed to establish any causality between the use of filtering facepiece class 2 or filtering facepiece class 3 respirators and airway complications.”