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LETTERS TO EDITOR
Year : 2020  |  Volume : 64  |  Issue : 1  |  Page : 72-73  

Cough projectile during emergence


Department of Anesthesiology, Wayne State University/Detroit Medical Center, Detroit, Michigan, United States

Date of Submission03-Apr-2019
Date of Decision23-Aug-2019
Date of Acceptance10-Nov-2019
Date of Web Publication7-Jan-2020

Correspondence Address:
Dr. Deepak Gupta
Department of Anesthesiology, Wayne State University/Detroit Medical Center, Box No 162, 3990 John R, Detroit, MI 48201
United States
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ija.IJA_257_19

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How to cite this article:
Gupta D. Cough projectile during emergence. Indian J Anaesth 2020;64:72-3

How to cite this URL:
Gupta D. Cough projectile during emergence. Indian J Anaesth [serial online] 2020 [cited 2020 Jan 27];64:72-3. Available from: http://www.ijaweb.org/text.asp?2020/64/1/72/275212



Cough projectile during emergence from anaesthesia is an occupational hazard spilling patient's secretions into operating room personnel's airspace. The narrow tubular conduit provided by the endotracheal tube causes cough projectile to travel large distance secondary to larger fluid velocity generated across a smaller cross-sectional area of the endotracheal tube. Usually, this distance travelled by patients' secretions lies enclosed within anaesthesia circuit. However, the anaesthesia circuit is sometimes transiently detached to avoid inadvertent premature extubation secondary to stretched circuit pulling out endotracheal tube during intubated patient's transfer from operating table to patient stretcher. The endotracheal tube should remain connected to right angle connector and in-line filter to contain cough projectile [Figure 1]a. Unless the anaesthesia team is pre-emptively using closed in-line suction catheter system, the operating room environment can get exposed to cough projectile during suctioning through an open endotracheal tube. An emergent suction catheter system can be created by simple replacement of right-angle connector with fibre-optic bronchoscopy swivel adapter to allow closed suctioning through an endotracheal tube with in-line filter containing cough projectile [Figure 1]b. Fibre-optic bronchoscopy swivel adapter can contain cough projectile during rarely performed inadvisable instillation of normal saline prior to endotracheal suctioning.[1] When secretions are expected to be voluminous enough to overwhelm in-line filter thereby leading to endotracheal spill-back,[2] in-line filter and anaesthesia circuit can be replaced during brief lavage and suction procedure with an anaesthesia circuit extension tubing [Figure 1]c and [Figure 1]d. The extension tubing allows spontaneous breathing among adults while containing cough projectile in its circular and corrugated boundaries or diverting it towards operating room ground.
Figure 1: Schematic diagram with manikin demonstrating how to contain cough projectile during emergence: By keeping endotracheal tube connected to right angle connector and in-line filter indicated by hollow arrowhead (a) or by connecting it to fibre-optic bronchoscopy swivel adapter accommodating either suction catheter (b) or alavage-syringe for normal saline instillation (c) while anaesthesia acircuit extension tubing catching copious cough secretions during suctioning (d) or diverting them to operation room ground

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Financial support and sponsorship

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Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Leddy R, Wilkinson JM. Endotracheal suctioning practices of nurses and respiratory therapists: How well do they align with clinical practice guidelines? Can J Respir Ther 2015;51:60-4.  Back to cited text no. 1
    
2.
Lawes EG. Hidden hazards and dangers associated with the use of HME/filters in breathing circuits. Their effect on toxic metabolite production, pulse oximetry and airway resistance. Br J Anaesth 2003;91:249-64.  Back to cited text no. 2
    


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