Endoscopic Endotracheal Intubation for ERCP In
the Era of COVID: An Approach To Minimize Risk of
Transmission of Infectious Diseases

Carlos de la Paz Estrada

Research Article

Endoscopic Endotracheal Intubation for ERCP In the Era of COVID: An Approach To Minimize Risk of Transmission of Infectious Diseases

Timothy Angelotti¹*, Monique T Barakat², Samer El Dika³ and Subhas Banerjee⁴

¹Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, CA 94305, United States

²Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, United States

³Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, United States

⁴Division of Gastroenterology and Hepatology, Stanford University School of Medicine, Stanford, CA 94305, United States

Corresponding Author

Received Date: September 26, 2023; Published Date:October 10, 2023

Abstract

Background and Aims: The close proximity between anesthesiologist and patient during endotracheal intubation are of major concern for potential infectious disease transmission. Development of intubation techniques with lower risks of infection transmission have led to a best practice recommendation of video laryngoscopy to minimize this distance. With ongoing infectious disease outbreaks, alternative intubation approaches to minimize risk of infection transmission still need to be established. Endoscopic intubation has not been widely considered, due to multiple concerns. However, it may be uniquely well-suited for patients undergoing endoscopic retrograde cholangiopancreatography (ERCP), due to the specific positioning and other requirements of the procedure.

Methods: We have previously studied the use of endoscopic rescue/elective asleep intubation in the semi-prone position during ERCP to enhance patient safety. We now report a series of patients who underwent ERCP following endoscopic intubation during our region’s initial COVID outbreak and highlight the features of this approach to reduce infectious disease transmission risk.

Results: We found endoscopic intubation to be quick (<1 minute) with minimal alterations to patients’ oxygen saturation or other vital signs. Endoscopic intubation maintained a minimum distance of four feet between the patient and anesthesiologist/endoscopist, with the patient oropharynx pointed down and away from both providers.

Conclusion: In this initial report and our prior studies, we have demonstrated the safety and efficiency of endoscopic intubation for ERCP. Therefore, we suggest that endoscopic intubation should be considered for lower risk, yet efficient, endotracheal intubation in the era of COVID and other infectious diseases.

Keywords:Endoscopic Retrograde Cholangiopancreatography (ERCP); Endotracheal Intubation; Monitored Anesthesia Care; General Anesthesia; COVID-19; Endoscopy; Fiberoptic Bronchoscopy

Abbreviations:ASA: American Society of Anesthesiologists; BMI: Body Mass Index; ERCP: Endoscopic Retrograde Cholangiopancreatography; ETT: Endotracheal Tube; MAC: Monitored Anesthesia Care

Article Details

Citation

Timothy Angelotti*, Monique T Barakat, Samer El Dika and Subhas Banerjee. Endoscopic Endotracheal Intubation for ERCP In the Era of COVID: An Approach To Minimize Risk of Transmission of Infectious Diseases. Anaest & Sur Open Access J. 4(3): 2023. ASOAJ.MS.ID.000588.