Surgical InfectionsVol. 21, No. 4 Letter to the EditorFree AccessResponse to Wen and Li, Anesthesia Procedure of Emergency Operation for Patients with Suspected or Confirmed COVID-19 (DOI: 10.1089/sur.2020.040)Alexander TrujilloAlexander TrujilloAddress correspondence to: Dr. Alexander Trujillo, Department of Surgery, Faculty of Health Sciences, Caldas University, Manizales, Caldas, Colombia E-mail Address: [email protected]Department of Surgery, Faculty of Health Sciences, Caldas University, Manizales, Caldas, Colombia; Faculty of Health Sciences, Medicine Program, Universidad de Manizales, Manizales, Colombia; Anesthesia Department, Clínica San Marcel, Manizales, Colombia.Search for more papers by this authorPublished Online:30 Apr 2020https://doi.org/10.1089/sur.2020.088AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail To the Editor:I read carefully Dr. Yiqun Li's letter to the editor [1]. It mentions very important measures to reduce the risk to healthcare personnel during anesthetic management of patients with suspected or confirmed COVID-19. These include strategies aimed at avoiding cough during intubation due to the risk of spreading the virus through respiratory drops and aerosols. However, there is no mention of the extubation process that also produces cough and risk for caregivers. To date, hundreds of doctors and nurses worldwide have been infected with COVID-19, some of them with fatal consequences. It is important that anesthesiology services implement “cough-free extubation” protocols in order to decrease the production of aerosols and respiratory drops. For this purpose, there are some useful strategies such as extubation with the deep patient in spontaneous ventilation and the use of some medications such as lidocaine [2], dexmedetomidine [3], remifentanil [4], and fentanyl [5] just before extubation. Furthermore, it is desirable to have the orotracheal tube clamped before being removed from the patient. These strategies can be useful in reducing the risk of contagion to healthcare professionals and should be adopted in extubation protocols in patients with suspected or confirmed COVID-19. Bread is burned at the oven door.References1. Wen X, Li Y. Anesthesia procedure of emergency operation for patients with suspected or confirmed COVID-19. Surg Infect 2020;21:299. Link, Google Scholar2. Aminnejad R, Salimi A, Saeidi M. Lidocaine during intubation and extubation in patients with coronavirus disease ( COVID-19 ). Can J Anesth Can d'anesthésie [Internet]. 2020;12630. Available from: https://doi.org/10.1007/s12630-020-01627-2. (last accessed March 27, 2020). Google Scholar3. Aouad MT, Zeeni C, Nawwar R Al, et al. Dexmedetomidine for improved quality of emergence from general anesthesia: A dose-finding study. Anesth Analg 2017;129:1504–1511. Crossref, Google Scholar4. Lee SY, Yoo JY, Kim JY, et al. Optimal effect-site concentration of remifentanil for preventing cough during removal of the double-lumen endotracheal tube from sevoflurane-remifentanil anesthesia. Medicine 2016;95:e3878. Crossref, Medline, Google Scholar5. Yoo Y, Na S, Jeong J, et al. Dose-dependent attenuation by fentanyl on cough during emergence from general anesthesia. Acta Anaesthesiol Scand 2011;55:1215–1220. Crossref, Medline, Google ScholarFiguresReferencesRelatedDetailsCited byElective, Non-urgent Procedures and Aesthetic Surgery in the Wake of SARS–COVID-19: Considerations Regarding Safety, Feasibility and Impact on Clinical Management14 May 2020 | Aesthetic Plastic Surgery, Vol. 44, No. 3Contributions of Latin American researchers in the understanding of the novel coronavirus outbreak: a literature review4 June 2020 | PeerJ, Vol. 8 Volume 21Issue 4May 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Alexander Trujillo.Response to Wen and Li, Anesthesia Procedure of Emergency Operation for Patients with Suspected or Confirmed COVID-19 (DOI: 10.1089/sur.2020.040).Surgical Infections.May 2020.398-398.http://doi.org/10.1089/sur.2020.088Published in Volume: 21 Issue 4: April 30, 2020Online Ahead of Print:March 30, 2020 PDF download