Airway management considerations for upper gastrointestinal endoscopic procedures in COVID-19 era

We read with interest the paper by Lauro and colleagues highlighting the emergency endoscopy experience during the SARS-CoV-2 pandemic in the north of Italy [1]. Aerosol and droplet generation during upper gastrointestinal endoscopies is attributed to scope insertion into the pharynx, instrument manipulation through the endoscope channel and positive gas insufation, that is often required to facilitate esophageal intubation with the endoscope. [2, 3]. Aerosol and droplet generation can be further augmented by airway manipulations and lighter planes of anesthesia resulting in patients bucking or coughing. The exposure to infection for anesthetists and endoscopists is high due to their proximity to the airway [4]. We outline airway management principles for endoscopy in known/suspected as well as unsuspected COVID-19 patients, based on existing guidelines and our practice adaptations.