Applying Relaxants for Tracheal Intubation in Covid-19 Patients: Discussion about Some Concerns

Patients with severe respiratory distress due to Covid-19 may require endotracheal intubation due to severe hypoxemia. To facilitate intubation and minimize the risk of staff contamination, most guidelines recommend rapid sequence intubation using hypnotics, narcotics, and muscle relaxants. The use of muscle relaxants may be associated with risks for some patients with Covid-19: Stressful environment, inexperienced nurses in newly established wards, cumbersome clothing, premature respiratory fatigue due to mask wearing, Also, the limited vision due to the formation of fog on the glasses and the surface of the face shield during laryngoscopy can make intubation difficult and time consuming. These factors, along with severe lung involvement and hypoxemia, and underlying cardiovascular diseases may exacerbate hypoxemia and expose the patient to hypoxic brain damage or cardiac arrest. Therefore, in Covid-19 patients, endotracheal intubation with full personal protective equipment and the use of hypnotics and narcotics to inhibit airway reflexes while maintaining the patientchr('39')s spontaneous respiration (deep sedation) seems to be a safer method. Otherwise, as a secondary solution, intubation is suggested by the most experienced person.