Surgical Considerations for an Awake Tracheotomy During the COVID-19 Pandemic

The current global COVID-19 pandemic is caused by the novel coronavirus Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2). Given that SARS-CoV-2 is highly transmissible, surgical societies have recommended that procedures with a high risk of aerosolization be avoided or delayed. However, some high-risk procedures, such as those related to head and neck malignancies, cannot always be delayed. Care must be taken during aerosol-generating procedures to minimize viral transmission as much as possible. Preoperative testing for COVID-19, limited operating room personnel, adequate personal protective equipment, and surgical technique are factors to consider for high-risk procedures. This article presents the case of an awake tracheotomy performed for a transglottic mass causing airway obstruction. With detailed planning and specific techniques, the amount of aerosolization was reduced, and the procedure was performed as safely as possible. This case provides a template for future aerosol-generating procedures during respiratory pandemics.