I have read with interest the paper by Lee‐Archer Pand von Ungern‐Sternberg BS in Pediatric Anesthesia entitled “Pediatric anesthetic implications of COVID‐19—A review of current literature”1 and would like to thank the authors for the effort of timely publishing a basis upon which other pediatric anesthesia colleagues may get support. In their paper, after reviewing the literature, the authors summarize the current knowledge on the topic and suggest an anesthesia management pathway in COVID‐19 children, which will be useful to many.
However, the purpose of my letter is to draw the attention of pediatric anesthesiologists upon the protection measures we should use during airway management of non‐COVID‐19 children during the following months or, who knows, perhaps from now on. Protection against blood‐borne infections is generalized in the OR settings, but universal respiratory protection is just starting to be in debate in adult literature2. Although identifying positive cases should be the goal to prevent infection transmission, we have learned from COVID‐19 that this may be challenging. Most children experience less severe symptoms of COVID‐19 than adults, and some might even be completely asymptomatic3. Therefore, epidemiological questionnaires might sometimes be not clarifying since the clinical features (respiratory or gastrointestinal symptoms) are quite nonspecific. Laboratory testing such as SARS‐CoV2 PCR tests, although highly recommended, is not widely available or may even be sometimes difficult to carry out effectively in young or noncooperative children.
The future course of COVID‐19 is unknown, but the world is moving on and surgeries need to be carried out. Therefore, pediatric anesthesiologists will continue to be exposed to unknown cases of airborne transmitted diseases, such as COVID‐19 now or maybe others in future. In addition to always paying extremely careful attention to intubation and extubation periods, it is maybe time to reinforce other common pediatric measures too. Possible areas of improvement are using any or several of the anxiolytic pediatric measures to avoid as often as possible a crying child during induction and implementing a more widespread use of videolaryngoscopes. Finally, it is maybe the time to always wear a N95 mask in the OR and maybe googles while intubating/extubating “supposedly non‐COVID 19” children.