{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T15:19:46Z","timestamp":1791040786823,"version":"4.1.0"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,1,29]],"date-time":"2023-01-29T00:00:00Z","timestamp":1674950400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["associationofanaesthetists-publications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Anaesthesia"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    Aerosol\u2010generating procedures are medical interventions considered high risk for transmission of airborne pathogens. Tracheal intubation of anaesthetised patients is not high risk for aerosol generation; however, patients often perform respiratory manoeuvres during awake tracheal intubation which may generate aerosol. To assess the risk, we undertook aerosol monitoring during a series of awake tracheal intubations and nasendoscopies in healthy participants. Sampling was undertaken within an ultraclean operating theatre. Procedures were performed and received by 12 anaesthetic trainees. The upper airway was topically anaesthetised with lidocaine and participants were not sedated. An optical particle sizer continuously sampled aerosol. Passage of the bronchoscope through the vocal cords generated similar peak median (IQR [range]) aerosol concentrations to coughing, 1020 (645\u20131245 [120\u201348,948]) vs. 1460 (390\u20132506 [40\u201312,280]) particles.l\n                    <jats:sup>-1<\/jats:sup>\n                    respectively, p\u00a0=\u00a00.266. Coughs evoked when lidocaine was sprayed on the vocal cords generated 91,700 (41,907\u2013166,774 [390\u2013557,817]) particles.l\n                    <jats:sup>-1<\/jats:sup>\n                    which was significantly greater than volitional coughs\u00a0(p\u2009&lt;\u20090.001). For 38 nasendoscopies in 12 participants, the aerosol concentrations were relatively low, 180 (120\u2013525 [0\u20139552]) particles.l\n                    <jats:sup>-1<\/jats:sup>\n                    , however, five nasendoscopies generated peak aerosol concentrations greater than a volitional cough. Awake tracheal intubation and nasendoscopy can generate high concentrations of respiratory aerosol. Specific risks are associated with lidocaine spray of the larynx, instrumentation of the vocal cords, procedural coughing and deep breaths. Given the proximity of practitioners to patient\u2010generated aerosol, airborne infection control precautions are appropriate when undertaking awake upper airway endoscopy (including awake tracheal intubation, nasendoscopy and bronchoscopy) if respirable pathogens cannot be confidently excluded.\n                  <\/jats:p>","DOI":"10.1111\/anae.15968","type":"journal-article","created":{"date-parts":[[2023,1,30]],"date-time":"2023-01-30T00:00:25Z","timestamp":1675036825000},"page":"587-597","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A quantitative evaluation of aerosol generation during awake tracheal intubation"],"prefix":"10.1111","volume":"78","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6790-909X","authenticated-orcid":false,"given":"A. J.","family":"Shrimpton","sequence":"first","affiliation":[{"name":"Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and Neuroscience University of Bristol  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G.","family":"O'Farrell","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia University Hospitals Bristol and Weston Foundation Trust  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H. M.","family":"Howes","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia University Hospitals Bristol and Weston Foundation Trust  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R.","family":"Craven","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia University Hospitals Bristol and Weston Foundation Trust  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. R.","family":"Duffen","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia University Hospitals Bristol and Weston Foundation Trust  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3654-497X","authenticated-orcid":false,"given":"T. M.","family":"Cook","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine Royal United Hospital NHS Trust  Bath UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6022-1778","authenticated-orcid":false,"given":"J. P.","family":"Reid","sequence":"additional","affiliation":[{"name":"School of Chemistry University of Bristol  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. M.","family":"Brown","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia and Intensive Care Medicine North Bristol NHS Trust  Bristol UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0345-0456","authenticated-orcid":false,"given":"A. E.","family":"Pickering","sequence":"additional","affiliation":[{"name":"Department of Anaesthesia University Hospitals Bristol and Weston Foundation Trust  Bristol UK"},{"name":"Anaesthesia, Pain and Critical Care Sciences, School of Physiology, Pharmacology and Neuroscience University of Bristol  UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"the Bristol Awake Fibre\u2010Optic Intubation Collective","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,1,29]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab691"},{"key":"e_1_2_6_3_1","doi-asserted-by":"crossref","DOI":"10.1136\/bmj-2021-068743","article-title":"Long distance airborne transmission of SARS\u2010CoV\u20102: rapid systematic review","volume":"377","author":"Duval D","year":"2022","journal-title":"British Medical Journal"},{"key":"e_1_2_6_4_1","unstructured":"World Health Organization.WHO Infection prevention and control of epidemic\u2010 and pandemic\u2010prone acute respiratory infections in health care.2014.https:\/\/www.who.int\/publications\/i\/item\/infection\u2010prevention\u2010and\u2010control\u2010of\u2010epidemic\u2010and\u2010pandemic\u2010prone\u2010acute\u2010respiratory\u2010infections\u2010in\u2010health\u2010care(accessed 08\/12\/2022)."},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0035797"},{"key":"e_1_2_6_6_1","unstructured":"Centers for Disease Control and Prevention. 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