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Droplet and Aerosol Generation With Endonasal Surgery: Methods to Mitigate Risk During the COVID-19 Pandemic.
Dharmarajan, Harish; Freiser, Monika E; Sim, Edward; Boorgu, Devi Sai Sri Kavya; Corcoran, Timothy E; Wang, Eric W; Gardner, Paul A; Snyderman, Carl H.
  • Dharmarajan H; Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Freiser ME; Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Sim E; University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
  • Boorgu DSSK; University of Pittsburgh School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
  • Corcoran TE; Division of Pulmonary, Allergy and Critical Care Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
  • Wang EW; Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Gardner PA; Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
  • Snyderman CH; Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Otolaryngol Head Neck Surg ; 164(2): 285-293, 2021 02.
Article in English | MEDLINE | ID: covidwho-1140419
ABSTRACT

OBJECTIVE:

To define the aerosol and droplet risks associated with endonasal drilling and to identify mitigation strategies. STUDY

DESIGN:

Simulation series with fluorescent 3-dimensional (3D) printed sinonasal models and deidentified cadaveric heads. SETTINGS Dedicated surgical laboratory. SUBJECTS AND

METHODS:

Cadaveric specimens irrigated with fluorescent tracer and fluorescent 3D-printed models were drilled. A cascade impactor was used to collect aerosols and small droplets of various aerodynamic diameters under 15 µm. Large droplet generation was measured by evaluating the field for fluorescent debris. Aerosol plumes through the nares were generated via nebulizer, and mitigation measures, including suction and SPIWay devices, nasal sheaths, were evaluated regarding reduction of aerosol escape from the nose.

RESULTS:

The drilling of cadaveric specimens without flexible suction generated aerosols ≤3.30 µm, and drilling of 3D sinonasal models consistently produced aerosols ≤14.1 µm. Mitigation with SPIWay or diameter-restricted SPIWay produced same results. There was minimal field contamination in the cadaveric models, 0% to 2.77% field tarp area, regardless of drill burr type or drilling location; cutting burr drilling without suction in the 3D model yielded the worst contamination field (36.1%), followed by coarse diamond drilling without suction (19.4%). The simple placement of a flexible suction instrument in the nasal cavity or nasopharynx led to complete elimination of all aerosols ≤14.1 µm, as evaluated by a cascade impactor positioned immediately at the nares.

CONCLUSION:

Given the findings regarding aerosol risk reduction, we strongly recommend that physicians use a suction instrument in the nasal cavity or nasopharynx during endonasal surgery in the COVID-19 era.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Infectious Disease Transmission, Patient-to-Professional / Aerosols / Natural Orifice Endoscopic Surgery / Nasal Surgical Procedures / COVID-19 Type of study: Experimental Studies / Prognostic study Limits: Humans Language: English Journal: Otolaryngol Head Neck Surg Journal subject: Otolaryngology Year: 2021 Document Type: Article Affiliation country: 0194599820949802

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Infectious Disease Transmission, Patient-to-Professional / Aerosols / Natural Orifice Endoscopic Surgery / Nasal Surgical Procedures / COVID-19 Type of study: Experimental Studies / Prognostic study Limits: Humans Language: English Journal: Otolaryngol Head Neck Surg Journal subject: Otolaryngology Year: 2021 Document Type: Article Affiliation country: 0194599820949802