Reducing fire and burn risk in the operating room-testing of a novel device.

BACKGROUND: Burn injury and operating room fires are significant risks for both surgical patients and staff. The purpose of this study was to examine the fire and burn risks associated with two types of fiberoptic light cables and evaluate the efficacy of a novel device in reducing the risk of these fire and burn injuries. METHODS: A 300-W light source was connected sequentially to two standard fiberoptic cables (Storz and Olympus). The distal ends were buried in, or rested on, standard operating room materials including a cotton green towel and a blue propylene drape to assess the risk of fire formation or burn injury. The Gloshield device was then attached to the ends of the cables and the experiment was repeated. Trials simulating improper use of the device were then conducted with the Gloshield device placed either too deep or too shallow on the end of the light cable. All trials were conducted for a maximum of 10 min or until a positive result (burn or fire) was achieved. Trials were conducted in room air or with supplemental 100% oxygen and repeated for accuracy. RESULTS: Both the Storz and Olympus fiber optic cables were capable of producing burns in standard operating room towels and drapes in control trials. The Gloshield device prevented thermal injury when properly attached in all conditions. Improper use trials demonstrated that the device may be ineffective when not applied properly. CONCLUSIONS: The Gloshield device is effective in reducing the risk of thermal burn injury by protecting the distal ends of endoscopic light cables from operating room materials. However, the device needs to be attached appropriately in order to provide protective benefits.

Povidone-iodine solution as SARS-CoV-2 prophylaxis for procedures of the upper aerodigestive tract a theoretical framework.

BACKGROUND: The COVID-19 pandemic has raised concerns of inadvertent SARS-CoV-2 transmission to healthcare workers during routine procedures of the aerodigestive tract in asymptomatic COVID-19 patients. Current efforts to mitigate this risk focus on Personal Protective Equipment, including high-efficiency filtration as well as other measures. Because the reservoir for SARS-CoV-2 shedding is in the nasopharynx and nasal and oral cavities, the application of viricidal agents to these surfaces may reduce virus burden. Numerous studies have confirmed that povidone-iodine inactivates many common respiratory viruses, including SARS-CoV-1. Povidone-iodine also has good profile for mucosal tolerance. Thus, we propose a prophylactic treatment protocol for the application of topical povidone-iodine to the upper aerodigestive tract. CONCLUSION: Such an approach represents a low-cost, low-morbidity measure that may reduce the risks associated with aerosol-generating procedures performed commonly in otorhinolaryngology operating rooms.

4D-CT facilitates focused parathyroidectomy in patients with primary hyperparathyroidism by maintaining a high negative-predictive value for uninvolved quadrants.

INTRODUCTION: Improved preoperative localization facilitates minimally invasive parathyroidectomy for removal of parathyroid lesions therefore preventing an invasive bilateral neck exploration. As 4D-CT has emerged, its high specificity has helped with preoperative parathyroid lesion localization. A high negative predictive value (NPV) would serve to further confirm parathyroid lesion localization and limit unnecessary surgical exploration. This study's objective was to determine the NPV of preoperative 4D-CT and its facilitation of minimally invasive parathyroidectomy. METHODS: A retrospective review was compiled for patients undergoing parathyroidectomy for primary hyperparathyroidism with a preoperative 4D-CT. Included patients were sorted into various groups for comparison: those with 4D-CT localizing to a single lesion, localizing to multiple lesions, and those with nonlocalizing findings; multiple hypercellular parathyroid gland versus single gland findings; extent of surgical exploration; lesion location; and patients with concomitant thyroid nodules. Negative predictive value was calculated and used to quantify the ability for 4D-CT to rule out biochemically significant parathyroid lesions. RESULTS: In our review of 68 patients: sensitivity was 81.3%, specificity was 95.5%, positive predictive value was 87.1%, and negative predictive value was 93.3%. 86% had a single localizing 4D-CT, 7% had a non-localizing 4D-CT, and 7% had a multiple quadrant localizing 4D-CT. NPV for single and multi-localizing 4D-CT were 96.8% and 88.9%, respectively. CONCLUSION: Preoperative 4D-CT has a high negative predictive value (93.3%), suggesting in the majority of cases, a quadrant with no 4D-CT radiographic findings suspicious for parathyroid is unlikely to harbor biochemically significant parathyroid lesions.