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Reducing the risks of endoscopic sinonasal surgery in the Covid‐19 era

Leong, Samuel, Mogre, Dilesh, Andrews, Peter and Davies, Elgan (2021) 'Reducing the risks of endoscopic sinonasal surgery in the Covid‐19 era'. Clinical Otolaryngology, Vol 46, Issue 4, pp. 809-815.

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Abstract

OBJECTIVES
Many powered instruments used in routine sinonasal surgery are regarded as an aerosol generating procedure (AGP). This study aimed to assess assess how different instrument settings may affect detectable droplet spread and the patterns of aerosolised droplet spread during simulated sinonasal surgery with powered instrumentation in order to identify mitigation strategies.

DESIGN
Simulation series using three-dimensional (3D) printed sinonasal model. Fluorescein droplet spread was assessed following microdebriding and drilling of fluorescein-soaked grapes and bones respectively.

SETTING
University dry lab.

PARTICIPANTS
3-D printed sinonasal model.

MAIN OUTCOME MEASURES
Patterns of aerosolised droplet spread.

RESULTS AND CONCLUSION
There were no observable fluorescein droplets or splatter in the measured surgical field after microdebridement of nasal polyps at a specific irrigation rate and suction pressure. Droplet splatter occurred when suction pressure was reduced; simulating a surgical condition where there was excessive fluid in the nasal cavity irrigation. Drilling with either coarse diamond or cutting burr resulted in detectable droplets. Greater droplet spread was observed when drilling within the anterior nasal cavity. The addition of a suction catheter reduces droplet spread when drilling. Activation of the microdebrider when there is fluid excess fluid (reduced or blocked suction pressure, excessive mucosal bleeding or irrigation fluid) accumulating in the nasal cavity resulted in detectable droplet spread. High-speed drilling is a high-risk AGP especially when drilling in the anterior nasal cavity, but the addition of suction reduces detectable droplet spread outside the nasal cavity.

Item Type: Article
Subjects: WV Otolaryngology > WV 100 General works
WV Otolaryngology > WV 20 Research (General)
WV Otolaryngology > Nose and Paranasal Sinuses > WV 300 General works
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI): https://doi.org/10.1111/coa.13743
Depositing User: Julie Franco
Date Deposited: 25 Feb 2021 08:49
Last Modified: 15 Jul 2021 12:25
URI: https://archive.lstmed.ac.uk/id/eprint/17056

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