Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA.
Harvard Medical School, Boston, MA.
Int Forum Allergy Rhinol. 2020 Jul;10(7):798-805. doi: 10.1002/alr.22577. Epub 2020 May 22.
International experience with coronavirus 2019 (COVID-19) suggests it poses a significant risk of infectious transmission to skull base surgeons, due to high nasal viral titers and the unknown potential for aerosol generation during endonasal instrumentation. The purpose of this study was to simulate aerosolization events over a range of endoscopic procedures to obtain an evidence-based aerosol risk assessment.
Aerosolization was simulated in a cadaver using fluorescein solution (0.2 mg per 10 mL) and quantified using a blue-light filter and digital image processing. Outpatient sneezing during endoscopy was simulated using an intranasal atomizer in the presence or absence of intact and modified surgical mask barriers. Surgical aerosolization was simulated during nonpowered instrumentation, suction microdebrider, and high-speed drilling after nasal fluorescein application.
Among the outpatient conditions, a simulated sneeze event generated maximal aerosol distribution at 30 cm, extending to 66 cm. Both an intact surgical mask and a modified VENT mask (which enables endoscopy) eliminated all detectable aerosol spread. Among the surgical conditions, cold instrumentation and microdebrider use did not generate detectable aerosols. Conversely, use of a high-speed drill produced significant aerosol contamination in all conditions tested.
We confirm that aerosolization presents a risk to the endonasal skull base surgeon. In the outpatient setting, use of a barrier significantly reduces aerosol spread. Cold surgical instrumentation and microdebrider use pose significantly less aerosolization risk than a high-speed drill. Procedures requiring drill use should carry a special designation as an "aerosol-generating surgery" to convey this unique risk, and this supports the need for protective personal protective equipment.
国际上针对 2019 年冠状病毒病（COVID-19）的经验表明，由于鼻腔病毒滴度高，以及经鼻内镜手术时未知的气溶胶生成潜在风险，该病毒对颅底外科医生具有重大传染性传播风险。本研究的目的是模拟一系列内镜手术中的气溶胶化事件，以获得基于证据的气溶胶风险评估。
使用荧光素溶液（每 10 毫升 0.2 毫克）在尸体上模拟气溶胶化，并使用蓝光滤光片和数字图像处理进行定量。在存在或不存在完整和改良手术口罩屏障的情况下，使用鼻内雾化器模拟门诊打喷嚏。在进行非动力器械操作、吸引微动力系统和鼻内荧光素应用后的高速钻孔时，模拟手术气溶胶化。
在门诊条件下，模拟喷嚏事件在 30 厘米处产生最大的气溶胶分布，延伸至 66 厘米。完整的手术口罩和改良的 VENT 口罩（可进行内镜检查）均可消除所有可检测到的气溶胶扩散。在手术条件下，冷器械和微动力系统使用不会产生可检测到的气溶胶。相反，高速钻头的使用在所有测试条件下均产生了显著的气溶胶污染。
我们证实气溶胶化对经鼻颅底外科医生构成风险。在门诊环境中，使用屏障可显著减少气溶胶扩散。冷手术器械和微动力系统的使用比高速钻头产生的气溶胶化风险小得多。需要使用钻头的手术应特别指定为“产生气溶胶的手术”，以传达这种独特的风险，这支持需要个人防护设备。
