Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
Am J Rhinol Allergy. 2021 Jul;35(4):426-431. doi: 10.1177/1945892420962335. Epub 2020 Oct 4.
Recent indirect evidence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission during endoscopic endonasal procedures has highlighted the dearth of knowledge surrounding aerosol generation with these procedures. As we adapt to function in the era of Coronavirus Disease 2019 (COVID-19) a better understanding of how surgical techniques generate potentially infectious aerosolized particles will enhance the safety of operating room (OR) staff and learners.
To provide greater understanding of possible SARS-CoV-2 exposure risk during endonasal surgeries by quantifying increases in airborne particle concentrations during endoscopic sinonasal surgery.
Aerosol concentrations were measured during live-patient endoscopic endonasal surgeries in ORs with an optical particle sizer. Measurements were taken throughout the procedure at six time points: 1) before patient entered the OR, 2) before pre-incision timeout during OR setup, 3) during cold instrumentation with suction, 4) during microdebrider use, 5) during drill use and, 6) at the end of the case prior to extubation. Measurements were taken at three different OR position: surgeon, circulating nurse, and anesthesia provider.
Significant increases in airborne particle concentration were measured at the surgeon position with both the microdebrider (p = 0.001) and drill (p = 0.001), but not for cold instrumentation with suction (p = 0.340). Particle concentration did not significantly increase at the anesthesia position or the circulator position with any form of instrumentation. Overall, the surgeon position had a mean increase in particle concentration of 2445 particles/ft3 (95% CI 881 to 3955; p = 0.001) during drill use and 1825 particles/ft3 (95% CI 641 to 3009; p = 0.001) during microdebrider use.
Drilling and microdebrider use during endonasal surgery in a standard operating room is associated with a significant increase in airborne particle concentrations. Fortunately, this increase in aerosol concentration is localized to the area of the operating surgeon, with no detectable increase in aerosol particles at other OR positions.
最近有间接证据表明，在鼻内镜内外科手术过程中存在严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）传播，这突显了我们对这些手术过程中气溶胶产生的认识不足。随着我们适应 2019 年冠状病毒病（COVID-19）时代，更好地了解手术技术如何产生潜在的传染性气溶胶化颗粒，将提高手术室（OR）工作人员和学习者的安全性。
通过量化鼻内镜鼻窦手术过程中空气传播粒子浓度的增加，来更好地了解鼻内镜手术过程中 SARS-CoV-2 的暴露风险。
在配备光学粒子计数器的手术室中，对活体患者的鼻内镜内外科手术进行了气溶胶浓度测量。在手术过程中，在六个时间点进行了测量：1）患者进入 OR 之前，2）OR 设置前的预切口超时，3）冷器械与吸引时，4）使用微型磨除器时，5）使用钻头时，6）在病例结束前拔管时。测量在三个不同的 OR 位置进行：外科医生、巡回护士和麻醉师。
在外科医生位置使用微型磨除器（p=0.001）和钻头（p=0.001）时，空气中的粒子浓度显著增加，但在冷器械与吸引时（p=0.340）则没有显著增加。在麻醉师位置或巡回护士位置，任何形式的器械都没有导致粒子浓度显著增加。总的来说，钻头使用时外科医生位置的粒子浓度平均增加 2445 个/立方英尺（95%CI 881 至 3955；p=0.001），微型磨除器使用时增加 1825 个/立方英尺（95%CI 641 至 3009；p=0.001）。
在标准手术室中进行鼻内镜内外科手术时，钻头和微型磨除器的使用会导致空气中的粒子浓度显著增加。幸运的是，气溶胶浓度的增加仅局限于手术外科医生的区域，在其他 OR 位置没有检测到气溶胶颗粒的增加。
