Department of Neurosurgery, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
Department of Mechanical Engineering, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia.
Pituitary. 2021 Aug;24(4):499-506. doi: 10.1007/s11102-021-01125-8. Epub 2021 Jan 19.
To determine the particle size, concentration, airborne duration and spread during endoscopic endonasal pituitary surgery in actual patients in a theatre setting.
This observational study recruited a convenience sample of three patients. Procedures were performed in a positive pressure operating room. Particle image velocimetry and spectrometry with air sampling were used for aerosol detection.
Intubation and extubation generated small particles (< 5 µm) in mean concentrations 12 times greater than background noise (p < 0.001). The mean particle concentrations during endonasal access were 4.5 times greater than background (p = 0.01). Particles were typically large (> 75 µm), remained airborne for up to 10 s and travelled up to 1.1 m. Use of a microdebrider generated mean aerosol concentrations 18 times above baseline (p = 0.005). High-speed drilling did not produce aerosols greater than baseline. Pituitary tumour resection generated mean aerosol concentrations less than background (p = 0.18). Surgical drape removal generated small and large particles in mean concentrations 6.4 times greater than background (p < 0.001).
Intubation and extubation generate large amounts of small particles that remain suspended in air for long durations and disperse through theatre. Endonasal access and pituitary tumour resection generate smaller concentrations of larger particles which are airborne for shorter periods and travel shorter distances.
在手术室环境中实际患者的内镜经鼻垂体手术中确定粒径、浓度、悬浮时间和传播范围。
本观察性研究招募了三名患者的便利样本。手术在正压手术室进行。使用粒子图像测速法和空气采样光谱法进行气溶胶检测。
插管和拔管产生的粒径小于 5μm 的小颗粒浓度比背景噪声高 12 倍（p<0.001）。经鼻入路时的平均颗粒浓度比背景高 4.5 倍（p=0.01）。颗粒通常较大（>75μm），可在空中停留长达 10 秒，传播距离可达 1.1 米。使用微型磨钻会产生比基线高 18 倍的平均气溶胶浓度（p=0.005）。高速钻孔不会产生大于基线的气溶胶。垂体瘤切除产生的平均气溶胶浓度低于背景（p=0.18）。手术巾的移除会产生比背景高 6.4 倍的大小颗粒（p<0.001）。
插管和拔管会产生大量的小颗粒，这些颗粒会长时间悬浮在空气中，并通过手术室扩散。经鼻入路和垂体瘤切除会产生较小浓度的较大颗粒，这些颗粒在空中停留时间较短，传播距离较短。
