Ye Michael J, Vadhul Raghav B, Sharma Dhruv, Campiti Vincent J, Burgin Sarah J, Illing Elisa A, Ting Jonathan Y, Park Jae Hong, Koehler Karl R, Lee Hui Bae, Vernon Dominic J, Johnson Jeffrey D, Nesemeier B Ryan, Shipchandler Taha Z
Indiana University Department of Otolaryngology - Head and Neck Surgery, USA.
Indiana University School of Medicine, USA.
Am J Otolaryngol. 2021 Jul-Aug;42(4):102970. doi: 10.1016/j.amjoto.2021.102970. Epub 2021 Feb 27.
The highly contagious COVID-19 has resulted in millions of deaths worldwide. Physicians performing orbital procedures may be at increased risk of occupational exposure to the virus due to exposure to secretions. The goal of this study is to measure the droplet and aerosol production during repair of the inferior orbital rim and trial a smoke-evacuating electrocautery handpiece as a mitigation device.
The inferior rim of 6 cadaveric orbits was approached transconjunctivally using either standard or smoke-evacuator electrocautery and plated using a high-speed drill. Following fluorescein inoculation, droplet generation was measured by counting under ultraviolet-A (UV-A) light against a blue background. Aerosol generation from 0.300-10.000 μm was measured using an optical particle sizer. Droplet and aerosol generation was compared against retraction of the orbital soft tissue as a negative control.
No droplets were observed following the orbital approach using electrocautery. Visible droplets were observed after plating with a high-speed drill for 3 of 6 orbits. Total aerosol generation was significantly higher than negative control following the use of standard electrocautery. Use of smoke-evacuator electrocautery was associated with significantly lower aerosol generation in 2 of 3 size groups and in total. There was no significant increase in total aerosols associated with high-speed drilling.
Droplet generation for orbital repair was present only following plating with high-speed drill. Aerosol generation during standard electrocautery was significantly reduced using a smoke-evacuating electrocautery handpiece. Aerosols were not significantly increased by high-speed drilling.
极具传染性的新型冠状病毒肺炎已在全球导致数百万例死亡。由于接触分泌物，进行眼眶手术的医生可能面临更高的职业暴露风险。本研究的目的是测量眶下缘修复过程中的飞沫和气溶胶产生情况，并试用一种排烟电灼手持器械作为缓解装置。
经结膜入路，使用标准电灼或排烟电灼处理6具尸体眼眶的下缘，并用高速钻进行打磨。接种荧光素后，在紫外线A（UV-A）灯下蓝色背景下计数来测量飞沫产生情况。使用光学粒子计数器测量0.300 - 10.000微米的气溶胶产生情况。将飞沫和气溶胶的产生情况与眼眶软组织回缩作为阴性对照进行比较。
使用电灼进行眼眶手术入路后未观察到飞沫。在6个眼眶中的3个使用高速钻打磨后观察到可见飞沫。使用标准电灼后，总气溶胶产生量显著高于阴性对照。使用排烟电灼在3个尺寸组中的2个以及总体上与显著更低的气溶胶产生相关。高速钻孔未导致总气溶胶显著增加。
仅在使用高速钻打磨后出现眼眶修复过程中的飞沫产生。使用排烟电灼手持器械可显著减少标准电灼过程中的气溶胶产生。高速钻孔未显著增加气溶胶。
