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Observational Study
. 2021 Aug;24(4):499-506.
doi: 10.1007/s11102-021-01125-8. Epub 2021 Jan 19.

Aerosolisation in endonasal endoscopic pituitary surgery

Rana S Dhillon  1 , Lana V Nguyen  2 , Wagih Abu Rowin  3 , Ruhi S Humphries  4 , Kevin Kevin  3 , Jason D Ward  4 , Andrew Yule  5 , Tuong D Phan  6   7 , Yi Chen Zhao  8 , David Wynne  2 , Peter M McNeill  2 , Nicholas Hutchins  3 , David A Scott  6   7
Affiliations
Observational Study

Aerosolisation in endonasal endoscopic pituitary surgery

Rana S Dhillon et al. Pituitary. 2021 Aug.

Abstract

Purpose: To determine the particle size, concentration, airborne duration and spread during endoscopic endonasal pituitary surgery in actual patients in a theatre setting.

Methods: 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.

Results: 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).

Conclusion: 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.

Keywords: Aerosol-generating procedure; Aerosols; COVID-19; Endonasal endoscopic pituitary surgery; Occupational exposure.

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Conflict of interest statement

NH receives competitive funding from the Australian Research Council, with Linkage funding from Mitsubishi Heavy Industries and AkzoNobel. DAS receives competitive research funding from the National Health and Medical Research Council, Medical Research Future Fund, Australia and New Zealand College of Anaesthetists Foundation and the Alzheimer’s Association. All other authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Timeline series of particle concentrations and diameter measured by aerodynamic particle sizer (APS) during intubation, endonasal access, pituitary tumour removal and extubation. a Total particle number concentrations with linear and log scales shown in dark and light blue, respectively. Dashed lines represent the detection limit (mean + 3 standard deviations) during an empty theatre (green) and during theatre setup (red). b Aerosol size distribution with colours showing the number concentration in each size bin. The integrated size distributions correspond to total concentrations
Fig. 2
Fig. 2
Timeline series of particle concentrations and diameter measured by aerodynamic particle sizer during endonasal access. a, b are as for Fig. 1
Fig. 3
Fig. 3
Timeline series of particle concentrations and diameters measured by aerodynamic particle sizer during tumour resection. a, b are as for Fig. 1
Fig. 4
Fig. 4
Timeline series of particle concentrations and diameters measured by aerodynamic particle sizer during drape removal. a, b are as for Fig. 1
Fig. 5
Fig. 5
Schematic diagram showing the distance travelled by particles generated during steps of endonasal surgery. Distance A represents use of a microdebrider during endonasal access. Distance B represents bag mask ventilation in a paralysed patient during intubation and extubation, with distance limited by the confines of the theatre
See this image and copyright information in PMC

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References

    1. Schwartz J, King CC, Yen MY. Protecting health care workers during the COVID-19 coronavirus outbreak - lessons from Taiwan’s SARS response. Clin Infect Dis. 2020 doi: 10.1093/cid/ciaa255. - DOI - PMC - PubMed
    1. Cohen E (2020) Disease detectives hunting down more information about “super spreader” of Wuhan coronavirus. CNN Health
    1. Patel ZM, Fernandez-Miranda J, Hwang PH, et al. Precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery. 2020;87(1):66–67. doi: 10.1093/neuros/nyaa125. - DOI - PMC - PubMed
    1. Margo J (2020) Extreme viral risk cuts ear, nose and throat surgery. Australian Financial Review
    1. Mitchell RA, King JAJ, Goldschlager T, Wang YY. Impact of COVID-19 on pituitary surgery. ANZ J Surg. 2020;90(6):963–964. doi: 10.1111/ans.15959. - DOI - PMC - PubMed

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