Aerosolisation in endonasal endoscopic pituitary surgery

Area of Science:

• Otorhinolaryngology
• Surgical Aerosols
• Patient Safety

Background:

• Surgical procedures, especially those involving the airway, can generate aerosols.
• Understanding aerosol generation and dispersion is crucial for infection control in operating rooms.

Purpose of the Study:

• To quantify particle size, concentration, airborne duration, and spread during endoscopic endonasal pituitary surgery.
• To assess aerosol generation during specific surgical steps in a real-world theatre setting.

Main Methods:

• Observational study involving three patients undergoing endoscopic endonasal pituitary surgery.
• Utilized particle image velocimetry and spectrometry with air sampling for aerosol detection.
• Procedures were conducted in a positive pressure operating room.

Main Results:

• Intubation, extubation, and surgical drape removal significantly increased particle concentrations (small and large particles).
• Endonasal access and microdebrider use generated elevated concentrations of larger particles with shorter airborne durations.
• High-speed drilling and pituitary tumor resection did not significantly increase aerosol levels above baseline.

Conclusions:

• Intubation, extubation, and drape removal are key events for aerosol generation and dispersion during these procedures.
• While endonasal access and tumor resection produce fewer aerosols, they can still contribute to airborne particles.
• Findings highlight the importance of aerosol management strategies in endoscopic pituitary surgery settings.