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CO2-Lasertonsillotomy Under Local Anesthesia in Adults
Published on: November 6, 2019
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Microdebrider is less aerosol-generating than CO2 laser and cold instruments in microlaryngoscopy
Enni Sanmark1,2, Lotta-Maria A H Oksanen3,4, Noora Rantanen3,4
1Faculty of Medicine, University of Helsinki, Valhallankatu 7a 21, 00250, Helsinki, Finland. enni@sanmark.fi.
Summary
Carbon dioxide (CO2) laser use in laryngeal surgery generates significant aerosols, unlike microdebrider or cold dissection. These latter methods produce low aerosol concentrations, recommending a step-down approach to minimize airborne infection risk for medical staff.
Area of Science:
- Otolaryngology
- Surgical Aerosol Generation
- Infection Control
Background:
- COVID-19 transmission occurs via aerosols from activities like coughing and talking.
- Surgical procedures can also generate aerosols, posing risks to healthcare workers.
- While CO2 laser's aerosol generation is known, other laryngeal surgery techniques require investigation.
Purpose of the Study:
- To assess aerosol generation during laryngeal operations.
- To compare aerosol production across different surgical instruments: CO2 laser, microdebrider, and cold dissection.
Main Methods:
- Particle concentration was measured using an Optical Particle Sizer during 13 laryngological surgeries.
- Aerosol data from coughing volunteers and an empty operating room served as reference points.
- Concentrations from different surgical techniques were compared against references and each other.
Main Results:
- CO2 laser generated significantly higher aerosol concentrations compared to microdebrider, cold dissection, background levels, and coughing (p < 0.0001).
- Microdebrider and cold dissection did not produce significant aerosol concentrations above coughing levels (p = 0.146, p = 0.753).
- Microdebrider produced the lowest aerosol particle count among the tested techniques.
Conclusions:
- Microdebrider and cold dissection generate aerosols but are not high-risk procedures, with concentrations comparable to or lower than coughing.
- A 'step-down' strategy, transitioning from CO2 laser to cold instruments or microdebrider, is advised.
- This approach aims to reduce the risk of airborne infections among surgical and medical staff.
