Aerosol mitigation in upper airway surgery.

Area of Science:

• Otolaryngology
• Infectious Disease Control
• Surgical Safety

Background:

• Aerosol generating procedures (AGPs) in otolaryngology pose significant SARS-CoV-2 transmission risks.
• Current methods for mitigating surgical aerosols are suboptimal.
• This study investigated strategies to reduce operating room aerosols.

Purpose of the Study:

• To evaluate the efficacy of different intraoral and extraoral strategies for mitigating surgical aerosols.
• To determine the optimal approach for reducing airborne particle transmission during otolaryngologic procedures.

Main Methods:

• Electrocautery-induced aerosols (0.5-10 μm particles) were generated using an intubation manikin.
• Particle counts were measured with a Sensirion SPS30 particle counter.
• Three mitigation strategies were tested: intraoral suction (Yankauer, suction Bovie pencil [SBP]), extraoral smoke evacuator system (SES), and combinations.

Main Results:

• Extraoral SES alone was less effective than intraoral methods (p < 0.0001).
• Combining SES with intraoral techniques did not improve mitigation and sometimes decreased effectiveness.
• No significant difference between intraoral techniques, though SBP showed the lowest particle levels.

Conclusions:

• Intraoral suction techniques are recommended for aerosol mitigation during otolaryngologic procedures.
• Extraoral SES is insufficient alone and potentially detrimental when combined with intraoral suction.
• Further research is needed to optimize intraoperative surgical aerosol mitigation strategies.