Management of aerosol generating particles with a novel self-retaining intraoral suction device

Surgical aerosols generated during adenotonsillectomy (T&A) pose risks to operating room personnel. Although aerosol mitigation is legally required in 20 states, current strategies may poorly integrate into procedure workflow, impair visualization, prolong procedure duration, or be ineffective. Here, we evaluated the effectiveness of a novel self-retaining intraoral suction device (Smovac) compared with existing mitigation strategies.

T&A simulations utilizing chicken tissue and electrocautery were performed in an intubation manikin. Mitigation strategies included Smovac, Yankauer, suction Bovie pencil (SBP), external smoke evacuator (ESE), suction tongue blade (STB), and no suction. Serial 1-min trials for each strategy involved fresh tissue cauterization in the tonsillar fossa. Aerosol particle counts were collected at 1 Hz for particle diameters 0.5 - 10 μm (μm). Sound levels were collected. Device performance was compared between devices via linear regressions to identify superiority.

Smovac demonstrated superior particle mitigation across all particle sizes including 0.5 μm when compared to: Yankauer (ratio difference: 351.5, 95% CI: 73.3, 1686.3, p < 0.001), ESE (1384.2, 95% CI: 288.5, 6641.0 p < 0.001), SBP (13.0, 95% CI: 2.7, 62.2, p < 0.001), and control (1905.3, 95% CI: 396.0, 9166.2, p < 0.001). All mitigation strategies demonstrated significantly lower peak sound levels compared to ESE but were equivalent to each other.

In this preclinical model, Smovac provided superior aerosol mitigation for particles 0.5-10 μm compared with commonly used alternatives while maintaining a largely equivalent acoustic profile. Its self-retaining, low-profile design may improve field visualization and reduce reliance on assistant-held suction.