Abstract
ObjectiveCOVID-19 spreads through aerosols produced in coughing, talking, exhalation, and also in some surgical procedures. Use of CO2 laser in laryngeal surgery has been observed to generate aerosols, however, other techniques, such cold dissection and microdebrider, have not been sufficiently investigated. We aimed to assess whether aerosol generation occurs during laryngeal operations and the effect of different instruments on aerosol production.MethodsWe measured particle concentration generated during surgeries with an Optical Particle Sizer. Cough data collected from volunteers and aerosol concentration of an empty operating room served as references. Aerosol concentrations when using different techniques and equipment were compared with references as well as with each other.ResultsThirteen laryngological surgeries were evaluated. The highest total aerosol concentrations were observed when using CO2 laser and these were significantly higher than the concentrations when using microdebrider or cold dissection (p < 0.0001, p < 0.0001) or in the background or during coughing (p < 0.0001, p < 0.0001). In contrast, neither microdebrider nor cold dissection produced significant concentrations of aerosol compared with coughing (p = 0.146, p = 0.753). In comparing all three techniques, microdebrider produced the least aerosol particles.ConclusionsMicrodebrider and cold dissection can be regarded as aerosol-generating relative to background reference concentrations, but they should not be considered as high-risk aerosol-generating procedures, as the concentrations are low and do not exceed those of coughing. A step-down algorithm from CO2 laser to cold instruments and microdebrider is recommended to lower the risk of airborne infections among medical staff.
Highlights
During the COVID-19 pandemic the evidence is mounting that spreading by inhalation of virus-laden aerosols is a significant transmission mode indoors, when aerosol-generating procedures (AGPs) are performed [1,2,3]
A total of 13 patients, 61 periods (18 with cold instruments, 36 with CO2 laser, and 7 with microdebrider) and 946 datapoints of laryngeal operations were included in the study
We followed a step-up algorithm from cold instruments to the microdebrider and C O2 laser which means that cold instruments picked collected only when they were used before the use of microdebrider and C O2 laser and microdebrider periods were picked only when it was used before the use of CO2 laser
Summary
During the COVID-19 pandemic the evidence is mounting that spreading by inhalation of virus-laden aerosols is a significant transmission mode indoors, when aerosol-generating procedures (AGPs) are performed [1,2,3]. Droplets that are likely to settle proximate to the source have been defined as particles bigger than 5 μm [6, 7]. As in the case of droplets, environmental factors have a significant impact. Aerosols concentrate near the source, but because their ability to stay in the air for a long time and spread in the space they create considerable challenges for infection control [6]. Whether a particle should be classified as a droplet or an aerosol depends on environmental factors such as temperature, barometric pressure, humidity, and air currents. 2.065 (1.852 to 2.279) 2.091 (1.873 to 2.309) 1.591 (1.457 to 1.724) 0.294 (− 0.147 to 0.735)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
