The microscope drape method to reduce aerosolisation during endoscopic sinus and skull base surgery in the COVID era. How i do it

Abstract

Background Otolaryngologists are faced with concerning challenges since the onset of the coronavirus disease (COVID-19) pandemic due to significant risk of occupational infection. Transmission can happen during intraoperative exposure to viral particles carried by droplets or aerosols. Endoscopic sinus and skull base surgery are notable for causing aerosolisation, putting healthcare staff at substantial risk. Method We describe the creation of a tight-seal tent from a microscope drape covering the operative field and the operator’s hands with the aim to contain aerosols during transnasal endoscopic surgery. Conclusion The microscope drape technique is a simple barrier measure that could potentially improve safety during endoscopic procedures.

Title of the Article: Paranasal Mucormycosis in COVID-19 Patient

“… Pre-operatively betadine (0.5%) drops [ 3 ] were instilled in each nostril of patient half an hour before procedure and after induction on the operative table. Surgical tent was created and secured by using barrier draping technique [ 4 ]. Three out pouches were created in drape – two for surgeon’s hand, and the third opening was for suction, camera and light carrier [Fi g.3 ].…”

“…Surgical tent was created and secured by using barrier draping technique [ 4 ]. Three out pouches were created in drape – two for surgeon’s hand, and the third opening was for suction, camera and light carrier [Fi g.3 ].…”

One year into the COVID-19 pandemic: What do we know so far from studies assessing risk and mitigation of droplet aerosolisation during endonasal surgery? A systematic review

“…Five very similar feasibility studies report on their experience of specific patient draping. [29][30][31][32][33] The majority employ a polythene sheet, under which the surgeon operates. [29][30][31][32] Of these, only Arefin et al (2021) 29 published outcomes, reporting no COVID-19 infections amongst twelve theatre team members over a fivemonth period.…”

“…The addition of a variety of adjunctive techniques (e.g. drapes, [29][30][31][32][33][34][35] negative-pressure masks 16.18,28 ) reflect the ingenuity of clinical groups across the world. Though innovative, such ideas would benefit from extended real-life testing and should also be balanced with their practicality and cost given that results suggest they do not eliminate aerosolisation to the point where staff would not wear higher levels of PPE.…”

COVID-19 Associated Mucormycosis in Head and Neck Region: Our Experiences at a Tertiary Care Teaching Hospital of Eastern India

“…Rhino-orbital-cerebral infection is a typical presentation of mucormycosis where fungi invade the paranasal sinuses to orbit and brain. 16 This clinical situation can result in orbital apex syndrome such as complete ophthalmoplegia with rapid loss of vision, involves cranial nerves such as II, III, IV, V and VI, which need urgent treatment with surgical intervention, antifungal drugs and control of risk factors for preventing such morbidity and fatal outcome. 17,18 Clinical suspicion and early diagnosis and prompt treatment are key steps for preventing the morbidity of the fatal condition like rhino-orbitalcerebral mucormycosis.…”