Author(s)
Brian W. Herrmann, MD
Min-Hyung Choi, PhD
Marina Vance, PhD
Kaci Pickett, MS
Norman R. Friedman, MD
Affiliation(s)
Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine, Aurora, CO
Children’s Hospital Colorado, Aurora, CO
Department of Computer Science and Engineering, University of Colorado Denver, Denver, CO
Department of Mechanical Engineering, University of Colorado Boulder, Boulder, CO
Abstract:
Introduction: Aerosol generating procedures are commonly performed by Otolaryngologists. An optimal method to mitigate this hazard does not currently exist. We hypothesize that intraoral suction will optimize aerosol mitigation, and introduce a novel imaging system to capture intraoperative aerosol migration within the operating room.
Objective: To analyze different suction methods to mitigate surgical aerosols during simulated upper airway surgical procedures, using both a particle counter and imaging system.
Methods: Utilizing an intubation mannequin (Nasco Healthcare), particle counter (Sensirion SPS30), and novel thermal imaging system that can capture surgical aerosols, a series of electrocautery-induced aerosols containing particles 0.1-10 µm in diameter were measured. Three different mitigation strategies were tested: intraoral (yankauer, suction bovie pencil (SBP)), extraoral (smoke evacuator system(SES)), and combination (yankauer and SES). To assess particle dispersion a novel multimodality camera with thermal, color and spatial depth imaging was utilized.
Results: Intraoral mitigation strategies were statistically superior to extraoral (SES) and combined (yankauer and SES) techniques (p<0.0001). Visual analysis of the aerosol plume demonstrated that the SES drew the plume from the oral cavity past the surgeon into the breathing space of OR personnel, while intraoral methods had less escape into the room.
Conclusion: Intraoral mitigation was the optimal method to address electrocautery derived aerosols during simulated upper airway procedures. The thermal imaging system did enable visualization of aerosol migration within the OR for each suction strategy that was not always captured through particle counts alone.