A Novel Technique of Draping for Otologic Surgery: Mitigation of Aerosol Generation During Covid Pandemic
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CLINICAL REPORT
A Novel Technique of Draping for Otologic Surgery: Mitigation of Aerosol Generation During Covid Pandemic Naresh K. Panda1
•
Ganesh Agarwal1 • Neemu Hage1 • R. Balaji1
Received: 18 June 2020 / Accepted: 16 July 2020 Ó Association of Otolaryngologists of India 2020
Abstract The surgical procedures in the temporal bone have the potential to generate aerosols which could affect the health care personnel. An innovative way to avoid aerosolization during ear surgery has been highlighted in this manuscript. Keywords Aerosol generating surgery Covid 19 pandemic Draping technique
Introduction The Covid-19 pandemic has posed challenges for the healthcare system all over the world. The otolaryngologists are constantly at risk of being exposed to aerosols during surgical procedures. Otological procedures particularly those requiring drilling of the temporal bone, have the potential of generating significant amount of aerosols. Aerosols, can carry viral particles up to several hours, thereby, having the potential to infect any individual within the confines of that space. We have come up with a novel technique of draping for the purpose of performing otological surgeries, which is simple to execute and makes use of routine components used conventionally in surgeries. It was employed for subtotal temporal bone resection for a case of squamous cell carcinoma of the temporal bone. The patient was tested negative for Covid 19 before being taken up for surgery as per the Institute Protocol.
& Naresh K. Panda [email protected] 1
Departmant of Otolaryngology, PGIMER, Chandigarh, India
Method The patient was laid supine on the OT table. Intubation was done under full precautions by an experienced anaesthetist. The head of the patient was then set to the desired position. Draping of the of the patient was done with surgical drapes. The microscope was draped as per the standard protocol. An instrument tray, which is an accessory attachment of the operative table, was attached to the table, on one side of the surgeon, depicted as ‘A’ in Fig. 1a. A Gottingen laser support table for laryngoscope holder 8575 K/KC, was then attached at the head end of the table, depicted as ‘B’ in figure-1a. Both the instrument tray and the laser support table were draped with sterile cloth drapes secured with towel clips. The vertical height of both the stands was adjusted sufficiently above the level of the head of the patient. A steri-drape (3 M) with its adhesive surface facing downwards was positioned between the two stands creating a bridge between them, as shown in Fig. 1b. The microscope was then brought forward, positioned between the two draped stands and the operative field was focussed. Following this, a cut was made in the centre of the steri-drape to accommodate the microscope lens cap. Two sterile transparent surgical drapes were then used to create a tent-like structure by sticking the centre of each polydrape to the two free adhesive ends of the steri-drape. The loose flaps of the polydrapes were secured to th
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