DOI: http://dx.doi.org/10.18203/issn.2454-5929.ijohns20204650

Guidelines for rhinology surgery in COVID-19 pandemic

Meenesh Juvekar, Baisali Sarkar

Abstract


COVID-19 disease was first identified in December 2019 in Wuhan, the capital of China's Hubei province. Amid the ongoing COVID-19 pandemic, India has witnessed a massive surge of coronavirus cases. This study reviews the measures to take by the clinicians involved in rhinology surgery in light of the recent COVID-19 pandemic. The current finding about COVID-19 infection and its relation with severe acute respiratory syndrome coronavirus 2 (SARS-CoV 2) virus is evaluated and possible safety measure guidelines to be taken while doing rhinology procedures is reviewed. The risk of coronavirus 2019 can be largely reduced by wearing personal protective equipment (PPE) kit with powered air purifying respirator, double gloves, eye protection, face shield, gown, shoe covers, limiting attendance to operation theatre, negative pressure room, using negative-pressure otolaryngology viral isolation drape (NOVID) system to cover the patient and proper removal of patient drape after operation. Additionally, low oscillation speeds of microdebrider with continuous suction is associated with low risk of aerosol transmission into the environment. Rhinology and endonasal surgeries are high risk procedures and should adhere to general guidelines set for high-risk procedures. If the proposed protocols are strictly maintained then the risk of getting infected by coronavirus is markedly reduced. In this current scenario is it mandatory to attain the emergent surgical cases with all possible precautions as mentioned and defer the rest of the cases till the pandemic gets over.


Keywords


SARS-CoV 2, COVID-19, Pandemic, Rhinology surgery

Full Text:

PDF

References


Coronavirus disease 2019 (COVID-19) - Symptoms and causes. Mayo Clinic. 2020. Available at: https://www.mayoclinic.org/diseases-conditions/cor onavirus/symptoms-causes/syc-20479963. Accessed on: 14 April 2020.

Hui DS, Azhar EI, Madani TA, Ntoumi F, Kock R, Dar O, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health- The latest 2019 novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2020;91:264-6.

WHO Director-General's opening remarks at the media briefing on COVID-19, 2020. World Health Organization (WHO). Available at: https://www.who.int/dg/speeches/detail/who-directo r-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. Accessed on: 12 March 2020.

How COVID-19 Spreads, 2020. Centers for Disease Control and Prevention (CDC). Available at: https://www.cdc.gov/coronavirus/2019-ncov/preven t-getting-sick/how-covid-spreads.html. Accessed on: 03 April 2020.

Q & A on COVID-19. European Centre for Disease Prevention and Control. 2020. Available at: https://www.ecdc.europa.eu/en/covid-19/questions-answers. Accessed on: 30 April 2020.

Anagiotos A, Petrikkos G. Otolaryngology in COVID-19 pandemic era: the impact on our clinical practice. Eur Arch Oto-Rhino-Laryngol. 2020;1-8.

van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARSCoV-1. New Engl J Med. 2020;382(16):1564-7.

Chen N, Min Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.

Symptoms of Coronavirus. Centers for Disease Control and Prevention (CDC). 2020. Available at: https://www.cdc.gov/coronavirus/2019-ncov/sympt oms-testing/symptoms.html. Accessed on: 18 June 2020.

Novel Coronavirus Information Center: Expert guidance and commentary. Elsevier Connect. 2020. Available at: https://www.elsevier.com/connect/ coronavirus-information-center. Accessed on: 20 January 2020.

Grant MC, Geoghegan L, Arbyn M, Mohammed Z, McGuinness L, Clarke EL, et al. The prevalence of symptoms in 24, 410 adults infected by the novel coronavirus (SARS-CoV-2; COVID-19): A systematic review and meta-analysis of 148 studies from 9 countries. Plos One. 2020;15(6):0234765.

Ramakrishna R, Zadeh G, Sheehan JP, Aghi MK. Inpatient and outpatient case prioritization for patients with neuro-oncologic disease amid the COVID-19 pandemic: general guidance for neuro-oncology practitioners from the AANS/CNS Tumor Section and Society for Neuro-Oncology. J Neurooncol. 2020;147(3):525-9.

Workman AD, Welling DB, Carter BS, Curry WT, Holbrook EH, Gray ST, et al. Endonasal instrumentation and aerosolization risk in the era of COVID-19: simulation, literature review, and proposed mitigation strategies. Int Forum Allergy Rhinol. 2020;10(7):798-805.

Guidance for return to practice for Otolaryngology-Head and Neck surgery. American Academy of Otolaryngology-Head and Neck surgery. 2020. Available at: https://www.entnet.org/content/guid ance-return-practice-otolaryngology-head-and-neck-surgery. Accessed on: 01 July 2020.

COVID-19 Educational Videos for Rhinologists. European Rhinologic Society. 2020. Available at: https://www.europeanrhinologicsociety.org/?page_id=2143. Accessed on: 14 April 2020.

Fakhry N, Schultz P, Morinière S, Breuskin I, Bozec A, Vergez S, et al. French consensus on management of head and neck cancer surgery during COVID-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis. 2020;137(3):159-60.

Zuo MZ, Huang YG, Ma WH, Xue ZG, Zhang JQ, Gong YH, et al. Expert recommendations for tracheal intubation in critically ill patients with novel coronavirus disease 2019. Chin Med Sci J. 2020;35(2):105-9.

Guidance for ENT surgeons during the COVID-19 pandemic. The Australian Society of Otolaryngology and Head and Neck Surgery. 2020. Available at: https://www.ahns.info/wp-content/uploads/2020/03 /Australian-Guidance-for-ENT-surgeons-during-the-COVID.pdf. Accessed on: 20 March 2020.

Considerations on H&N during COVID-19. Irish Head and Neck Society. 2020. Available at: https://www.ahns.info/wp-content/uploads/2020/03 /Irish-Head-and-Neck-Society-considerations-on-COVID-20-3-20.pdf. Accessed on: 10 April 2020.

COVID-19: considerations for optimum surgeon protection before, during, and after operation. American College of Surgeons. 2020. Available at: https://www.facs.org/covid-19/clinical-guidance/surgeon-protection. Accessed on: 10th April 2020.

Lu D, Wang H, Yu R, Yang H, Zhao Y. Integrated infection control strategy to minimize nosocomial infection of coronavirus disease 2019 among ENT healthcare workers. J Hosp Infect. 2020;104(4):454-5.

Irish J. Synopsis of the Toronto Approach. American Head and Neck Society. 2020. Available at: https://www.ahns.info/wp-content/uploads/2020/03 /Jonathan-Irish-Synopsis-of-the-Toronto-Approach. pdf. Accessed on: 10 April 2020.

Appendix B. Air guidelines for environmental infection control in health-care facilities. U.S. Centres for disease control and prevention. 2003. Available at: https://www.cdc.gov/infectioncontrol /guidelines/environmental/appendix/air.html. Accessed on: 20 April 2020.

David AP, Jiam NT, Reither JM, Gurrola JG, Aghi M, El-Sayed IH, et al. Endoscopic Skull Base and Transoral Surgery During the COVID-19 Pandemic: Minimizing Droplet Spread with a Negative-Pressure Otolaryngology Viral Isolation Drape (NOVID). Head Neck. 2020;10.

Workman AD, Welling DB, Carter BS, Curry WT, Holbrook EH, Gray ST, et al. Endonasal instrumentation and aerosolization risk in the era of COVID-19: simulation, literature review, and proposed mitigation strategies. Int Forum Allergy Rhinol. 2020;10(7):798-805.

He F, Deng Y, Li W. Coronavirus disease 2019: What we know? J Med Virol. 2020;92(7):719-25.

Europe’s Doctors Repeat Errors Made in Wuhan, China Medics Say. Bloomberg News. 2020. Available at: https:// www.bloomberg.com/news/ articles/2020-03-17/europe-sdoctors-getting-sick-like-in-wuhan-chinese-doctors-say. Accessed on: 17 March 2020.

Patel ZM, Fernandez-Miranda J, Hwang PH, Nayak JV, Dodd R, Sajjadi H, et al. Precautions for endoscopic transnasal skull base surgery during the COVID-19 pandemic. Neurosurgery. 2020;87(1):66-7.