Povidone Iodine ‘WET’ technique: Adenotonsillectomy in COVID
era
Key Points
Most of the ENT surgeries are aerosol generating procedures and pose a
risk of infection to health care workers.
Povidone-iodine irrigation has been used in surgery and has proven to
reduce surgical site infection.
Povidone iodine has good virucidal action even in low concentrations.
The novel technique of wet tonsillectomy with povidone iodine flush
would possibly reduce the viral load.
This technique, in adjunct to other safety measures and personal
protective equipment, could be a safe way to restart elective oral, ear
and nasal procedures in asymptomatic patients during the pandemic.
COVID 19 pandemic has significantly changed ENT Practice. Most elective
ENT (Ear, Nose, Throat) surgeries possess a risk of infection, as well
as potentially increasing complication (1). With the current pandemic
slowly evolving and ever-increasing demand for elective services to
restart, service delivery with minimal risk to healthcare workers is a
challenge. ENT procedures like Adenotonsillectomy, Microdebrider FESS
and Mastoidectomy and many more are aerosol generating procedures.
Adenotonsillectomy is particularly challenging with high risk to the
operating room personnel as the viral load is significantly high in the
nasopharynx and oropharynx. Evidence from China shows us that the
pandemic could last for at least six months(2) and modifications of
techniques and adapting to the new norm is the key.
Some countries are now considering RTPCR as routine. The sensitivity of
the test is questioned with false negative rate of up to 30%(3)It is
therefore imperative to be cautious even in patients who are RTPCR
negative. We propose a technique of ‘WET’ (wash every time)
adenotonsillectomy with povidone iodine wash to minimise the viral load,
if any, to healthcare workers while performing adenotonsillectomy
surgery.