Technique
Once the patient is listed for Adenotonsillectomy, patients have to be screened in the OPD for history and for symptoms suggestive of COVID-19. This is done by a questionnaire as per institutional protocol. (Although we started ENT surgeries with COVID RTPCR screening initially, the current ICMR guidelines precludes routine screening). Patients needing adenotonsillectomy as per international guidelines are chosen for surgery. It is ensured that the patient does not have other comorbidities (Diabetes, Hypertension) especially thyroid illness. A preoperative surgical consent and COVID-19 consent are obtained from the patient (or parent). Patient is asked to gargle his/her mouth with 2% povidone iodine gargle three days before and just before shifting to the operating room. All the staff in operating room must wear the recommended PPE (personal protective equipment) which includes a cover all gown (2 layers), an N-95 mask or Respirators, gloves, and an eye cover. Intubation is done with standard anaesthetic precautions using an intubation Box. The patient is then positioned in Tonsillectomy position.
After application of a throat pack, a 2.5% povidone iodine is applied in the oral cavity and Nasal cavity for five minutes. Adenoidectomy is done using suction diathermy and tonsillectomy is done using bipolar dissection to minimize bleeding and blood flash. Throughout the surgery, 2.5 % povidone iodine solution is flushed with a syringe into the operating field, (oral cavity and nasal cavity for Adenoidectomy), and is suctioned out intermittently(Figure 1). The surgery in carried out in the small pool of povidone iodine solution. Complete haemostasis is achieved and extubation is carried out with aerosol precautions. The patient is sent home the next day with antibiotics and Quarantine instructions.