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.