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Meretsky CR, Mahmoodi A, Knecht EM, Popovich J, Schiuma AT. The Impact of Electrocautery Smoke on Surgical Staff and the Efficacy of Normal Surgical Masks Versus N95 Masks. Cureus 2024; 16:e58106. [PMID: 38738122 PMCID: PMC11088792 DOI: 10.7759/cureus.58106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Electrocautery is a commonly used technique in surgical procedures, generating smoke that poses health risks to surgical staff. This study investigates the comparative efficacy of normal surgical masks versus N95 masks in mitigating the harmful effects of electrocautery smoke. Through a systematic review of literature spanning two decades, we explore the causes and effects of electrocautery smoke exposure, including potential long-term inhalation effects. Our findings highlight significant disparities in the protection offered by different masks and underscore the importance of adequate respiratory protection in surgical settings. In addition, we examine the factors influencing the generation and composition of electrocautery smoke, such as the power settings used, the type of tissue being cauterized, and the duration of the procedure. Furthermore, we discuss the potential health risks associated with long-term exposure to electrocautery smoke, including the possibility of respiratory conditions, cardiovascular effects, and carcinogenicity. Our analysis also addresses the importance of implementing appropriate smoke evacuation systems and optimizing operating room ventilation to minimize the concentration of smoke particles in the surgical environment. Overall, this comprehensive analysis provides valuable insights into the impact of electrocautery smoke in surgical settings and the varying levels of protection offered by different masks.
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Affiliation(s)
| | - Arshia Mahmoodi
- Surgery, St. George's University School of Medicine, Great River, USA
| | - Erik M Knecht
- Surgery, Chicago Medical School at Rosalind Franklin University, Chicago, USA
| | - Jay Popovich
- Internal Medicine, St. George's University School of Medicine, Great River, USA
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Canicoba ARB. Surgical smoke and occupational health. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1303. [PMID: 36660725 PMCID: PMC9843373 DOI: 10.21037/atm-22-5631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022]
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Zhang B, Guan Q, Zhu Y, Zhu J, Liu X, Li S, Yang R, Li X. Smoke analysis of a new surgical system that applies low-temperature plasma. ANNALS OF TRANSLATIONAL MEDICINE 2022; 10:1053. [PMID: 36330412 PMCID: PMC9622500 DOI: 10.21037/atm-22-608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/04/2022] [Indexed: 01/21/2023]
Abstract
Background The high-frequency electrotome (ES), which is widely used in surgical procedures, generates surgical smoke that is potentially hazardous to operating personnel. Previous research shows that the PlasmaBlade (PB) may be able to overcome this problem. The present study set out to analyze potentially hazardous surgical smoke generated during electrosurgery by the ES, the PB, and. a new surgical system that applies low-temperature plasma, the NTS-100. Methods In vitro and in vivo healthy porcine models were used to compare volatile organic compounds (VOCs) and particulate matter (PM) in smoke generated by the NTS-100, the PB, and the conventional ES when cutting liver, muscle, and skin and subcutaneous tissues. The detected indexes included the VOCs in surgical smoke, the concentration and percentage of each part, the PM2.5 concentration, the mass of particles, and the diameter distribution of particles. Results The smoke generated by the NTS-100 contained fewer hazardous components than that generated by the ES (P<0.05) and a comparable amount to that generated by the PB (P>0.05). The PM2.5 concentration and mass of particles in the smoke generated by the NTS-100 were lower than those with the ES (P<0.05 and P<0.01, respectively) and similar to those with the PB (P>0.05). The NTS-100 generated larger particles than did the ES and the PB (P<0.05). Conclusions Surgical smoke contains harmful VOCs and PM, but the NTS-100 generated less hazardous surgical smoke than did the conventional ES and performed comparably to the PB. Therefore, using the NTS-100 may reduce the potential hazard of surgical smoke to operating room personnel.
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Affiliation(s)
- Boya Zhang
- School of Medicine, Nankai University, Tianjin, China;,Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Qingyu Guan
- School of Medicine, Nankai University, Tianjin, China;,Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Yunsheng Zhu
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jingjin Zhu
- School of Medicine, Nankai University, Tianjin, China;,Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xiaohan Liu
- School of Medicine, Nankai University, Tianjin, China;,Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Shuaiqi Li
- School of Medicine, Nankai University, Tianjin, China;,Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Rungong Yang
- Department of Tissue Repair and Regeneration, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xiru Li
- Department of General Surgery, Chinese People’s Liberation Army General Hospital, Beijing, China
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Investigating surgical smoke in otolaryngology operating rooms. Sci Rep 2022; 12:1719. [PMID: 35110589 PMCID: PMC8810908 DOI: 10.1038/s41598-022-05701-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/10/2022] [Indexed: 01/02/2023] Open
Abstract
Surgical smoke is a common chemical hazard produced from the use of electrocautery, laser, or ultrasonic scalpels during surgery. It has been proved harmful to medical personnel. Thus, it is important to monitor surgical smoke concentrations in the operating room. In the past decade, many researches regarding surgical smoke were discussed in different professional healthcare fields, but few showed the correlation between surgical smoke and otolaryngology surgery. In this study, the concentrations of particulate matter and formaldehyde were measured during thirty cases of several types of otolaryngology surgery in a regional research hospital in Taiwan. The concentrations of 0.3 µm and 0.5 µm particulate matter raised rapidly in the main knife range at the beginning of the electrocautery knife used, and then decreased by half after 5-10 min of use. The concentrations of formaldehyde were ranged from 1 to 2 ppm during the surgery, which is higher than the permissible exposure limit. While many medical staffs are working in the operating room and are exposed to the smoke hazard, effective strategies for collecting and eliminating the smoke should be taken in all medical facilities.
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Vortman R, McPherson S, Cecilia Wendler M. State of the Science: A Concept Analysis of Surgical Smoke. AORN J 2021; 113:41-51. [PMID: 33377508 DOI: 10.1002/aorn.13271] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/26/2020] [Accepted: 07/09/2020] [Indexed: 12/29/2022]
Abstract
Surgical smoke has not been clearly defined in the literature and often is identified using surrogate terms (eg, plume). In January 2020, a literature search was performed and a principle-based concept analysis involving four general principles (epistemological, pragmatic, linguistic, and logical) was used to define surgical smoke and identify implications for perioperative personnel, patients, researchers, and policymakers. Surgical smoke is a visible plume of aerosolized combustion byproducts produced by heat-generating surgical instruments. It consists of water vapor and gaseous substances; can carry toxic chemicals, bacteria, viruses, and tumors; can obscure the surgical field; and can be inhaled. Surgical smoke has a distinctive noxious odor and can cause physical symptoms such as watery eyes and throat irritation. Perioperative leaders should promote protection from occupational harm by educating their staff members on the use of smoke evacuators to mitigate the effects of surgical smoke on perioperative patients and personnel.
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Mowbray NG, Ansell J, Horwood J, Cornish J, Rizkallah P, Parker A, Wall P, Spinelli A, Torkington J. Safe management of surgical smoke in the age of COVID-19. Br J Surg 2020; 107:1406-1413. [PMID: 32363596 PMCID: PMC7267397 DOI: 10.1002/bjs.11679] [Citation(s) in RCA: 137] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 04/09/2020] [Indexed: 12/21/2022]
Abstract
Background The COVID-19 global pandemic has resulted in a plethora of guidance and opinion from surgical societies. A controversial area concerns the safety of surgically created smoke and the perceived potential higher risk in laparoscopic surgery. Methods The limited published evidence was analysed in combination with expert opinion. A review was undertaken of the novel coronavirus with regards to its hazards within surgical smoke and the procedures that could mitigate the potential risks to healthcare staff. Results Using existing knowledge of surgical smoke, a theoretical risk of virus transmission exists. Best practice should consider the operating room set-up, patient movement and operating theatre equipment when producing a COVID-19 operating protocol. The choice of energy device can affect the smoke produced, and surgeons should manage the pneumoperitoneum meticulously during laparoscopic surgery. Devices to remove surgical smoke, including extractors, filters and non-filter devices, are discussed in detail. Conclusion There is not enough evidence to quantify the risks of COVID-19 transmission in surgical smoke. However, steps can be undertaken to manage the potential hazards. The advantages of minimally invasive surgery may not need to be sacrificed in the current crisis.
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Affiliation(s)
- N G Mowbray
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Ansell
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Horwood
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - J Cornish
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
| | - P Rizkallah
- School of Medicine, Cardiff University, Cardiff, UK
| | - A Parker
- School of Medicine, Cardiff University, Cardiff, UK
| | - P Wall
- Isca Healthcare Research, Caerleon, UK
| | - A Spinelli
- Department of General and Minimally Invasive Surgery, Istituto Clinico Humanitas, Rozzano, Italy
| | - J Torkington
- Department of General Surgery, University Hospital of Wales, Cardiff, UK
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Smith C, Srivastava D, Nijhawan RI. Optimizing Patient Safety in Dermatologic Surgery. Dermatol Clin 2019; 37:319-328. [DOI: 10.1016/j.det.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Lee T, Soo JC, LeBouf RF, Burns D, Schwegler-Berry D, Kashon M, Bowers J, Harper M. Surgical smoke control with local exhaust ventilation: Experimental study. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2018; 15:341-350. [PMID: 29283318 PMCID: PMC6460469 DOI: 10.1080/15459624.2017.1422082] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This experimental study aimed to evaluate airborne particulates and volatile organic compounds (VOCs) from surgical smoke when a local exhaust ventilation (LEV) system is in place. Surgical smoke was generated from human tissue in an unoccupied operating room using an electrocautery surgical device for 15 min with 3 different test settings: (1) without LEV control; (2) control with a wall irrigation suction unit with an in-line ultra-low penetration air filter; and (3) control with a smoke evacuation system. Flow rate of LEVs was approximately 35 L/min and suction was maintained within 5 cm of electrocautery interaction site. A total of 6 experiments were conducted. Particle number and mass concentrations were measured using direct reading instruments including a condensation particle counter (CPC), a light-scattering laser photometer (DustTrak DRX), a scanning mobility particle sizer (SMPS), an aerodynamic particle sizer (APS), and a viable particle counter. Selected VOCs were collected using evacuated canisters using grab, personal and area sampling techniques. The largest average particle and VOCs concentrations were found in the absence of LEV control followed by LEV controls. Average ratios of LEV controls to without LEV control ranged 0.24-0.33 (CPC), 0.28-0.39 (SMPS), 0.14-0.31 (DustTrak DRX), and 0.26-0.55 (APS). Ethanol and isopropyl alcohol were dominant in the canister samples. Acetaldehyde, acetone, acetonitrile, benzene, hexane, styrene, and toluene were detected but at lower concentrations (<500 μg/m3) and concentrations of the VOCs were much less than the National Institute for Occupational Safety and Health recommended exposure limit values. Utilization of the LEVs for surgical smoke control can significantly reduce but not completely eliminate airborne particles and VOCs.
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Affiliation(s)
- Taekhee Lee
- Exposure Assessment Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Jhy-Charm Soo
- Exposure Assessment Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Ryan F. LeBouf
- Field Study Branch Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Dru Burns
- Field Study Branch Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Diane Schwegler-Berry
- Pathology and Physiology Research Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Michael Kashon
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
| | - Jay Bowers
- West Virginia University Ruby Memorial Hospital, Morgantown, West Virginia
| | - Martin Harper
- Exposure Assessment Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, West Virginia
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Claudio CV, Ribeiro RP, Martins JT, Marziale MHP, Solci MC, Dalmas JC. Polycyclic aromatic hydrocarbons produced by electrocautery smoke and the use of personal protective equipment 1. Rev Lat Am Enfermagem 2017; 25:e2853. [PMID: 28301033 PMCID: PMC5363329 DOI: 10.1590/1518-8345.1561.2853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 11/14/2016] [Indexed: 11/22/2022] Open
Abstract
Objective analyze the concentration of polycyclic aromatic hydrocarbons in electrocautery smoke in operating rooms and the use of personal protective equipment by the intraoperative team when exposed to hydrocarbons. Method exploratory and cross-sectional field research conducted in a surgery center. Gases were collected by a vacuum suction pump from a sample of 50 abdominal surgeries in which an electrocautery was used. A form was applied to identify the use of personal protective equipment. Gases were analyzed using chromatography. Descriptive statistics and Spearman's test were used to treat data. Results there were 17 (34%) cholecystectomies with an average duration of 136 minutes, while the average time of electrocautery usage was 3.6 minutes. Airborne hydrocarbons were detected in operating rooms in 100% of the surgeries. Naphthalene was detected in 48 (96.0%) surgeries and phenanthrene in 49 (98.0%). The average concentration of these compounds was 0.0061 mg/m3 and a strong correlation (0.761) was found between them. The intraoperative teams did not use respirator masks such as the N95. Conclusion electrocautery smoke produces gases that are harmful to the health of the intraoperative team, which is a concern considering the low adherence to the use of personal protective equipment.
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Affiliation(s)
| | - Renata Perfeito Ribeiro
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Júlia Trevisan Martins
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Maria Helena Palucci Marziale
- PhD, Full Professor, Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Maria Cristina Solci
- PhD, Associate Professor, Departamento de Química, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - José Carlos Dalmas
- PhD, Associate Professor, Departamento de Estatística, Universidade Estadual de Londrina, Londrina, PR, Brazil
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