Laser smoke effect on the bronchial system

Abstract

The photoresection of endobronchial tumors produces smoke which is partly inhaled by the patient as well as the surgical staff. In an animal study we investigated whether a single exposure or repetitive exposures to smoke might have harmful side effects on the airways. Eleven sheep were exposed to smoke produced by laser-vaporizing (6,500 J) sections of bronchial tissue (1 cm3) in a Plexiglas chamber. The smoke analysis revealed 0.92 mg/liter particles with a mean particle size of 0.54 micron. Carbon monoxide content was estimated as 0.04%. We measured the effects of one or three separate ten-minute exposures on airway resistance, gas exchange, and mucociliary clearance rate in the trachea. We found that the smoke inhalation resulted in a decrease of arterial PO2 with relatively little change in airway mechanics. Tracheal mucus velocity, a marker of lung mucociliary clearance, was significantly depressed in a dose-dependent manner with increasing smoke exposures. Results of bronchoalveolar lavages performed before and one day after the exposure showed that the smoke inhalation induced a severe inflammation with dramatic increases of inflammatory cells. The total number of cells per milliliter lavage return increased from 3.2 million to 25 million; percent neutrophils increased from 2.3 to 45.6% and percent macrophages decreased from 86 to 41%. These findings indicate that the side effects of smoke inhalation during intrabronchial laser surgery should not be neglected. The impairment of the defense mechanism of the lung combined with the inflammation as well as hypoxia might be fatal in compromised patients. Effective smoke removal devices should be developed to protect the patient as well as the surgeon.

Operating room nursing and lung cancer risk in a cohort of female registered nurses

“…Other laboratory studies have demonstrated that smoke from both electrocautery and laser surgery is mutagenic to certain strains of Salmonella typhimurium (16,17). Animal studies have shown that repeated exposure to high levels of surgical smoke can induce inflammatory pulmonary changes, including emphysema and bronchiolitis (18)(19)(20)(21). Despite these laboratory and animal data, there are no population-based studies available to suggest whether or not repeated exposure to surgical smoke can induce carcinogenesis or chronic inflammation in humans.…”

“…Laboratory and animal studies indicate that surgical smoke has mutagenic potential and can induce inflammatory pulmonary changes in animals after repeated exposure (16)(17)(18)(19)(20)(21). On the basis of an in vitro assay, Tomita et al (16) estimated that the smoke produced during laser irradiation or electrocauterization of 1 gram of tissue is equivalent to three to six cigarettes in mutagenic potential.…”

Is It Time for a More Systematic Approach to the Hazards of Surgical Smoke?: Reconsidering the Evidence

“…Two studies on animals revealed decreased ciliary action and increased inflammatory responses in the lungs (Freitag, Chapman, Sielczak, Ahmed, & Russin, 1987) as well as histological lung changes (Wenig, Stenson, Wenig, & Tracey, 1993). Other studies have reported similarities between surgical smoke and the adverse effects of air pollution and passive cigarette smoke (Barrett & Garber, 2003;Brüske-Hohlfeld et al, 2008;Ulmer, 2008;Weston et al, 2009).…”

“…Surgical smoke showed mutagenicity in Salmonella. Freitag, et al 1987 Eleven sheep were exposed to surgical smoke for 3 ten minute exposures to identify changes in lung function.…”

Safety Concerns Regarding the use of Dental Lasers

“…Inhalations of these toxic aerosols have been found to be potentially damaging to the respiratory system. 18,19 Ablation of the infectious tissue poses an even …”