State of the Science: A Concept Analysis of Surgical Smoke

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.

Design of an ultrasonic scalpel acoustic system

“…As an advanced surgical instrument, ultrasonic scalpel can be used in various soft tissue anatomical operations [1][2][3] . Compared with traditional scalpels, ultrasonic scalpels have higher cutting accuracy, less release of toxic surgical smoke [4] , and can reduce the probability of safety hazards such as implanted electronic device failures [5] . Therefore, relevant scholars have conducted a lot of research on ultrasonic scalpel.…”

Operating room nurses' perceptions of the impact of surgical smoke and its countermeasures: A mixed‐methods study

“…Additionally, the National Institute for Occupational Safety and Health (2017) has proposed local exhaust ventilation in the OR as a method for the immediate elimination of surgical smoke. Despite such proposals, only two states in the United States -Rhode Island and Coloradohave laws requiring surgical smoke control and mitigation, while nine other states (Georgia, Oregon, Tennessee, Illinois, Iowa, Kentucky, Utah, Connecticut, and New Jersey) are currently introducing similar legislation (Vortman et al, 2021). These acts require all state-licensed hospitals and ambulatory surgery centers to use smoke evacuation systems during procedures that generate surgical smoke.…”

The case for compulsory surgical smoke evacuation systems in the operating theatre

“…The remainder is particulate matter that can contain blood fragments, bacteria, viruses, viable cancer cells, and gases that are known carcinogens, teratogens, and mutagens such as benzene, toluene, acetylene, xylene, and hydrogen cyanide. 1,3 Experimental evidence has also shown that surgical smoke can carry human coronavirus RNA, suggesting a possibility that SARS-CoV-2 (COVID-19) could also be present; 4 however, at the time of writing there is no evidence of transmission.…”