‘The air that we breathe’: Assessment of laser and electrosurgical dissection devices on operating theater air quality

Brace, Matthew D; Stevens, Elizabeth; Taylor, S. Mark; Butt, Sarah; Sun, Zhennan; Hu, Licai; Borden, Megan; Khanna, Neeraj A.; Kuchta, James; Trites, Jonathan; Hart, Robert D.; Gibson, Mark

doi:10.1186/s40463-014-0039-1

Cited by 12 publications

(23 citation statements)

References 30 publications

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“…recommendation of 30-55% relative humidity by the Health Canada 2008 Indoor Air Quality Guidelines [37], the OR air ranged 22-23%, while hallway air had a relative humidity of 26%. While these measures are low by indoor air standards [38], they do fall within the accepted range of 20-60% for health care facilities recommended by the American Society of Heating, Refrigerating, and Air Conditioning Engineers Standard [34,40]. For OR personnel, this may lead to airway irritation from dryness, independent of chemical or particulate content of the air.…”

Section: Discussionmentioning

confidence: 99%

“…These surgeries routinely require the use of electrocautery, carbon dioxide (CO 2 ) and potassium titanyl phosphate (KTP) lasers, as well as ultrasonic scalpels. [40] NO 2 ≤ 100 μg/m 3 (≤0.05 ppm) over a 24 hour period (Health Canada, 2012) [40] ≤ 480 μg/m 3 (≤0.25 ppm) over a 1 hour period (Health Canada, 2012) [40] SO 2 ≤ 50 μg/m 3 (≤0.019 ppm) (Health Canada, 2012) [40] Fine particle number count* -Coarse particle number count* -Relative humidity 30% to 55% (Health Canada, 2008) [37] Indoor temperature 17 to 27°C (Balaras et al, 2006) [38] CO 2 ≤ 6300 mg/m 3 (≤3500 ppm) (Health Canada, 2012) [40] Canadian indoor air quality exposure limit guidelines. *No current guidelines exist for ultrafine, fine, or coarse particle number counts.…”

Section: Methodsmentioning

confidence: 99%

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`The air that we breathe¿: assessment of laser and electrosurgical dissection devices on operating theater air quality

Brace

Stevens

Taylor

et al. 2014

J Otolaryngol - Head Neck Surg

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Objectives: To measure changes in air quality during surgery.Methods: Operating room (OR) and hallway air quality was continuously monitored over a 3-month period. Rooftop monitoring was used to control for environmental changes and to account for the infiltration of outdoor air pollutants. Air quality measurements were correlated with operative times and electro-dissection equipment used.Results: OR air is cooler and drier compared to the adjacent hallway. Volatile organic compounds and other gases are below indoor air exposure limit guidelines. Lasers create greater 2.5 μm particulate matter (PM 2.5 ) mass concentration, and greater fine and coarse particle number than cautery or cold tissue dissection. Cautery produces more ultrafine particles (UFP) than other dissection techniques. OR air has lower particle counts than outdoor environmental air by virtue of air conditioning HEPA filtration. Conclusion:Compared to the outside air, operating room air has lower particle counts. Lasers produce higher concentrations of PM 2.5 mass and, fine and coarse particle number counts. Cautery produces higher concentrations of UFP number counts than other modalities and warrants consideration of the use of masks with ultrafine particle filtration capacity. Operating room air is consistently cooler with decreased humidity, which may cause airway irritation.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

`The air that we breathe¿: assessment of laser and electrosurgical dissection devices on operating theater air quality

Brace

Stevens

Taylor

et al. 2014

J Otolaryngol - Head Neck Surg

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“…1 Extensive use of electrosurgical tools during surgical procedures creates a large quantity of surgical smoke. 2,3 Surgical smoke can contain chemicals (polycyclic aromatic hydrocarbons), bacteria, and viruses that are harmful and increase the risk of infection for surgeons and the operating team due to long-term exposure in the coronavirus disease 2019 (COVID-19) age. [1][2][3][4] Best practices should consider the operating room setup, patient movement, and operating theater equipment when developing a COVID-19 operating protocol.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 Surgical smoke can contain chemicals (polycyclic aromatic hydrocarbons), bacteria, and viruses that are harmful and increase the risk of infection for surgeons and the operating team due to long-term exposure in the coronavirus disease 2019 (COVID-19) age. [1][2][3][4] Best practices should consider the operating room setup, patient movement, and operating theater equipment when developing a COVID-19 operating protocol. [3][4][5] Devices that remove surgical smoke, including extractors, filters, and nonfilter devices, are necessary to improve the safety of the surgical team.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Best practices should consider the operating room setup, patient movement, and operating theater equipment when developing a COVID-19 operating protocol. [3][4][5] Devices that remove surgical smoke, including extractors, filters, and nonfilter devices, are necessary to improve the safety of the surgical team. [3][4][5][6][7] Electrosurgery units should be set to the lowest possible settings for the desired effect.…”

Section: Introductionmentioning

confidence: 99%

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Low‐cost, safe, and effective smoke evacuation device for surgical procedures in the COVID‐19 age

Andrade

Gonçalves²,

Medeiros

et al. 2020

Journal of Surgical Oncology

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Background Smoke is generated by energy‐based surgical instruments. The airborne by‐products may have potential health implications. Methods We developed a simple way to use de conventional surgical evacuator coupled with de electrosurgical pen attached to a 14G bladder catheter for open surgery. It was used in ten prospective patients with breast cancer. Results We notice a high reduction in surgical smoke during all breast surgery. A questionnaire was used for all participants of the surgery to answer the impression that they had about the device. The subjective impression was that the surgical smoke in contact whit the surgical team was reduced by more than 95%. Conclusions Surgical smoke is the gaseous by‐product produced by heat‐generating devices in various surgical procedures. Surgical smoke may contain chemicals particles, bacteria, and viruses that are harmful and increase the risk of infection for surgeons and all the team in the operation room due to long term exposure of smoke mainly in coronavirus disease 2019 age. The adapted device described is a very simple and cheaper way to use smoke evacuators attached with the monopolar electrosurgical pen to reduce smoke exposure to the surgical team worldwide.

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Surgical Smoke Exposure in Operating Room Personnel

2019

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t is widely accepted that inhalation of smoke, specifically, the particulate matter (PM) found within smoke, can cause adverse effects on health. When diathermy devices, such as electrocauterization instruments, lasers, and ultrasonic scalpels, are used during surgery, surgical smoke, also called cautery smoke, surgical plume, laser plume, and diathermy plume, is released into the ambient environment. This process occurs in open surgery as well as laparoscopic surgery, as ports are often vented into the atmosphere. There is a lack of studies regarding the long-term effects of surgical smoke; findings from such studies may inform methods to prevent adverse outcomes on the health of operating room personnel. There are several other forms of smoke that the general population encounters, including secondhand smoke, cooking smoke, and environmental pollution. There have been more in-depth studies on these forms of smoke than of surgical smoke, and they can help bolster the present knowledge of the danger of surgical smoke.Although smoke evacuation devices exist, they are not often used in practice owing to inconvenience and lack of awareness. A study done in 2016 reported that 14% of operating room personnel always used local exhaust ventilation during electrosurgery. 1 These respon-dents were also more likely to report training and employer standard procedures regarding the hazards of surgical smoke. The largest difference in consistent use of local exhaust ventilation was attributed to knowledge and training on the hazards of surgical smoke. 1 Most operating room staff acknowledge adverse symptoms (eg, coughing, headache) from surgical smoke, yet few wear effective personal protection. 2 Although multiple health organizations, such as the Occupational Safety and Health Administration and the National Institute for Occupational Safety and Health, have created guidelines regarding exposure to surgical smoke, no laws mandate that protective measures be taken. 3,4 However, there has been increasing research and awareness of the harmful effects of surgical smoke on operating room personnel, leading to a push to increase regulation of surgical smoke exposure, for example, in the California legislature. 5 Signs regarding the dangers of surgical smoke can be found outside the operating room. 6 The medical community is becoming more sensitive to the possible hazards of surgical smoke exposure. 7 While emphasizing the importance of using current evacuation techniques is important, there are new modalities that could improve smoke evacuation beyond the simple vacuum and filter system. IMPORTANCE Smoke generated during surgical procedures has long been thought to be hazardous to hospital personnel; however, the degree of danger has yet to be determined.OBSERVATIONS The dangers of surgical smoke are associated with the composition of the plume. Small-particulate matter is found in the smoke that is easily inhaled. Particulates deposit in the lungs, circulatory system, and other organs, which may cause numerous health problems....

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‘The air that we breathe’: Assessment of laser and electrosurgical dissection devices on operating theater air quality

Cited by 12 publications

References 30 publications

`The air that we breathe¿: assessment of laser and electrosurgical dissection devices on operating theater air quality

`The air that we breathe¿: assessment of laser and electrosurgical dissection devices on operating theater air quality

Low‐cost, safe, and effective smoke evacuation device for surgical procedures in the COVID‐19 age

Surgical Smoke Exposure in Operating Room Personnel

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