SLR - April 2018 - Todd A. Hasenstein

The Dangers of Electrosurgical Smoke to Operating Room Personnel: A Review
Reference: Bree K, Barnhill S, Rundell W. The Dangers of Electrosurgical Smoke to Operating Room Personnel: A Review. Workplace Health Safety. 2017 Nov; 65(11): 517–526.

Scientific Literature Review

Reviewed By: Todd A. Hasenstein, DPM
Residency Program: Temple University Hospital, Philadelphia, PA

Podiatric Relevance:
Surgery is and will remain a large part of our profession. An important concept of surgery is hemostatic control, and there are multiple ways a surgeon can achieve it. The majority of surgeons utilize an electrocautery device in their practice. However, many tend to give little attention to the smoke produced by such devices. This article examines the health concerns that individuals in the operating room, including the surgeon, potentially face related to the exposure of smoke emitted from the use of electrocautery.

Methods: This is a level IV review article. The authors performed the review by executing a PubMed search for the following terms: electrosurgical smoke, electrocautery smoke, diathermy smoke and William Bovie. The timeframe for the search was set between 1981 to present (which is 36 years). Inclusion criteria for the articles were peer-reviewed publications, those published in English, discussion of the effects of electrosurgical smoke and discussion of methods for minimizing exposure to smoke. A total of 191 articles were identified, of which only 43 met the inclusion criteria.

Of the 43 articles included this study, 22 (51 percent) discussed the composition and harmful effects of the smoke, 12 (28 percent) discussed protection from the smoke and nine (21 percent) simply provided background information. Of the 43 articles, 15 (35 percent) listed the detection of at least one type of carcinogen within the electrocautery smoke. Three (7 percent) of the articles mentioned particle sizes within the smoke, while one particularly mentioned that 77 percent of the matter inside the smoke had a diameter of less than 1.1 µm (avg. diameter 0.07 µm). Four (9 percent) articles mentioned that particle sizes can be filtered by a mask, whereas one article stated that particle sizes smaller than 5 µm cannot be filtered by the mask and are therefore being inhaled. Three (7 percent) talked about the presence of bacterial and viral particles within the smoke, possibly leading to transmission of disease; with one study reporting detection of the virus particles in the surgical mask postoperatively. Lastly three (7 percent) of the articles directly compared electrocautery smoke to cigarette smoke, stating that smoke from 1 gram of tissue has the same mutagenic potential as smoking six cigarettes, and the amount of smoke produced in a plastic surgery case can be equivalent to 27 to 30 cigarettes.

Conclusion: Surgeons have exposure to electrocautery smoke on a weekly basis, if not more frequent. Recent literature, including this review, has started to mount significant evidence toward the potential harm this smoke could cause to operating room personnel. Some advocate for modification to filter systems in the operating room and more sophisticated personal protection devices. We encourage patients not to smoke to help with wound healing, yet we are potentially inhaling smoke with similar mutagenic potential. This review effectively emphasized what surgeons should be aware of regarding their health with respect to electrocautery smoke. 

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