Management of Surgical Smoke Tool Kit Part II: The Hazards of Surgical Smoke

There are five slide decks related to the management of surgical smoke in the perioperative setting. It is recommended to review the slide decks in order. This is Part II. Part I: Introduction to Surgical Smoke Part II: The Hazards of Surgical Smoke Part III: An Overview of Health Care Regulations, Standards, and Guidelines Related to Surgical Smoke Part IV: Smoke Evacuation in the Perioperative Setting Part V: Additional Perioperative Nursing Care Instructions to the Learner

The Hazards of Surgical Smoke Part II

Patients Perioperative Team Members Others (anyone in the procedure room) Inhalation and Exposure Potential to Harm

Odor Particulate Matter Viable/non-viable virus or bacteria Hazards

Using the CO2 laser on one gram of tissue is like inhaling the smoke from three cigarettes in 15 minutes. Using ESU on one gram of tissue is like inhaling smoke from six cigarettes in 15 minutes. Tomita Y, et al Inhaling Surgical Smoke

Acetaldehyde*** Acrolein Acrylonitrile** Benzene** Butadiene*** Carbon monoxide Cyanide Ethanol Formaldehyde** Hydrogen cyanide Methane Phenol Polycyclic aromatic hydrocarbons* Toluene *** Carcinogen ** Potential Carcinogen * Increased risk of certain cancers Pierce JS, et al Examples of Toxic Substances found in Surgical Smoke

Carbonized tissue Blood Intact virus and bacteria human immunodeficiency virus (HIV) human papilloma virus (HPV) hepatitis Particulate Matter

Particle Sizes Figure 2. Particle sizes and associated type of protection against pathogens and atmospheric hazards commonly found in hospital environments. The boxes with the dotted background are airborne- transmissible diseases. Reprinted with permission from the AORN Journal. Copyright © 2013, AORN, Inc, 2170 S. Parker Road, Suite 400, Denver, CO All rights reserved. Citation: Benson SM, Novak DA, Ogg MJ. Proper use of surgical N95 respirators and surgical masks in the OR. AORN J. 2013;97(4):

Smoke is evenly distributed throughout the OR Smoke particles can travel about 40 mph When ESU is activated, the concentration of the particles can rise from 60,000 particles/cubic feet to over 1 million particles/cubic feet It takes 20 min after the activation of the ESU for the concentration will return to the baseline level. Nicola JH, et al Particle Distribution

Chemical composition of gases surgeons are exposed to during endoscopic urological resections. (Weston et al. 2009) Occupational hazards facing orthopedic surgeons. ( Lester et al. 2012) Surgical smoke - a health hazard in the operating theatre: a study to quantify exposure and a survey of the use of smoke extractor systems in UK plastic surgery units. (Hill et al. 2012) Surgical smoke evacuation guidelines: Compliance among perioperative nurses. ( Ball, 2010) Surgical smoke and the dermatologist. (Lewin et al Sept 2011) Surgical Smoke: It’s a Universal Concern

Patient Safety

Laparoscopic procedures present unique exposures to smoke to the patient. Patient Safety: Exposures to Surgical Smoke

Minimally Invasive Surgery (MIS) Levels of carboxyhemoglobin of patients who underwent laparoscopic procedures using laser were significantly elevated

Pulse oximeter readings may be falsely elevated and could result in unrecognized patient hypoxia Laparoscopic Surgical Procedures

Carbon monoxide levels increase in the peritoneal cavity and exceed recommended exposure limits Laparoscopic Surgical Procedures

Exposure to carbon monoxide Increased levels of carboxyhemoglobin Occurrence of methemoglobin Loss of visibility in the surgical field or potential delay of the procedure Port site metastasis Exposure to Surgical Smoke during MIS: Risks to Patients

Exposure to carbon monoxide Increased levels of carboxyhemoglobin Occurrence of methemoglobin Loss of visibility in the surgical field or potential delay of the procedure Port-site metastasis Exposure to Surgical Smoke during MIS: Risks to Patients

Health Care Worker Safety

“Each year, an estimated 500,000 workers, including surgeons, nurses, anesthesiologists, and surgical technologists, are exposed to laser or electrosurgical smoke.” Laser/Electrosurgery Plume. Occupational Safety and Health Administration (OSHA) Quick Takes. United States Department of Labor (accessed July 22, 2015) Worker Safety: Exposures to Smoke/Plume

Long time exposure to fine particulate air pollution is associated with incidence of cardiovascular disease and death among postmenopausal women Miller KA, et al Air Pollution and Women

Eye, nose, throat irritation Headaches Nausea, dizziness Runny nose Coughing Respiratory irritants Fatigue Skin irritation Allergies Health Effects Reported by Healthcare Workers

Respiratory Problems Perioperative nurses have twice the incidence of many respiratory problems as compared to the general population. Allergies – Sinus infections/problems – Asthma – Bronchitis Ball, 2010

44-year old laser physician developed laryngeal papillomatosis Biopsy identified the same virus type as anogenital condyloma Hallmo P, et al Case Report

Health effects to the perioperative team When pneumoperitoneum is released into the OR without filtration Important to use a filtering device or a closed evacuation system Exposure to Surgical Smoke during MIS: Perioperative Team Members

Surgical smoke is a hazard to patients and the health care providers Particulate matter in surgical smoke can contain carbonized tissue, blood, and intact virus and bacteria (e.g. HIV, HPV, Hepatitis) Patients and health care providers are also at unique risks during minimally invasive surgical procedures related surgical smoke Summary Part II

Please continue to the next slide deck: Part III Part I: Introduction to Surgical Smoke Part II: The Hazards of Surgical Smoke Part III: An Overview of Health Care Regulations, Standards, and Guidelines Related to Surgical Smoke Part IV: Smoke Evacuation in the Perioperative Setting Part V: Additional Perioperative Nursing Care End of Part II