The Danger of Surgical Smoke

The Danger of Surgical Smoke
AP Photo/Nam Y. Huh
The Danger of Surgical Smoke
AP Photo/Nam Y. Huh
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Smoking is no longer allowed in hospitals, but that doesn't mean that hospitals are smoke-free. A surprising amount is produced during surgeries that utilize electronic, laser, drilling, or ultrasonic tools to cut or cauterize tissue, roughly 85% of all surgical procedures performed in the U.S.

"Contents of surgical smoke have been described as particulate matter that contains blood, and potentially infectious viruses and bacteria," Donna Watson, a 30+ year veteran perioperative nurse, said. "An additional component is the various potentially hazardous chemicals found in surgical smoke."

"Some examples of the chemicals contained in surgical smoke include acrylonitrile and hydrogen cyanide," she added. "Acrylonitrile is a volatile, colorless chemical that can be absorbed through the skin and lungs. Acrylonitrile liberates hydrogen cyanide. Hydrogen cyanide is toxic, colorless and can also be absorbed into the lungs, through the skin and via the gastrointestinal tract."

Burned muscle from a pig after the use of an electrosurgical device.

Surgical smoke can burn the eyes, irritate the lungs, and even transmit disease.

According to the CDC, "Transmission of human papillomavirus (HPV) through surgical smoke from lasers has been documented. Over one-half million healthcare workers including surgeons, nurses, surgical technologists, and others are exposed to surgical smoke each year."

Fascinatingly, the liver seems to produce the most surgical smoke particles, far more than any other bodily tissue. This could have something to do with its key functions as a blood reservoir and a detoxification center. Fat, skin, and brain tissue produce the least surgical smoke.

Adequate ventilation and dedicated smoke evacuation systems in operating rooms may be the best defenses against surgical smoke. Masks can block some of the particles but many are small enough to seep through and be inhaled. Harmonic scalpels that use ultrasonic vibrations to cut and cauterize tissue can also lessen the amount of smoke created. The rise of robot surgery takes doctors, nurses, and other medical personnel out of surgical smoke's harmful plume, but does not minimize the risk to patients.

There are currently no specific OSHA standards regulating surgical smoke, and the long-term effects of chronic exposure are presently unknown.


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