How Risky Is Surgical Smoke?

10 October 2017
Posted by Megan Ray Nichols.

Any surgery is a stressful and scary procedure for patients. While they can, and do, save many lives, things can go wrong during the procedure, the operations can exacerbate other underlying conditions and so on. However, surgeons have to deal with something patients might not even know exists: surgical smoke. But what is it, and what are the short and long-term effects on people?

What Is Surgical Smoke?

Sometimes referred to by the name Bovie smoke, surgical smoke is a byproduct of the specialised, powered tools surgeons use to cut and otherwise manipulate body tissue. Specifically, surgical smoke is the result of surgeons using devices that raise a patient’s intracellular tissue temperature to at least 212 degrees Fahrenheit and cause vaporisation.

The smoke is a typical component of most procedures: statistics show 95 percent of all surgeries produce surgical smoke to some degree.

Analysis has indicated surgical smoke is made up of 95 percent water and 5 percent other materials, including more than 80 known toxic ingredients. Many of these ingredients are carcinogenic. Some include dangerous body fluids, too. 

The Short-Term Effects

The exact symptoms surgeons experience as a result of surgical smoke vary depending on what’s inside it. Headaches, eye irritation, and soreness of the nose and throat are some of the symptoms that can arise shortly after exposure.

Surgeons often perform multiple operations throughout just one day. Many in-demand surgeons have very few breaks during their workdays, so they do not have adequate time to recover from some of those ailments that result due to the operating room environment.

Although irritating effects may dissipate once surgeons leave the operating room, headaches may persist for much longer. This could make it hard for surgical professionals to fully concentrate on the procedures that follow the initial incidence of exposure to the smoke.

Some people have raised concerns that surgical smoke could contain infectious viral or bacterial components that could contribute to the spread of disease once inhaled.

The long-term

Long-term, there is not much research into the effects of surgical smoke, but there are a few concerns that have been raised. One of the most common treatments for genital warts is electrocautery, and there are concerns that the smoke generated during the procedure could present risks of HPV, especially in outpatient facilities that are not properly set up to expel smoke.

Research has also shown surgeons get exposed to dangerous gases at a rate 20 to 30 times higher than what's present in an outdoor environment. As time spent inside operating rooms goes up, scientists are concerned that the cancer risk for workers rises, as well.

These collective risk factors have led to people within and outside of the health industry to argue in favor of more protections for individuals who regularly get exposed to surgical smoke due to their occupations.

What Can Hospitals Do to Keep Surgeons Safer?

Health facilities that include operating rooms aren’t completely ignoring how surgical smoke can harm surgeons. However, there are concerns that the methods hospitals currently employ are not doing enough.

For example, research has shown that the use of routine suction designed for elimination of liquids from the surgical field is not adequate to evacuate electrosurgical smoke and eliminate the health hazards associated with it. Evidence indicates wearing surgical masks reduces some of the risks related to the spread of diseases, but experts assert wearing protection over the nose and mouth should never be the only defense against the smoke.

Standard surgical masks can filter particles that are about five μm in size (about the tenth of the width of a human hair) but are not considered adequate for respiratory system protection. Surgical smoke particles are usually much smaller and can enter through gaps in a mask.

Instead, hospitals must install dedicated systems that remove smoke from operating rooms. There are published recommendations about how to keep operating rooms as hazard-free as possible through ventilation techniques, as well as suction and smoke evacuation systems.

As a study by the National Institute of Occupational Safety and Health unfortunately reports, despite ongoing knowledge that surgical smoke poses dangers to health professionals, facilities do not prioritise keeping operating rooms safer by using appliances that pull smoke from the area.

Those statistics come from the United States, but they paint an unsettling picture of what may be happening around the rest of the world. For example, a small study carried out in Turkey found that people who work in surgical settings generally don’t use respiratory equipment that’s effective in protecting from surgical smoke. They merely used standard masks without specialized filtration systems, which are inadequate to handle the effects of the smoke.

Furthermore, hospital managers often do not require operating room employees to go through training to keep them aware of what surgical smoke can do to a person’s well-being. The problem worsens when considering that many hospitals don’t conduct regular inspections to ensure they are sufficiently minimizing surgical smoke exposure. In these cases, the burden of reporting problems falls on health professionals.

Unfortunately, Ren Scott-Feagle, a Clinical Educator for Surgical Services at the University Medical Center of Southern Nevada in Las Vegas, NV says staff members often fail to recognize the dangers of microparticles.

To help improve our understanding of the dangers associated with surgical smoke, we need more research on its long-term effects. While we have evidence of its short-term impacts and knowledge of its prevalence, researchers haven’t yet conducted many long-term studies looking into the issue.

As Scott-Feagle has said, however, health organizations are ultimately responsible for making their workplaces safe and healthy. So far, hospitals only have voluntary guidelines to follow because there are no regulatory measures in place for managing the surgical smoke.

For real, lasting changes to happen, hospital facilities must recognize surgical smoke as a genuine risk for operating room employees. That’ll mean investing in the proper equipment and learning how to use it for best results. Ongoing education will need to teach workers how to practice personal protective measures that supplement the smoke removal methods of the specialized equipment.

Once those steps are in place — on a widespread basis — operating rooms will become safer for all the people who work in them. Existing data gives a strong indicator of the risks of smoke from surgeries, but it’s up to hospital administrators to take it seriously — and act accordingly. 


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