How should we safely handle surgical smoke?

Born, Hayley; Ivey, Chandra M.

doi:10.1002/lary.24624

Cited by 7 publications

(4 citation statements)

References 6 publications

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“…Overall, CO 2 laser use was associated with an increase in cumulative particles, and specifically in particles smaller than 2.5 μm, which is consistent with previous reports 29 . Surgical smoke exposure and its associated hazards to operating room staff have been previously discussed in the medical and occupational health literature 30 . One topic of consideration includes the potential for disease transmission from viral particles in smoke plumes generated by the CO 2 laser, though cited literature is scant and inconsistent 31 .…”

Section: Discussionsupporting

confidence: 89%

“…29 Surgical smoke exposure and its associated hazards to operating room staff have been previously discussed in the medical and occupational health literature. 30 One topic of consideration includes the potential for disease transmission from viral particles in smoke plumes generated by the CO 2 laser, though cited literature is scant and inconsistent. 31 Plume-derived papillomavirus DNA has been found to maintain infectious capability in bovine specimens, but not in human specimens.…”

Section: Discussionmentioning

confidence: 99%

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Aerosol Generation During Laryngology Procedures in the Operating Room

et al. 2021

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Objective: Severe acute respiratory syndrome coronavirus-2 spreads through respiratory fluids. We aim to quantify aerosolized particles during laryngology procedures to understand their potential for transmission of infectious aerosol-based diseases.Study Design: Prospective quantification of aerosol generation. Methods: Airborne particles (0.3-25 μm in diameter) were measured during live-patient laryngology surgeries using an optical particle counter positioned 60 cm from the oral cavity to the surgeon's left. Measurements taken during the procedures were compared to baseline concentrations recorded immediately before each procedure. Procedures included direct laryngoscopy with general endotracheal anesthesia (GETA), direct laryngoscopy with jet ventilation, and carbon dioxide (CO 2 ) laser use with or without jet ventilation, all utilizing intermittent suction.Results: Greater than 99% of measured particles were 0.3 to 1.0 μm in diameter. Compared to baseline, direct laryngoscopy was associated with a significant 6.71% increase in cumulative particles, primarily 0.3 to 1.0 μm particles (P < .0001). 1.0 to 25 μm particles significantly decreased (P < .001). Jet ventilation was not associated with a significant change in cumulative particles; when analyzing differential particle sizes, only 10 to 25 μm particles exhibited a significant increase compared to baseline (+42.40%, P = .002). Significant increases in cumulative particles were recorded during CO 2 laser use (+14.70%, P < .0001), specifically in 0.3 to 2.5 μm particles. Overall, there was no difference when comparing CO 2 laser use during jet ventilation versus GETA.Conclusions: CO 2 laser use during laryngology surgery is associated with significant increases in airborne particles. Although direct laryngoscopy with GETA is associated with slight increases in particles, jet ventilation overall does not increase particle aerosolization.

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Aerosol Generation During Laryngology Procedures in the Operating Room

et al. 2021

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“…The importance of containing laser plume expands beyond that of limiting exposure to viral infection 5 . Although the carcinogenic and cardiotoxic effects of laser plume remain theoretical in the absence of epidemiologic evidence, there is indirect evidence for the negative impact of environmental exposure to these substances.…”

Section: Discussionmentioning

confidence: 99%

“…High energy surgical devices such as laser and electrocautery produce plumes that contain cardiotoxic and carcinogenic aerosols as well as viable viral contaminants 1‐5 . Efforts to control spread of these substances include recommendations from the Centers for Disease Control and Prevention (CDC) to limit dispersion through use of smoke evacuators containing a suction unit 6…”

Section: Introductionmentioning

confidence: 99%

Laser plume containment during flexible transnasal laryngoscopy

Hoffman

Walsh

Pratt

et al. 2021

Laryngoscope Investig Oto

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Objective To evaluate a negative pressure microenvironment designed to contain laser plume during flexible transnasal laryngoscopy. Methods The Negative Pressure Face Shield (NPFS) was previously reported as well tolerated with initial use on 30 patients. Diagnostic transnasal laryngoscopy was performed on an additional 108 consecutive patients who were evaluated by questionnaires and sequential pulse oximetry. Further study addressed operative transnasal potassium‐titanyl‐phosphate (KTP) laser laryngoscopy with biopsy done on four patients employing the NPFS. Results The previously described NPFS version 3 (v.3), a transparent acrylic barrier with two anterior instrumentation ports, was modified by repositioning the side suction port closer to the level of the nose and deepening the lateral sides, squaring off the lower projection. A post‐procedure questionnaire employing a 5‐point Likert scale ranging from no symptoms (rating of 1) to intolerable (rating of 5) identified excellent patient tolerance of the new design (v.4), among 22 patients evaluated and similar in the comparison to the 116 patients using version 3. Among the 138 patients analyzed, only one patient rated the experience as greater than “mild claustrophobia.” 100% of patients answered either “none” or “mild” to the pain and shortness of breath questions. The NPFS (v.4) was then successfully used in four patients for laser laryngoscopy with biopsy of laryngeal papilloma (3/4) and hemorrhagic polyp (1/4). Post‐procedure questionnaire identified no shortness of breath (4/4), no claustrophobia (4/4), no pain (4/4) and no significant changes in pulse oximetry during use. Conclusion Extensive experience in performing diagnostic laryngoscopy with the NPFS directed design changes leading to successful use for transnasal flexible laser laryngoscopy with biopsy in a negative pressure microenvironment. Level of Evidence Level 2b (Cohort Study).

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Surgical smoke and the anesthesia provider

Swerdlow

2020

J Anesth

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How should we safely handle surgical smoke?

Cited by 7 publications

References 6 publications

Aerosol Generation During Laryngology Procedures in the Operating Room

Aerosol Generation During Laryngology Procedures in the Operating Room

Laser plume containment during flexible transnasal laryngoscopy

Surgical smoke and the anesthesia provider

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