Odor of Surgical Smoke

When surgical smoke is generated, an awful, offensive odor is produced by the inorganic and organic compounds that are created. Inorganic compounds, such as carbon monoxide, carbon dioxide, sulfur, and nitrogen, can lead to hypoxia if inhaled. Organic compounds, such as acrolein, benzene, and polycyclic and aromatic hydrocarbons, can lead to nausea, headaches, and fatigue. The odor is from the combination of these toxic gases that are found in trace amounts in the plume; however, the cumulative effect makes surgical smoke an inhalation hazard. Some of these toxic gases, such as benzene and formaldehyde, are also known carcinogens, so continual inhalation of these gases must be avoided (Ball, 2007; Ulmer, 2008).

The Centers for Disease Control and Prevention (CDC) (2006) has warned health care professionals that the toxic gases produced within surgical smoke can cause eye irritation. Providers wearing contact lenses may have difficulty if exposed to a lot of surgical smoke; therefore adequate smoke evacuation practices must be in place.

Size of Particulate Matter

The size of the particles within surgical smoke has been shown to be extremely small. Mihashi et al (1981) found that 77% of the particles in smoke are less than 1.1 μm in size. If inhaled, these particles can be carried to the bronchioles and alveoli of the lungs, where they can cause respiratory problems (Taravella et al, 2001). The mean particle size of smoke particulate produced by electrosurgical energy is approximately 0.07 μm in size, whereas laser plume particulate is approximately 0.31 μm in size (Bigony, 2007; Ulmer, 2008).

Baggish et al (1988) conducted research involving laboratory rats inhaling surgical smoke with and without the use of a smoke evacuator to filter the plume. The rats breathing in filtered plume had no lung changes, whereas the rats inhaling surgical smoke that was not filtered by a smoke evacuator developed hypoxia and other respiratory problems. This research demonstrated that smoke evacuation systems are effective if used properly.

Many surgical team members today have reported respiratory problems that may be connected to the inhalation of surgical smoke (Ball, 2009). Latex allergies and sensitivities have often been associated with repeated exposure to latex. In much the same way, allergies or respiratory conditions may be attributed to the continual exposure to surgical smoke.

Potential Viability

Of great concern is the potential for the transmission of viable organisms within surgical smoke. Garden et al (2002) conducted a classic research study on the probability of transmission of viable particulate during laser surgery. Laser energy was used to vaporize lesions on a cow. In the surgical smoke, intact DNA for bovine papilloma virus was identified. This intact DNA was then injected into another area of the cow, which led to the growth of more viral lesions. The cow was injected with the infective particulate; the cow did not inhale it. Results note that there is a high potential for the transmission of viable organisms within surgical smoke. Other studies have been conducted that have demonstrated similar results (Sawchuck et al, 1989; Bigony, 2007).

There are many anecdotal stories related today about health care professionals contracting a disease similar to that of their patients. Surgical smoke has been implicated as the carrier that can potentially transmit disease from the patient to the provider. Hallmo and Naess (1991) reported that a 44-year-old surgeon in Norway became hoarse after years of inhaling surgical smoke from the vaporization of condyloma. When biopsies of the surgeon’s lesions were performed, examination revealed the presence of the same DNA strain as is found in anogenital warts, not normally found in the throat. The theory is that surgical smoke that is not evacuated can spread disease to another host.

Laparoscopic Plume

When a laparoscopic procedure is performed using a hot tool, such as the laser or electrosurgery device, surgical smoke is created within the abdominal cavity. Visibility is obscured, making the surgery difficult and sometimes unsafe to perform. When the smoke is directly evacuated, the CO₂ gas pressure is decreased and the pneumoperitoneum that is needed for proper visualization is compromised. Performing a laparoscopic procedure requires the delicate balance between smoke evacuation and insufflation to maintain the pneumoperitoneum.

Ott et al (1997) performed a research study to determine the reason for postoperative laparoscopic patients’ complaints of headaches, nausea, or vision problems. When surgical smoke was not evacuated during the laparoscopy, the patients with untoward symptoms also had an increase in blood methemoglobin and carboxyhemoglobin. When these elements increase, the oxygen-carrying capabilities of the patient’s red blood cells decrease, leading to symptoms of nausea, headaches, and visual problems. When the surgical smoke is properly evacuated during laparoscopy, the patient does not complain of these symptoms postoperatively and an increase in methemoglobin or carboxyhemoglobin is not detected. Therefore, to prevent the patient from absorbing the byproducts of combustion during laser or electrosurgery, proper smoke evacuation methods must be employed.