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Present the evidence
The list of chemicals found in surgical smoke, as detailed in an influential study (tinyurl.com/l3w6cdy) by William Barrett, MD, and Shawn Garber, MD, is eye-opening. Of these, say Drs. Barrett and Garber, carbon monoxide, acrylonitrile, hydrogen cyanide, formaldehyde and benzene are especially worrisome.
The most common misconception regarding surgical smoke is among perioperative team members who claim they've been exposed to surgical smoke for years and had no ill effects. They often fail to connect their respiratory problems to smoke exposure. But one study found that perioperative nurses are twice as likely as the general population to develop respiratory issues.
Patients face risks, too, including having malignant cells transplanted to other tissues during laparoscopic procedures and increased risk of methemoglobin and carboxyhemoglobin, which can lead to hypoxia and decreased oxygen perfusion
of tissues.
Unfortunately, there's often a lack of multidisciplinary support for smokeevacuation efforts — many surgical team members simply continue to resist using smoke evacuators. One reason is there's a learning curve with some products — ESU pencils that have integrated tubing to evacuate smoke, for example. They can be difficult to maneuver in small spaces and the profile is larger at the tip. The cost can also be hard to swallow. Surgical pencils with integrated tubing cost 8 to 10 times as much as standard ESU pencils. Surgeons and facility leaders typically prefer to use resources on other products.
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NASTY HABIT Every plume of surgical smoke is
likely to contain numerous hazardous substances.
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For those reasons and others, the overall situation appears to be improving little, if at all. Ben Edwards and Robert Reiman, MD, surveyed a random sample of AORN members in 2007 and again in 2010. They found
