Measurement of particulate matter 2.5 in surgical smoke and its health hazards.

PURPOSE: Surgical smoke is generated during the cauterization, coagulation, and incision of biological tissues by electrocautery, ultrasonic coagulation, incising devices, and lasers. Surgical smoke comprises water, water vapor, steam, and some particulate matter, including bacteria, viruses, cell fragments, and volatile organic compounds, which can pose health risks to the operating room personnel. In this study, we measured the concentration of particulate matter 2.5 (particles with a diameter of ≤ 2.5 µm) in surgical smoke. METHODS: We used digital dust counters for real-time monitoring of particulate matter 2.5 generated intraoperatively in breast and gastrointestinal surgeries performed at our hospitals between 2019 and 2020. RESULTS: Concentrations of particulate matter 2.5 were measured in surgical smoke generated when performing 14 different surgeries. Immediately after electrocautery, the concentration of particulate matter 2.5 increased to 2258 µg/m3 and then, when we stopped using the devices, it decreased rapidly to the initial levels. Interestingly, the concentrations increased after each intermittent electrocautery procedure. Higher concentrations of particulate matter 2.5 were observed during breast surgeries than during laparoscopic procedures. CONCLUSION: Surgical smoke poses potential health risks to operating room personnel by contaminating their breathing zone with high concentrations of particulate matter 2.5. A local exhaust ventilation system is needed to reduce exposure.

Haemostatic devices in parotid surgery: a systematic review.

OBJECTIVE: The Harmonic Scalpel and Ligasure (Covidien) devices are commonly used in head and neck surgery. Parotidectomy is a complex and intricate surgery that requires careful dissection of the facial nerve. This study aimed to compare surgical outcomes in parotidectomy using these haemostatic devices with traditional scalpel and cautery. METHOD: A systematic review of the literature was performed with subsequent meta-analysis of seven studies that compared the use of haemostatic devices to traditional scalpel and cautery in parotidectomy. Outcome measures included: temporary facial paresis, operating time, intra-operative blood loss, post-operative drain output and length of hospital stay. RESULTS: A total of 7 studies representing 675 patients were identified: 372 patients were treated with haemostatic devices, and 303 patients were treated with scalpel and cautery. Statistically significant outcomes favouring the use of haemostatic devices included operating time, intra-operative blood loss and post-operative drain output. Outcome measures that did not favour either treatment included facial nerve paresis and length of hospital stay. CONCLUSION: Overall, haemostatic devices were found to reduce operating time, intra-operative blood loss and post-operative drain output.

Precision silver nitrate cautery of the posterior nasal cavity.

BACKGROUND: This technical note describes a novel method of cauterising the posterior nasal cavity through the use of a plastic straw and silver nitrate. OBJECTIVE: This technique aims to prevent unwanted damage to surrounding nasal mucosa. METHODS: Once the nasal cavity has been prepared for cauterisation, the silver nitrate stick is navigated to the bleeding point covered by the plastic straw. The silver nitrate stick is then advanced onto the bleeding point allowing precise cauterisation of the nasal mucosa, without effecting surrounding healthy mucosa.

Knowledge about the effects of electrosurgery smoke among operating room nurses during COVID-19 Pandemic: A Cross-Sectional Study.

BACKGROUND: Electrosurgery smoke is the smoke emitted from tissue cauterization when using the electrosurgery device. Accordingly, in this smoke, more than 80 harmful toxins have been discovered. In the current study, we aimed to investigate the level of knowledge reported by the operating room nurses on the effects of electrosurgery smoke during the current COVID-19 pandemic. METHODS: This descriptive, survey-based cross-sectional study was performed on 533 OR nurses in all the referring hospitals of COVID-19 infection. The required information were collected using a questionnaire regarding the knowledge on the side effects of electrosurgery smoke. The obtained data were then analyzed using t-test and ANOVA by SPSS software. RESULTS: Most of the included participants (93.6%) had a low level of awareness and only a small number of them (0.4%) had a good level of knowledge on the effects of electrosurgery smoke. As well, a significant relationship (P˂0.05) was found between the level of knowledge reported by the OR nurses and the type of hospital (educational or private). Most of the studied hospitals used no electrosurgery smoke reduction equipment during electrosurgery. CONCLUSION: The level of knowledge reported by the OR nurses was generally poor. It is recommended that managers and health officials try to increase the level of awareness of OR nurses during the COVID-19 pandemic by providing standard and protective equipment as well as holding some well-organized and related training courses.

Suction mitigation of airborne particulate generated during sinonasal drilling and cautery.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has significantly impacted endonasal surgery, and recent experimentation has demonstrated that sinonasal drilling and cautery have significant propensity for airborne particulate generation immediately adjacent to the surgical field. In the present investigation, we assessed nasopharyngeal suctioning as a mitigation strategy to decrease particulate spread during simulated endonasal surgical activity. METHODS: Airborne particulate generation in the 1-µm to 10-µm range was quantified with an optical particle sizer in real-time during cadaveric-simulated anterior and posterior endonasal drilling and cautery conditions. To test suction mitigation, experiments were performed both with and without a rigid suction placed in the contralateral nostril, terminating in the nasopharynx. RESULTS: Both anterior (medial maxillary wall and nasal septum) and posterior (sphenoid rostrum) drilling produced significant particulate generation in the 1-µm to 10-µm range throughout the duration of drilling (p < 0.001) without the use of suction, whereas nasopharyngeal suction use eliminated the detection of generated airborne particulate. A similar effect was seen with nasal cautery, with significant particle generation (p < 0.001) that was reduced to undetectable levels with the use of nasopharyngeal suction. CONCLUSION: The use of nasopharyngeal suctioning via the contralateral nostril minimizes airborne particulate spread during simulated sinonasal drilling and cautery. In the era of COVID-19, this technique offers an immediately available measure that may increase surgical safety.