Hazards of Surgical Smoke

Surgical smoke has been shown to contain a large number potential of Biological and Chemical hazards. It also reduces creates an offensive odour and reduces visibility for the surgical team.

The plume contains Carcinogens, Poisons and Infective Virus and Bacteria.

 Visibility:

The most obvious hazard of surgical smoke is that it reduces the visibility for the surgical team during a procedure.

 Odour:

The strong noxious and offensive odour produced by Electro and Laser surgery is permeates throughout the operating theatre during and after the procedure. This odour is the first warning sign of the danger of surgical smoke. The odour is caused by the dangerous chemicals present in the plume produced.

 Biological Hazards:

Multiple studies have shown that virus and bacteria are expelled with the surgical plume intact. These studies found that not only was the virus intact it was also still viable and infectious.

The Biological hazards released during Electro and Laser surgery include:
Virus including:

• Hepatitis B & C
• HIV
• HPV (Human Papilloma Virus)
• Bacteria including:
• S. Aureus
• M Tuberculoisis
• E. coli
• Spores
• Also present are other Biologicals such as:
• Blood
• Carbonised Tissue

Chemical Hazards:

The Chemical hazards released during Electro and Laser surgery are carcinogens, allergens, toxic gases, respiratory tract irritants, mutagens and carcinogens including:
– acetonitrile – acrolein – acrylonitrile
– acetylene – alkyd benzenes – benzene
– buene – butadiene – carbon monoxide
– cresols – ethane – ethylene
– formaldehyde – free radicals – hydrogen cyanide
– isobutene – methane – PAHs
– propene – propylene – pyridine
– pyrole – styrene – toluene
– xylene

The Dangers associated with some these chemicals include:

• Carcinogenic Effects
• Dizziness
• Nausea
• Anxiety
• Increased Blood Pressure and Pulse Rates
• Gastrointestinal Issues
• Respiratory Tract Irritation
• And More …

 Acertonitrile

“Acetonitrile liquid or vapor is irritating to the skin, eyes, and respiratory tract. At high enough doses, death can occur quickly from respiratory failure. Lower doses cause typical symptoms of cyanide poisoning such as salivation, nausea, vomiting, anxiety, confusion, hyperpnea, dyspnea, rapid pulse, unconsciousness, and convulsions.”

_{From: CHEMICAL SUMMARY FOR ACETONITRILE (CAS NO. 75-05-8) prepared by OFFICE OF POLLUTION PREVENTION AND TOXICS U.S.EVIRONMENTAL PROTECTION AGENCY August 1994}

 Acrolein

“Symptoms of single or short-term exposure to acrolein may include irritation to the eyes, skin and the mucous membranes of the respiratory and gastrointestinal systems. It can be corrosive. Exposure can lead to decreased pulmonary function, pulmonary oedema (a build up of fluid in the lungs, characterised by severe shortness of breath), and chronic respiratory disease.
Longer term exposure to acrolein may result in general respiratory congestion and eye, nose and throat irritation. Systemic effects to the respiratory, reproductive, neurological and haematological systems may also result.”
_{From: National Pollutant Inventory – Australian Government – Department of Sustainability, Environment, Water, Population and Communities}

 Acrylonitrile

“Effects of acrylonitrile on human health and the environment depend on how much acrylonitrile is present and the length and frequency of exposure. Effects also depend on the health of a person or the condition of the environment when exposure occurs.

Breathing acrylonitrile for short periods of time adversely affects the nervous system, the blood, the kidneys, and the liver. These effects subside when exposure stops. Nervous system effects of AN range from headaches and dizziness to irritability, rapid heart beat, and death. Symptoms of acrylonitrile poisoning may occur quickly
after exposure or after levels of breakdown products like cyanide build up in the body. Direct contact with acrylonitrile liquid severely damages the skin. Acrylonitrile liquid or vapor irritates the eyes, the nose, and the throat. These effects are not likely to occur at levels of acrylonitrile that are normally found in the environment.

There are several health effects case studies of acrylonitrile workers. The methods used in these studies limit conclusions that can be made from the results. These studies show that workers repeatedly breathing small amounts of acrylonitrile over long periods of time may develop cancer. Cancer occurs primarily in the respiratory tract.”

From: Acrylonitrile Fact Sheet (CAS No. 107-13-1) – US EPA (7407) – Pollution Prevention and Toxics – Dec 1994 – EPA 794-F95-001

 Benzene – Carcinogen

“Benzene is found in the air from emissions from burning coal and oil, gasoline service stations, and motor vehicle exhaust. Acute (short-term) inhalation exposure of humans to benzene may cause drowsiness, dizziness, headaches, as well as eye, skin, and respiratory tract irritation, and, at high levels, unconsciousness.  Chronic (long-term) inhalation exposure has caused various disorders in the blood, including reduced numbers of red blood cells and aplastic anemia, in occupational settings.  Reproductive effects have been reported for women exposed by inhalation to high levels, and adverse effects on the developing fetus have been observed in animal tests.  Increased incidence of leukemia (cancer of the tissues that form white blood cells) have been observed in humans occupationally exposed to benzene.  EPA has classified benzene as a Group A, human carcinogen.”

From: Agency for Toxic Substances and Disease Registry (ATSDR). Toxicological Profile for Benzene (Draft). U.S. Public Health Service, U.S. Department of Health and Human Services, Atlanta, GA. 1997.

 Formaldehyde – Carcinogen

“Formaldehyde is used mainly to produce resins used in particleboard products and as an intermediate in the synthesis of other chemicals.  Exposure to formaldehyde may occur by breathing contaminated indoor air, tobacco smoke, or ambient urban air.  Acute (short-term) and chronic (long-term) inhalation exposure to formaldehyde in humans can result in respiratory symptoms, and eye, nose, and throat irritation.  Limited human studies have reported an association between formaldehyde exposure and lung and nasopharyngeal cancer.  Animal inhalation studies have reported an increased incidence of nasal squamous cell cancer. EPA considers formaldehyde a probable human carcinogen (Group B1).”

From: U.S. Environmental Protection Agency. Health and Environmental Effects Profile for Formaldehyde. EPA/600/x-85/362

 Toluene

“Toluene is added to gasoline, used to produce benzene, and used as a solvent.  Exposed to toluene may occur from breathing ambient or indoor air.  The central nervous system (CNS) is the primary target organ for toluene toxicity in both humans and animals for acute (short-term) and chronic (long-term) exposures. CNS dysfunction and narcosis have been frequently observed in humans acutely exposed to toluene by inhalation; symptoms include fatigue, sleepiness, headaches, and nausea.”

From: Agency for Toxic Substances and Disease Registry’s (ATSDR’s) Toxicological Profile for Toluene – USA.