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Hurst RD, Stewart CL. Hazards of surgical smoke from electrocautery: A critical review of the data. Am J Surg 2024; 233:29-36. [PMID: 38365552 DOI: 10.1016/j.amjsurg.2024.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/23/2024] [Accepted: 02/08/2024] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Concerns have been voiced regarding the possibility of health risks to the operating room personnel from exposure to surgical smoke generated from electrocautery. METHODS Ovid Medline was queried using search terms "surgical smoke", "electrosurgery," "smoke evacuator". The NIOSH Health Hazard Evaluations Database was searched using terms, "hospital", "operating room", "Ames", "mutagen", and "salmonella". RESULTS Levels of pollutants in the breathable airspace within the operating room have been repeatedly shown to be very low. Absolute counts of particulate matter in the operating room are low when compared to other environments. The possibility for virus transmission with electrocautery in the operating room is unknown. CONCLUSIONS The risks related to the exposure to electrocautery surgical smoke have been overstated. Rigid mandates requiring smoke evacuators in all situations are not justified at this time.
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Affiliation(s)
- Roger D Hurst
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA.
| | - Camille L Stewart
- University of Colorado School of Medicine, Department of Surgery, Aurora, CO, USA
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2
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Meretsky CR, Mahmoodi A, Knecht EM, Popovich J, Schiuma AT. The Impact of Electrocautery Smoke on Surgical Staff and the Efficacy of Normal Surgical Masks Versus N95 Masks. Cureus 2024; 16:e58106. [PMID: 38738122 PMCID: PMC11088792 DOI: 10.7759/cureus.58106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/14/2024] Open
Abstract
Electrocautery is a commonly used technique in surgical procedures, generating smoke that poses health risks to surgical staff. This study investigates the comparative efficacy of normal surgical masks versus N95 masks in mitigating the harmful effects of electrocautery smoke. Through a systematic review of literature spanning two decades, we explore the causes and effects of electrocautery smoke exposure, including potential long-term inhalation effects. Our findings highlight significant disparities in the protection offered by different masks and underscore the importance of adequate respiratory protection in surgical settings. In addition, we examine the factors influencing the generation and composition of electrocautery smoke, such as the power settings used, the type of tissue being cauterized, and the duration of the procedure. Furthermore, we discuss the potential health risks associated with long-term exposure to electrocautery smoke, including the possibility of respiratory conditions, cardiovascular effects, and carcinogenicity. Our analysis also addresses the importance of implementing appropriate smoke evacuation systems and optimizing operating room ventilation to minimize the concentration of smoke particles in the surgical environment. Overall, this comprehensive analysis provides valuable insights into the impact of electrocautery smoke in surgical settings and the varying levels of protection offered by different masks.
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Affiliation(s)
| | - Arshia Mahmoodi
- Surgery, St. George's University School of Medicine, Great River, USA
| | - Erik M Knecht
- Surgery, Chicago Medical School at Rosalind Franklin University, Chicago, USA
| | - Jay Popovich
- Internal Medicine, St. George's University School of Medicine, Great River, USA
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3
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Benaim EH, Jaspers I. Surgical smoke and its components, effects, and mitigation: a contemporary review. Toxicol Sci 2024; 198:157-168. [PMID: 38243717 DOI: 10.1093/toxsci/kfae005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024] Open
Abstract
Energy-based surgical instruments produce surgical smoke, which contains harmful byproducts, such as polycyclic aromatic hydrocarbons, volatile organic compounds, particulate matter, and viable microorganisms. The research setting has shifted from the laboratory to the operating room. However, significant heterogeneity in the methods of detection and placement of samplers, diversity in the tissue operated on, and types of surgeries tested has resulted in variability in detected levels and composition of surgical smoke. State regulation limiting surgical smoke exposure through local evacuators is expanding but has yet to reach the national regulatory level. However, most studies have not shown levels above standard established limits but relatively short bursts of high concentrations of these harmful by-products. This review highlights the limitations of the current research and unsupported conclusions while also suggesting further areas of interest that need more focus to improve Occupational Safety and Health Administration guidelines.
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Affiliation(s)
- Ezer H Benaim
- Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
| | - Ilona Jaspers
- Center for Environmental Medicine, Asthma and Lung Biology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- Curriculum in Toxicology & Environmental Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- Center for Environmental Medicine, Asthma, and Lung Biology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
- Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599, USA
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Soysal GE, Ilce A, Lakestani S, Sit M, Avcioglu F. Comparison of the Effects of Surgical Smoke on the Air Quality and on the Physical Symptoms of Operating Room Staff. Biol Res Nurs 2023:10998004221151157. [PMID: 36609167 DOI: 10.1177/10998004221151157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Surgical smoke can be a hazard because e it contains toxic gases with carcinogenic effects that may threaten health. This study aims to determine the effect of surgical smoke containing toxic chemicals on indoor air quality and examine employees' physical symptoms in the operating room. METHOD The study was conducted in the operating room between June 2020 and July 2020. In the study, 45 air samples were taken before, during, and after surgery using the active sampling method. Nineteen employees working in the operating room were asked about their physical complaints and their throat cultures were taken before and after surgery. These results were compared with those of the employees working in internal units. RESULTS The Total Volatile Organic Compounds value at the time of surgery was significantly higher (p ≤ 0.05). Benzene concentrations remained constantly high (p ≤ 0.05) throughout the surgery, exceeding the limit values. Other VOCs (Volatile Organic Compounds) were significantly higher during surgery and remained below the limit values (p ≤ 0.05). When compared in terms of open and laparoscopic surgery, no difference between VOC concentrations was observed (p ≤ 0.05). The physical symptoms of the surgical team increased during the operation, and they experienced more complaints of tearing, burning in the eyes, hair odor, nausea, and cough than those working in the internal units (e.g., internal medicine, dermatology; (p ≤ 0.05). CONCLUSIONS Surgical smoke was an important contaminant for indoor air quality in the operating room.
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Affiliation(s)
- Ganime Esra Soysal
- Surgical Nursing Department, Faculty of Health Sciences, 52942Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Arzu Ilce
- Department of Nursing, 52942Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Sanaz Lakestani
- Scientific Industrial and Technological Application and Research Center, 52942Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Mustafa Sit
- General Surgery, Medical Faculty, 52942Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Fatma Avcioglu
- Medical Microbiology Department, Medical Faculty, 52942Bolu Abant Izzet Baysal University, Bolu, Turkey
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5
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Carroll GT, Kirschman DL. A Peripherally Located Air Recirculation Device Containing an Activated Carbon Filter Reduces VOC Levels in a Simulated Operating Room. ACS OMEGA 2022; 7:46640-46645. [PMID: 36570243 PMCID: PMC9774396 DOI: 10.1021/acsomega.2c05570] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/21/2022] [Indexed: 06/13/2023]
Abstract
Electrosurgery procedures produce airborne contaminants including volatile organic compounds (VOCs). The effectiveness of commercial grade activated carbon at removing toluene, a typical VOC, from the air in an enclosed simulated operating room (OR) when interfaced with an air recirculation device was tested. The concentration of toluene in the air was measured using gas sensitive semiconductor VOC sensors. When the air recirculation device containing activated carbon was turned on, the concentration of toluene in the air decayed exponentially. When the device was off, the toluene concentration reduced much more slowly. After 130 min, a VOC sensor placed near the air recirculation device showed VOC reductions of approximately 30% when the device is on and less than 1% when the device is off. Changing the activated carbon filter after 22 h of constant use showed an abrupt increase in the rate of toluene removal.
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Ravanbakhsh M, Yousefi H, Lak E, Ansari MJ, Suksatan W, Qasim QA, Asban P, Kianizadeh M, Mohammadi MJ. Effect of Polycyclic Aromatic Hydrocarbons (PAHs) on Respiratory Diseases and the Risk Factors Related to Cancer. Polycycl Aromat Compd 2022. [DOI: 10.1080/10406638.2022.2149569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Majid Ravanbakhsh
- Department of Physiotherapy, School of Rehabilitation Sciences, Musculoskeletal Rehabilitation Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Homayon Yousefi
- Thalassemia & Hemoglobinopathy Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elena Lak
- Department of Internal Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Javed Ansari
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
| | - Wanich Suksatan
- Faculty of Nursing, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand
| | | | - Parisa Asban
- Student of Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mahsa Kianizadeh
- Department of Environmental Health Engineering, School of Public Health and Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Javad Mohammadi
- Department of Environmental Health Engineering, School of Public Health and Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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7
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Riopelle AM, Potter CT, Jeong D, Schanbacher CF. Plume Generated by Different Electrosurgical Techniques: An In Vitro Experiment on Human Skin. Dermatol Surg 2022; 48:949-953. [PMID: 36054048 DOI: 10.1097/dss.0000000000003518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Plume generated by electrosurgical techniques is a health hazard to patients and dermatologists. OBJECTIVE To compare the particle concentration generated by various energy devices used in dermatologic surgery. MATERIALS AND METHODS Five surgical techniques were tested on human tissue samples in a closed chamber. A particle counter, positioned at a fixed point 20 cm away from the sample, recorded the concentrations of aerosolized particles generated over 7 particle sizes (0.3, 0.5, 0.7, 1, 2.5, 5, and 10 μm). RESULTS Monopolar electrocoagulation created the greatest concentration of particles followed by electrocautery, electrodesiccation, electrofulguration, and bipolar electrocoagulation. Bipolar electrocoagulation created 80 times fewer 0.3 μm particles and 98 times fewer 0.5 μm particles than monopolar electrocoagulation. Across all electrosurgical techniques, the greatest concentrations of particles generated were of the 0.3 and 0.5 μm particle size. CONCLUSION Bipolar electrocoagulation created the lowest concentration of particulate matter. Given the noxious and hazardous nature of surgical plume, the bipolar forceps offer surgeons a safer method of performing electrical surgery for both the surgical staff and the patient.
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Affiliation(s)
| | | | | | - Carl F Schanbacher
- Kuchnir Dermatology, Milford, Massachusetts
- Department of Dermatology, Tufts University School of Medicine, Boston, Massachusetts
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Yousefi H, Lak E, Mohammadi MJ, Shahriyari HA. Carcinogenic Risk Assessment among Children and Adult due to Exposure to Toxic Air Pollutants. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:23015-23025. [PMID: 34797534 DOI: 10.1007/s11356-021-17300-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 10/27/2021] [Indexed: 06/13/2023]
Abstract
Health endpoint and risk of carcinogenic among people enhancement due to Exposures to toxic air pollutants. The purpose of this study was investigation of a carcinogenic risk assessment among children and adults due to exposure to toxic pollutants. A review study of literature was performed with seven hundred and twenty-six articles were retrieved based on Google Scholar, Web of Science, PubMed, Elsevier, and Springer databases. Studies reporting data on predetermined consequences potential toxic air pollutants and related to lifetime cancer risk (LCR) and hazard quotient (HQ) were used to assess carcinogenic and non-carcinogenic risk. The literature signs a notable undesirable affect from potential toxic air pollutants related to carcinogenic risk assessment among children and adult. Based on Result this study, the toxic air pollutants can endanger health of children and adult exposure to this pollutant and increase lifetime cancer risk number and carcinogenic risk among exposed people. Useful for health policymaker in order to cope with the incidence of cancer among citizenship Can be the main application the results of this study. Increasing the level of public awareness, especially of sensitive groups, about the incidence of cancer and its important factors and reduce exposures to toxic air pollutants are the main vital government actions for decrease the prevalence of cancer. Further research using more sophisticated methodology is warranted.
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Affiliation(s)
- Homayon Yousefi
- Thalassemia & Hemoglobinopathy Research center, Health research institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Elena Lak
- Alimentary Tract Research Center, Clinical Sciences Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Javad Mohammadi
- Department of Environmental Health Engineering, School of Public Health AND Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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9
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Vance ME, Strauss F. Preventing Exposure to Surgical Smoke. AORN J 2022; 115:169-174. [PMID: 35084771 DOI: 10.1002/aorn.13613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 10/14/2021] [Indexed: 11/06/2022]
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10
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Ostapovych U, Vortman R. Implementing a Surgical Smoke Evacuation Policy and Procedure: A Quality Improvement Project. AORN J 2022; 115:139-146. [PMID: 35084765 DOI: 10.1002/aorn.13603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/09/2021] [Accepted: 05/03/2021] [Indexed: 11/11/2022]
Abstract
Energy-generating surgical devices (eg, electrosurgical units, lasers) produce surgical smoke that can cause negative health effects in exposed individuals. In 2019, a review of nursing documentation at an urban teaching hospital revealed that personnel were properly evacuating surgical smoke during less than 0.5% of applicable procedures. To address the noncompliance and reduce exposure to surgical smoke, an interdisciplinary team initiated a quality improvement project to implement a surgical smoke evacuation policy for all smoke-generating procedures. The project included creation and implementation of a smoke evacuation policy, staff member education on the hazards of surgical smoke and proper evacuation device use, and acquisition of the proper smoke evacuation equipment. After instituting the policy in June 2020, results of a three-month chart audit showed that there was nursing documentation confirming personnel used energy-generating devices and the corresponding surgical smoke evacuation devices during 664 of 2,224 procedures, for a compliance rate of 30%.
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11
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Merajikhah A, Imani B, Khazaei S, Bouraghi H. Impact of Surgical Smoke on the Surgical Team and Operating Room Nurses and Its Reduction Strategies: A Systematic Review. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:27-36. [PMID: 35223623 PMCID: PMC8837875 DOI: 10.18502/ijph.v51i1.8289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Surgical smoke is an integral part of surgical operations that the surgical team has been exposed to for so long. This study aimed to investigate the effects of smoke, on members of the surgical team. METHODS A systematic review was conducted focusing on the complexity of surgical smoke. PubMed, Scopus and web of science databases were searched until May 2020 without any time or language limitation. All documents were reviewed by title or abstract according to the search strategy. The screening process of articles was performed by two independent authors. The articles were selected according to the inclusion and exclusion criteria. RESULTS Overall, 37 studies in this systematic study were investigated. The effects of many surgical smokes were found in a nutshell including complications such as carcinogenic, toxicity, mutation, irritant, transmission of tumor cells, virus transmission, headaches, dizziness, sleepiness, headache, the bad odor in head hair, the tearing of the eye on the surgical team and staff. CONCLUSION Surgical smoke, produced during surgical operations, is one of the risks and threats to which the surgical team and operating room staff are at risk then can affect the organs of different bodies from the body of all operating room staff and surgical team.
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Affiliation(s)
- Amirmohammad Merajikhah
- Department of Operating Room, School of Paramedicine Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Behzad Imani
- Department of Operating Room, School of Paramedicine Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Salman Khazaei
- Social Determinants of Health Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Hamid Bouraghi
- Department of Health Information Technology, School of Paramedicine Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
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12
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A study to quantify surgical plume and survey the efficiency of different local exhaust ventilations. Sci Rep 2021; 11:14096. [PMID: 34238937 PMCID: PMC8266899 DOI: 10.1038/s41598-021-92859-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 06/09/2021] [Indexed: 12/26/2022] Open
Abstract
This study aimed to compare the concentration of surgical smoke produced by different tissues and electric diathermy modes and to measure the effectiveness of various local exhaust ventilations. We compared the surgical plume concentration from different tissues and settings with a porcine tissue model. We also compared the efficiency of three local exhaust ventilations: (1) a desktop unit (Medtronic Rapid Vac), (2) a central evacuation system with ENT suction, and (3) a central evacuation system with a urethral catheter (PAHSCO Urethral Catheter). In the cutting setting, the skin tissue had a higher concentration of total suspended particulates (TPS), which were 1990 ± 2000 (mean ± SD, μg/m3), 6440 ± 3000 and 9800 ± 2300 at 15, 30 and 45 s, respectively (p < 0.05). In the coagulation setting, the adipose tissue had a higher concentration of TPS, which were 3330 ± 2600, 11,200 ± 5500 and 15,800 ± 7300, respectively (p < 0.05). We found that all three smoke extractors had more than 96% efficiency in clearing surgical smoke. With electric diathermy, skin tissue in the cutting model and adipose tissue in the coagulation mode will produce higher concentration of particles within surgical plumes. An electric surgical scalpel adapted with a urethral catheter is a simple and effective way to exhaust smoke in surgical operations.
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Knowledge about the effects of electrosurgery smoke among operating room nurses during COVID-19 Pandemic: A Cross-Sectional Study. ACTA ACUST UNITED AC 2021; 24:100189. [PMID: 34179520 PMCID: PMC8214320 DOI: 10.1016/j.pcorm.2021.100189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 06/02/2021] [Accepted: 06/14/2021] [Indexed: 12/28/2022]
Abstract
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.
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Goudarzi G, Alavi N, Babaei AA, Geravandi S, Idani E, Salmanzadeh S, Mohammadi MJ. Investigation of Ambient Polycyclic Aromatic Hydrocarbons in a Populated Middle Eastern City. Polycycl Aromat Compd 2020. [DOI: 10.1080/10406638.2020.1823857] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Gholamreza Goudarzi
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nadali Alavi
- Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Akbar Babaei
- Department of Environmental Health Engineering, School of Public Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Environmental Technologies Research Center (ETRC), Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Esmaeil Idani
- Department of Internal Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shokrolah Salmanzadeh
- Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Javad Mohammadi
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Environmental Health Engineering, School of Public Health and Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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15
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Searle T, Ali FR, Al-Niaimi F. Surgical plume in dermatology: an insidious and often overlooked hazard. Clin Exp Dermatol 2020; 45:841-847. [PMID: 32780880 PMCID: PMC7436401 DOI: 10.1111/ced.14350] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 06/05/2020] [Indexed: 02/06/2023]
Abstract
Dermatologists performing surgical procedures face occupational and health hazards when exposed to surgical plume released during electrosurgical and ablative laser procedures. These hazardous fumes have toxic, infectious and carcinogenic effects. Understanding this risk is of particular importance during the COVID-19 pandemic as the understanding of the transmissibility and infectious nature of the virus is still evolving rapidly. In this article, we present the hazards from laser and surgical plumes, and discuss possible preventative measures aimed at reducing these risks.
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Affiliation(s)
- T Searle
- University of Birmingham Medical School, Birmingham, UK
| | - F R Ali
- Vernova Healthcare Community Interest Company, Macclesfield, UK.,Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's Hospital Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - F Al-Niaimi
- Dermatological Surgery and Laser Unit, St John's Institute of Dermatology, Guy's Hospital Cancer Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK.,Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
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16
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Rai R, Fritschi L, Carey RN, Lewkowski K, Glass DC, Dorji N, El‐Zaemey S. The estimated prevalence of exposure to carcinogens, asthmagens, and ototoxic agents among healthcare workers in Australia. Am J Ind Med 2020; 63:624-633. [PMID: 32236973 DOI: 10.1002/ajim.23108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/07/2020] [Accepted: 03/17/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Healthcare workers are occupationally exposed to various hazardous chemicals and agents that can potentially result in long-term adverse health effects. These exposures have not been comprehensively examined at a population level. The aim of this study was to examine occupational exposures to a wide range of asthmagens, carcinogens, and ototoxic agents among healthcare workers in Australia. METHODS Data were collected as part of the Australian Work Exposures Studies, which were computer-assisted telephone surveys conducted in 2011, 2014, and 2016 to assess the prevalence of occupational exposures to carcinogens, asthmagens, and ototoxic agents, respectively, among Australian workers. Using data on healthcare workers, the prevalence of exposures to these agents was calculated and associations of demographic variables and occupation groups with exposure status were examined. RESULTS The prevalence of exposure to at least one asthmagen, carcinogen, and ototoxic agent was 92.3%, 50.7%, and 44.6%, respectively. The most common exposures were to (a) cleaning and sterilizing agents in the asthmagen group; (b) shift work in the carcinogen group; and (c) toluene and p-xylene among ototoxic agents. Exposure varied by occupation, with exposure to carcinogens and ototoxic agents highest among personal carers and exposure to carcinogens most likely among nursing professionals and health and welfare support workers. CONCLUSION The results demonstrate that a substantial proportion of Australian healthcare workers are occupationally exposed to asthmagens, carcinogens, and ototoxic agents. These exposures are more common among certain occupational groups. The information provided by this study will be useful in prioritizing and implementing control strategies.
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Affiliation(s)
- Rajni Rai
- School of Public HealthCurtin University Bentley Western Australia Australia
| | - Lin Fritschi
- School of Public HealthCurtin University Bentley Western Australia Australia
| | - Renee N. Carey
- School of Public HealthCurtin University Bentley Western Australia Australia
| | - Kate Lewkowski
- School of Public HealthCurtin University Bentley Western Australia Australia
| | - Deborah C. Glass
- School of Public Health and Preventive MedicineMonash University Melbourne Victoria Australia
| | - Nidup Dorji
- Faculty of Nursing and Public HealthKhesar Gyalpo University of Medical Sciences of Bhutan Thimphu Bhutan
| | - Sonia El‐Zaemey
- School of Public HealthCurtin University Bentley Western Australia Australia
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17
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Leachi HFL, Marziale MHP, Martins JT, Aroni P, Galdino MJQ, Ribeiro RP. Polycyclic aromatic hydrocarbons and development of respiratory and cardiovascular diseases in workers. Rev Bras Enferm 2020; 73:e20180965. [PMID: 32321136 DOI: 10.1590/0034-7167-2018-0965] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 06/05/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to identify the scientific evidence on the development of cardiovascular and respiratory diseases due to workplace contamination by polycyclic aromatic hydrocarbons. METHODS integrative literature review. The search for primary articles was held in October 2017 in the Medical Literature Analysis and Retrieval System Online (through Pubmed), Web of Science and Latin American and Caribbean Literature in Health Sciences (LILACS). RESULTS the 16 studies analyzed showed that exposure to polycyclic aromatic hydrocarbons was associated with cardiovascular diseases, such as increased blood pressure, heart rate variation, and ischemic heart disease; and respiratory disorders, such as decreased lung function, chronic obstructive pulmonary disease, asthma, wheeze, coughing, pulmonary wheezing, chest tightness, effort dyspnea, and sore throat. CONCLUSIONS polycyclic aromatic hydrocarbons cause deleterious effects on the cardiovascular and respiratory systems through mutations and cellular inflammation, being a risk to exposed individuals.
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Affiliation(s)
| | | | | | - Patricia Aroni
- Universidade Estadual de Londrina. Londrina, Paraná, Brazil
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Carr MM, Patel VA, Soo JC, Friend S, Lee EG. Effect of Electrocautery Settings on Particulate Concentrations in Surgical Plume during Tonsillectomy. Otolaryngol Head Neck Surg 2020; 162:867-872. [PMID: 32228131 DOI: 10.1177/0194599820914275] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To describe the effect of monopolar electrocautery (EC) settings on surgical plume particulate concentration during pediatric tonsillectomy. STUDY DESIGN Cross-sectional study. SETTING Tertiary medical center. SUBJECTS AND METHODS During total tonsillectomy exclusively performed with EC, air was sampled with a surgeon-worn portable particle counter. The airborne mean and maximum particle concentrations were compared for tonsillectomy performed with EC at 12 W vs 20 W, with smoke evacuation system (SES) and no smoke evacuation (NS). RESULTS A total of 36 children were included in this analysis: 9 cases with EC at 12 W and SES (12SES), 9 cases with EC at 20 W and SES (20SES), 9 cases with EC at 12 W without SES (12NS), and 9 cases with EC at 20 W without SES (20NS). Mean particle number concentration in the breathing zone during tonsillectomy was 1661 particles/cm3 for 12SES, 5515 particles/cm3 for 20SES, 8208 particles/cm3 for 12NS, and 78,506 particles/cm3 for 20NS. There was a statistically significant difference in the particle number concentrations among the 4 groups. The correlation between the particle number concentration and EC time was either moderate (for 12SES) or negative (for remaining groups). CONCLUSION Airborne particle concentrations during tonsillectomy are over 9.5 times higher when EC is set at 20 W vs 12 W with NS, which is mitigated to 3.3 times with SES. Applying lower EC settings with SES during pediatric tonsillectomy significantly reduces surgical plume exposure for patients, surgeons, and operating room personnel, which is a well-known occupational health hazard.
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Affiliation(s)
- Michele M Carr
- Department of Otolaryngology-Head and Neck Surgery, West Virginia University, Morgantown, West Virginia, USA
| | - Vijay A Patel
- Department of Otolaryngology, The Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Jhy-Charm Soo
- National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Sherri Friend
- National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
| | - Eun Gyung Lee
- National Institute for Occupational Safety and Health, Morgantown, West Virginia, USA
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Yeganeh A, Hajializade M, Sabagh AP, Athari B, Jamshidi M, Moghtadaei M. Analysis of electrocautery smoke released from the tissues frequently cut in orthopedic surgeries. World J Orthop 2020; 11:177-183. [PMID: 32280607 PMCID: PMC7138863 DOI: 10.5312/wjo.v11.i3.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 11/13/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Electrosurgical smoke could be different by the device of cutting or the type of tissue that is being cut.
AIM To analyze the electrocautery smoke released from the tissues that are frequently cut in orthopedic surgeries.
METHODS The released smoke from electrocautery of five different tissue types (meniscus, ligament, adipose, muscle, and synovium) of five patients who underwent total knee arthroplasty were collected and analyzed for volatile organic compounds (VOCs) and 27 candidate polycyclic aromatic hydrocarbons (n = 25). Surgical smoke was produced with an electrocautery device for 4 min.
RESULTS None of the 27 evaluated polycyclic aromatic hydrocarbons compounds were detectable in electrocautery smoke collected from the surgical cutting of the different tissues. The number and identity of detected VOCs were similar between the patients but not between tissue types. The number of detected VOCs was the highest in synovial tissue (n = 21) and the lowest in the meniscus and adipose tissue (n = 12). The number of toxic and/or carcinogenic VOCs were the most in the muscle and meniscus tissues (Toluene, Ethylbenzene, and Styrene). No toxic and/or carcinogenic VOCs were identified in the ligament and adipose tissue.
CONCLUSION Meniscus and muscle tissue are associated with the highest number of toxic and/or carcinogenic VOCs. Therefore, we recommend that surgeons avoiding the electrocautery of these tissues.
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Affiliation(s)
- Ali Yeganeh
- Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Mikaiel Hajializade
- Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Alireza Pahlevan Sabagh
- Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran 1445613131, Iran
| | - Babak Athari
- Department of Orthopaedics Surgery, Shahid Mohammadi Hospital, Hormozgan University of Medical Sciences, Hormozgan, Bandarabbas 1445613131, Iran
| | - Mahbobeh Jamshidi
- Department of Chemistry, Payam-e-Nour University, Ghazvin 1445613131, Iran
| | - Mehdi Moghtadaei
- Department of Orthopaedics Surgery, Rasoul Akram Hospital, Iran University of Medical Tehran âProvince, Tehran, Satarkhan 1445613131, Iran
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Cheng NY, Chuang HC, Shie RH, Liao WH, Hwang YH. Pilot Studies of VOC Exposure Profiles during Surgical Operations. Ann Work Expo Health 2020; 63:173-183. [PMID: 30551204 DOI: 10.1093/annweh/wxy099] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 10/23/2018] [Accepted: 11/12/2018] [Indexed: 01/09/2023] Open
Abstract
Volatile organic chemical exposure resulting from surgical operations is common in operating room personnel. The potential risk of long-term exposure to these low-level chemicals is always a concern. This study was conducted in an area hospital located in northern Taiwan to investigate the internal exposure scenario for operating room personnel. Breath samples were collected before and after surgery, whereas area samples were collected during the surgeries in process. There were 18 volatile organic compounds identified in the samples with gas chromatography-mass spectrometry. The average concentrations of sevoflurane (P = 0.0082), dimethyl sulfide (P = 0.0550), and methyl methacrylate (P = 0.0606) in breath samples collected after surgical operations were significantly higher compared to those obtained before surgical operations, whereas only slight elevations were present for benzene and hexamethyldisiloxane (P < 0.100). In addition, electrosurgical smoke-related chemicals, such as benzene, toluene, ethylbenzene, and m/p-xylene, also presented higher levels in operating room samples compared to the control area. Specifically, the findings in this preliminary study suggested the associations of elevated exposure to sevoflurane across various surgeries to methyl methacrylate with orthopedic surgery and to hexamethyldisiloxane with conventional electrosurgical units. Future study is warranted to explore the short-term high-level chemical exposure in operating rooms and to propose effective preventive measures accordingly to keep any exposure to chemicals at the lowest practical level.
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Affiliation(s)
- Nai-Yun Cheng
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan, R.O.C.,Institute of Labor, Occupational Safety and Health, Ministry of Labor, Executive Yuan, Taipei, Taiwan, R.O.C
| | - Hsiao-Chi Chuang
- School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan, R.O.C.,Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan, R.O.C
| | - Ruei-Hao Shie
- Industrial Technology Research Institute, Hsinchu, Taiwan, R.O.C
| | - Wei-Heng Liao
- Institute of Labor, Occupational Safety and Health, Ministry of Labor, Executive Yuan, Taipei, Taiwan, R.O.C
| | - Yaw-Huei Hwang
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan, R.O.C.,Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan, R.O.C
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Limchantra IV, Fong Y, Melstrom KA. Surgical Smoke Exposure in Operating Room Personnel. JAMA Surg 2019; 154:960-967. [DOI: 10.1001/jamasurg.2019.2515] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
| | - Yuman Fong
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California
| | - Kurt A. Melstrom
- Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California
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Stanganelli NC, Bieniek AA, Margatho AS, Galdino MJQ, Barbosa KH, Ribeiro RP. Inalação da fumaça cirúrgica: coorte de sinais e sintomas em residentes. ACTA PAUL ENFERM 2019. [DOI: 10.1590/1982-0194201900053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Analisar os sinais e sintomas apresentados por médicos residentes das clínicas cirúrgicas e anestesiologia expostos à fumaça cirúrgica. Métodos Estudo de coorte prospectivo realizado com médicos residentes expostos a fumaça cirúrgica em um hospital universitário. Houve um acompanhamento durante 17 meses dos residentes ingressantes nos anos de 2015 e 2016, que atendiam aos critérios de estar regularmente matriculado na residência de clínica cirúrgica ou anestesiologia e não ser tabagista. O instrumento de coleta de dados foi composto de dados sociodemográficos e acadêmicos e dos sinais e sintomas relacionados com a inalação da fumaça cirúrgica, citados na literatura. A análise de dados ocorreu de forma descritiva e inferencial, por testes estatísticos e medidas de efeito. Resultados A amostra foi composta por 39 residentes, cuja maioria era do sexo masculino (56,4%) e idade abaixo dos 30 anos (74,3%). Prevaleceram residentes da ginecologia e obstetrícia (30,8%), seguidos de cirurgia geral (28,2%) e anestesiologia (20,5%). Ardência na faringe (p=0,030), náusea e vômito (p=0,018) e irritação dos olhos (p=0,050) incidiram ainda no primeiro ano de residência. O risco de desenvolver ardência de faringe foi 7,765 vezes (p=0,019) no sexo feminino em relação ao masculino. Conclusão Os sinais e sintomas analisados incidiram em até 12 meses do início da residência e o risco de apresentar ardência de faringe foi maior no sexo feminino, o que indica a exposição aos riscos da inalação da fumaça cirúrgica e, portanto, a necessidade de adoção de medidas de proteção individuais e coletivas.
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Schlosshauer T, Kiehlmann M, Ramirez P, Riener M, Djedovic G, Rieger UM. Comparative analysis on the effect of low-thermal plasma dissection device (PEAK PlasmaBlade) versus conventional electro surgery in post-bariatric body-contouring procedures: A retrospective randomised clinical study. Int Wound J 2019; 16:932-939. [PMID: 30938101 PMCID: PMC7949418 DOI: 10.1111/iwj.13124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 03/15/2019] [Accepted: 03/15/2019] [Indexed: 11/28/2022] Open
Abstract
Postoperative wound-healing problems are relatively high in post-bariatric body-contouring procedures, partly because of electrosurgery and the associated thermal tissue damage. This study is a retrospective randomised evaluation of the effect of a low-thermal plasma dissection device (PEAK PlasmaBlade, Medtronic, Minneapolis, Minnesota) in comparison with conventional electrosurgery. A total of 24 patients undergoing upper arm or medial thigh lifting were randomised to PEAK PlasmaBlade on one side and to monopolar electrosurgery on the other side of the same patient. Wounds of 10 patients were examined histologically for acute thermal injury depth. Significantly lower total volume of drain output (61,1 ± 70,2 mL versus 95,1 ± 176,0 mL; P = .04) was found on the PEAK PlasmaBlade side compared with the electrosurgery side. Furthermore, the PEAK PlasmaBlade side showed fewer seromas (no case of seroma versus three seromas in the electrosurgery group) and less thermal damage (40% versus 70%; P = .26). Acute thermal injury depth from the PEAK PlasmaBlade was less than from monopolar electrosurgery (425 ± 171 μm versus 686 ± 1037 μm; P = .631). PEAK PlasmaBlade appears to be superior to traditional monopolar electrosurgery for post-bariatric body-contouring procedures because it demonstrated less tissue damage, lower total volume of drain output, and fewer postoperative seromas resulting in faster wound healing.
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Affiliation(s)
- Torsten Schlosshauer
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
| | - Marcus Kiehlmann
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
| | - Pablo Ramirez
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
| | | | - Gabriel Djedovic
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
| | - Ulrich M. Rieger
- Department of Plastic and AestheticReconstructive and Hand Surgery at AGAPLESION Markus HospitalFrankfurt am MainGermany
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Smith C, Srivastava D, Nijhawan RI. Optimizing Patient Safety in Dermatologic Surgery. Dermatol Clin 2019; 37:319-328. [DOI: 10.1016/j.det.2019.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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25
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Saito AC, Margatho AS, Bieniek AA, Stanganelli NC, Ribeiro RP. Signs and symptoms related to inhalation of surgical smoke in the nursing team. ESCOLA ANNA NERY 2019. [DOI: 10.1590/2177-9465-ean-2018-0292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: To compare the prevalence of signs and symptoms related to inhalation of surgical smoke among surgical technologists and non-surgical technologists nursing professionals. Method: A cross-sectional study with 46 professionals from a university hospital. To evaluate the prevalence, an instrument with signs/symptoms related to the inhalation of electrocautery smoke was used. To verify the comparison between the prevalence of signs/symptoms, the Fisher’s exact test was performed. Results: Higher prevalence of all signs/symptoms among surgical technologists, with a statistically significant difference between the act of instrumenting with the presence of at least one signs/symptoms related to inhalation of surgical smoke (p=0.01); eye irritation (p=0.02); irritation of nasal mucosa and oral cavity (p=0.03); headache (p=0.04). Conclusion: The presence of problems related to surgical smoke in nursing workers elicits more attention. Implications for practice: Health units must be aware of the risk of such exposure and take measures to preventing it.
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26
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Seipp HM, Steffens T, Weigold J, Lahmer A, Maier-Hasselmann A, Herzog T, Herzog-Niescery J. Efficiencies and noise levels of portable surgical smoke evacuation systems. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2018; 15:773-781. [PMID: 30156970 DOI: 10.1080/15459624.2018.1513134] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Surgical smoke resulting from electrocauterization is a health risk for operating room personnel. The U.S. National Institute for Occupational Safety and Health recommends the use of local exhaust ventilation such as a portable smoke evacuation system to reduce surgical smoke, but its efficiency has never been assessed under experimental conditions. In this study, particle filtration efficiencies of five commercially available smoke evacuation systems were investigated in a model operating room. Two cutting angles, the devices' suction capacities, three unidirectional displacement flow rates, and the noise exposures were considered. Results demonstrated that portable smoke evacuation systems reduce surgical smoke up to 99% under optimal conditions. A cutting angle of 45°, the device's maximum suction capacity, and a unidirectional displacement flow rate of 10,500 m³/hr were advantageous. Sound levels ranged between 51-69 dBA and exceeded recommended threshold limits, if used with medium or maximum suction capacity. Hence, portable smoke evacuation systems are beneficial and are recommended. However, a combination with general unidirectional room ventilation and a strict limitation of the use of electrocauterization is strongly advised.
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Affiliation(s)
- Hans-Martin Seipp
- a Department of Life Science Engineering , University of Applied Sciences , Giessen , Germany
| | - Thomas Steffens
- a Department of Life Science Engineering , University of Applied Sciences , Giessen , Germany
| | - Janine Weigold
- a Department of Life Science Engineering , University of Applied Sciences , Giessen , Germany
| | - Armin Lahmer
- a Department of Life Science Engineering , University of Applied Sciences , Giessen , Germany
| | | | - Torsten Herzog
- c Department of Surgery , Ruhr-University Bochum , St . Josef Hospital , Bochum , Germany
| | - Jennifer Herzog-Niescery
- d Department of Anesthesiology , Ruhr-University Bochum , St . Josef Hospital , Bochum , Germany
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27
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Goudarzi G, Geravandi S, Alavi N, Idani E, Salmanzadeh S, Yari AR, Jamshidi F, Mohammadi MJ, Ranjbarzadeh A, Alamdari FA, Darabi F, Rohban A. Association between cancer risk and polycyclic aromatic hydrocarbons' exposure in the ambient air of Ahvaz, southwest of Iran. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:1461-1470. [PMID: 29959528 DOI: 10.1007/s00484-018-1543-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 03/24/2018] [Accepted: 04/06/2018] [Indexed: 05/24/2023]
Abstract
Nowadays, a large number of health endpoints such as disease rates, treatment costs, and death, by air pollutants, have been a serious health problem for humans. One of the most hazardous air pollutants, which is highly dangerous for human health, is polycyclic aromatic hydrocarbons (PAHs). The existence of the emission of industries' pollutants and seasonal variations are the primary agents affecting PAHs' concentration. The purposes of this study were to calculate the cancer risk and measure PAHs' exposure in the ambient air of Ahvaz, southwest of Iran, during 2017. Three distinct areas ((S1) industrial, (S2) high traffic, and (S3) residential) of Ahvaz metropolitan were selected. Omni sampler equipped with polytetrafluoroethylene (PTFE) filters were used for active sampling of PAHs. To detect the level of PAHs, gas chromatography with mass spectrometry (GC/MS) was used. Incremental lifetime cancer risk (ILCR) and lifetime average daily dose (LADD) were used to estimate the health risk caused by PAHs. The results showed that the residential and industrial areas had the lowest and highest level of PAHs. Moreover, the average levels of PAHs in industrial, high traffic, and residential areas were 8.44 ± 3.37, 7.11 ± 2.64, and 5.52 ± 1.63 ng m-3, respectively. Furthermore, ILCR in autumn and winter was higher than EPA standard, 0.06307 and 0.04718, respectively. In addition, ILCR in different areas was significantly higher than standard. Research findings imply that the levels of exposure to PAHs can increase ILCR and risk of health endpoint. The cancer risk attributed to PAHs should be further investigated from the perspective of the public health in metropolitans.
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Affiliation(s)
- Gholamreza Goudarzi
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Nadali Alavi
- Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Esmaeil Idani
- Air Pollution and Respiratory Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
- Department of Internal Medicine, Division of Pulmonology, Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Shokrolah Salmanzadeh
- Health Research Institute, Infectious and Tropical Diseases Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Reza Yari
- Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran
| | - Farkhondeh Jamshidi
- Department of Forensic Medicine and Toxicology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mohammad Javad Mohammadi
- Department of Environmental Health Engineering, School of Public Health and Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
| | | | | | - Fatemeh Darabi
- Department of Public Health, Asadabad School of Medical Sciences, Asadabad, Iran
| | - Alireza Rohban
- Rehabilitation Management, School of Rehabilitation, Iran University of Medical Sciences, Tehran, Iran
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York K, Autry M. Surgical Smoke: Putting the Pieces Together to Become Smoke-Free: 1.6 www.aornjournal.org/content/cme. AORN J 2018; 107:692-703. [PMID: 29851040 DOI: 10.1002/aorn.12149] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Surgical smoke is generated when tissue vaporizes from the use of various energy-generating devices (eg, electrosurgery units, lasers). Surgical smoke contains toxic gases and vapors that can be hazardous to patients and perioperative staff members. In addition to ocular and upper respiratory tract irritation, surgical smoke can have mutagenic potential. Although many regulatory agencies agree that surgical smoke is dangerous, they have been slow to commit to a firm standard to address the inhalation hazards related to surgical smoke. With the clear evidence supporting the need to filter surgical smoke, perioperative nurses and surgical technologists at our facility implemented a plan to protect patients and staff members. The plan included identifying and evaluating in-house equipment and the perceived barriers to becoming smoke-free. Perioperative personnel tested multiple smoke-evacuating products to determine which best met the needs of our staff members and facility, and our ORs are now smoke-free.
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Goudarzi G, Alavi N, Geravandi S, Idani E, Behrooz HRA, Babaei AA, Alamdari FA, Dobaradaran S, Farhadi M, Mohammadi MJ. Health risk assessment on human exposed to heavy metals in the ambient air PM 10 in Ahvaz, southwest Iran. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2018; 62:1075-1083. [PMID: 29464337 DOI: 10.1007/s00484-018-1510-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/17/2018] [Accepted: 01/30/2018] [Indexed: 05/24/2023]
Abstract
Heavy metals (HM) are one of the main components of urban air pollution. Today, megacities and industrial regions in southwest of Iran are frequently suffering from severe haze episodes, which essentially caused by PM10-bound heavy metals. The purpose of this study was to evaluate the health risk assessment on human exposed to heavy metals (Cr, Ni, Pb, and Zn) in the ambient air PM10 in Ahvaz, southwest Iran. In this study, we estimated healthy people from the following scenarios: (S3) residential site; (S2) high-traffic site; (S1) industrial site in Ahvaz metropolitan during autumn and winter. In the current study, high-volume air samplers equipped with quartz fiber filters were used to sampling and measurements of heavy metal concentration. Inductively coupled plasma optical emission spectroscopy (ICP-OES) was utilized for detection of heavy metal concentration (ng m-3). Also, an estimate of the amount of health risk assessment (hazard index) of Cr, Ni, Pb, and Zn of heavy metal exposure to participants was used. Result of this study showed that the residential and industrial areas had the lowest and the highest level of heavy metal. Based on the result of this study, average levels of heavy metal in industrial, high-traffic, and residential areas in autumn and winter were 31.48, 30.89, and 23.21 μg m-3 and 42.60, 37.70, and 40.07 μg m-3, respectively. Based on the result of this study, the highest and the lowest concentration of heavy metal had in the industrial and residential areas. Zn and Pb were the most abundant elements among the studied PM10-bound heavy metals, followed by Cr and Ni. The carcinogenic risks of Cr, Pb, and the integral HQ of metals in PM10 for children and adults via inhalation and dermal exposures exceeded 1 × 10-4 in three areas. Also, based on the result of this study, the values of hazard index (HI) of HM exposure in different areas were significantly higher than standard. The health risks attributed to HM should be further investigated from the perspective of the public health in metropolitans. The result of this study showed increasing exposure concentrations to heavy metal in the studied scenarios have a significant potential for generating different health endpoints, while environmental health management in ambient air can cause disorders in citizenship and causing more spiritual and material costs.
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Affiliation(s)
- Gholamreza Goudarzi
- Department of Environmental Health Engineering, School of Public Health AND Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Nadali Alavi
- Department of Environmental Health Engineering, School of Public Health and Environmental and Occupational Hazards Control Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Esmaeil Idani
- Department of Internal Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Ali Akbar Babaei
- Department of Environmental Health Engineering, School of Public Health AND Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Sina Dobaradaran
- Department of Environmental Health Engineering, Faculty of Health, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Majid Farhadi
- Nutrition Health Research Center, Department of Environmental Health, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Mohammad Javad Mohammadi
- Department of Environmental Health Engineering, School of Public Health AND Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
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30
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Claudio CV, Ribeiro RP, Martins JT, Marziale MHP, Solci MC, Dalmas JC. Polycyclic aromatic hydrocarbons produced by electrocautery smoke and the use of personal protective equipment 1. Rev Lat Am Enfermagem 2017; 25:e2853. [PMID: 28301033 PMCID: PMC5363329 DOI: 10.1590/1518-8345.1561.2853] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 11/14/2016] [Indexed: 11/22/2022] Open
Abstract
Objective analyze the concentration of polycyclic aromatic hydrocarbons in electrocautery smoke in operating rooms and the use of personal protective equipment by the intraoperative team when exposed to hydrocarbons. Method exploratory and cross-sectional field research conducted in a surgery center. Gases were collected by a vacuum suction pump from a sample of 50 abdominal surgeries in which an electrocautery was used. A form was applied to identify the use of personal protective equipment. Gases were analyzed using chromatography. Descriptive statistics and Spearman's test were used to treat data. Results there were 17 (34%) cholecystectomies with an average duration of 136 minutes, while the average time of electrocautery usage was 3.6 minutes. Airborne hydrocarbons were detected in operating rooms in 100% of the surgeries. Naphthalene was detected in 48 (96.0%) surgeries and phenanthrene in 49 (98.0%). The average concentration of these compounds was 0.0061 mg/m3 and a strong correlation (0.761) was found between them. The intraoperative teams did not use respirator masks such as the N95. Conclusion electrocautery smoke produces gases that are harmful to the health of the intraoperative team, which is a concern considering the low adherence to the use of personal protective equipment.
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Affiliation(s)
| | - Renata Perfeito Ribeiro
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Júlia Trevisan Martins
- PhD, Adjunct Professor, Departamento de Enfermagem, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - Maria Helena Palucci Marziale
- PhD, Full Professor, Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo, WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
| | - Maria Cristina Solci
- PhD, Associate Professor, Departamento de Química, Universidade Estadual de Londrina, Londrina, PR, Brazil
| | - José Carlos Dalmas
- PhD, Associate Professor, Departamento de Estatística, Universidade Estadual de Londrina, Londrina, PR, Brazil
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Tramontini CC, Galvão CM, Claudio CV, Ribeiro RP, Martins JT. Composition of the electrocautery smoke: integrative literature review. Rev Esc Enferm USP 2016; 50:148-57. [DOI: 10.1590/s0080-623420160000100019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 08/29/2015] [Indexed: 11/22/2022] Open
Abstract
Abstract OBJECTIVE To identify the composition of the smoke produced by electrocautery use during surgery. METHOD Integrative review with search for primary studies conducted in the databases of the US National Library of Medicine National Institutes of Health, Cumulative Index to Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences, covering the studies published between 2004 and 2014. RESULTS The final sample consisted of 14 studies grouped into three categories, namely; polycyclic aromatic hydrocarbons, volatile compounds and volatile organic compounds. CONCLUSION There is scientific evidence that electrocautery smoke has volatile toxic, carcinogenic and mutagenic compounds, and its inhalation constitutes a potential chemical risk to the health of workers involved in surgeries.
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Ferron G, Simon L, Guyon F, Glehen O, Goere D, Elias D, Pocard M, Gladieff L, Bereder JM, Brigand C, Classe JM, Guilloit JM, Quenet F, Abboud K, Arvieux C, Bibeau F, De Chaisemartin C, Delroeux D, Durand-Fontanier S, Goasguen N, Gouthi L, Heyd B, Kianmanesh R, Leblanc E, Loi V, Lorimier G, Marchal F, Mariani P, Mariette C, Meeus P, Msika S, Ortega-Deballon P, Paineau J, Pezet D, Piessen G, Pirro N, Pomel C, Porcheron J, Pourcher G, Rat P, Regimbeau JM, Sabbagh C, Thibaudeau E, Torrent JJ, Tougeron D, Tuech JJ, Zinzindohoue F, Lundberg P, Herin F, Villeneuve L. Professional risks when carrying out cytoreductive surgery for peritoneal malignancy with hyperthermic intraperitoneal chemotherapy (HIPEC): A French multicentric survey. Eur J Surg Oncol 2015; 41:1361-7. [PMID: 26263848 DOI: 10.1016/j.ejso.2015.07.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/10/2015] [Accepted: 07/15/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Over the last two decades, many surgical teams have developed programs to treat peritoneal carcinomatosis with extensive cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC). Currently, there are no specific recommendations for HIPEC procedures concerning environmental contamination risk management, personal protective equipment (PPE), or occupational health supervision. METHODS A survey of the institutional practices among all French teams currently performing HIPEC procedures was carried out via the French network for the treatment of rare peritoneal malignancies (RENAPE). RESULTS Thirty three surgical teams responded, 14 (42.4%) which reported more than 10 years of HIPEC experience. Some practices were widespread, such as using HIPEC machine approved by the European Community (100%), individualized or centralized smoke evacuation (81.8%), "open" abdominal coverage during perfusion (75.8%), and maintaining the same surgeon throughout the procedure (69.7%). Others were more heterogeneous, including laminar flow air circulation (54.5%) and the provision of safety protocols in the event of perfusate spills (51.5%). The use of specialized personal protective equipment is ubiquitous (93.9%) but widely variable between programs. CONCLUSION Protocols regarding cytoreductive surgery/HIPEC and the associated professional risks in France lack standardization and should be established.
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Affiliation(s)
- G Ferron
- Department of Surgical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France.
| | - L Simon
- Department of Surgical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France
| | - F Guyon
- Department of Surgical Oncology, Bergonie Institute, Bordeaux, France
| | - O Glehen
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France; EMR 3738, Lyon 1 University, Lyon, France
| | - D Goere
- Department of Surgical Oncology, Gustave Roussy Institute, Villejuif, France
| | - D Elias
- Department of Surgical Oncology, Gustave Roussy Institute, Villejuif, France
| | - M Pocard
- Surgical Oncologic & Digestive Unit, Lariboisière University Hospital, Paris, France; INSERM, U 965, Paris, France
| | - L Gladieff
- Department of Medical Oncology, Claudius Regaud Institute - IUCT, Toulouse, France
| | - J M Bereder
- Department of General Surgery, Archet 2 University Hospital, Nice, France
| | - C Brigand
- Department of General Surgery, Hautepierre University Hospital, Strasbourg, France
| | - J M Classe
- Department of Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - J M Guilloit
- Department of Surgical Oncology, Francois Baclesse Comprehensive Cancer Center, Caen, France
| | - F Quenet
- Department of Surgical Oncology, Val d'Aurelle Montpellier Cancer Center, Montpellier, France
| | - K Abboud
- Department of Digestive Surgery, University Hospital of Saint Etienne, Saint Etienne, France
| | - C Arvieux
- Department of Digestive Surgery, Michallon University Hospital, Grenoble, France
| | - F Bibeau
- Department of Pathology, Val d'Aurelle Montpellier Cancer Center, Montpellier, France
| | - C De Chaisemartin
- Department of Surgical Oncology, Paoli-Calmettes Institute, Marseille, France
| | - D Delroeux
- Department of Digestive Surgery, Jean Minjoz University Hospital, Besançon, France
| | - S Durand-Fontanier
- Department of Visceral Surgery and Transplantation, Dupuytren University Hospital, Limoges, France
| | - N Goasguen
- Department of General Surgery, Diaconesses Croix Saint Simon Group Hospital, Paris, France
| | - L Gouthi
- Department of Digestive Surgery, Purpan University Hospital, Toulouse, France
| | - B Heyd
- Department of Digestive Surgery, Jean Minjoz University Hospital, Besançon, France
| | - R Kianmanesh
- Department of Digestive Surgery, Robert Debré University Hospital, Reims, France
| | - E Leblanc
- Department of Gynaecological Surgery, Oscar Lambret Cancer Center, Lille, France
| | - V Loi
- Department of Digestive Surgery, Tenon University Hospital, Paris, France
| | - G Lorimier
- Department of Surgical Oncology, Paul Papin Cancer Center, Angers, France
| | - F Marchal
- Department of Surgical Oncology, Lorraine Institute of Oncology, Vandoeuvre-les-Nancy, France
| | - P Mariani
- Department of Surgical Oncology, Curie Institute, Paris, France
| | - C Mariette
- Department of Digestive and Oncological Surgery, Claude-Huriez University Hospital, Lille, France
| | - P Meeus
- Department of Surgery, Léon Bérard Comprehensive Cancer Center, Lyon, France
| | - S Msika
- Department of Surgery, Louis Mourier University Hospital, Colombes, France
| | - P Ortega-Deballon
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - J Paineau
- Department of Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - D Pezet
- Department of Digestive Surgery, Estaing University Hospital, Clermont-Ferrand, France
| | - G Piessen
- Department of Digestive and Oncological Surgery, Claude-Huriez University Hospital, Lille, France
| | - N Pirro
- Department of Digestive Surgery, Timône University Hospital, Marseille, France
| | - C Pomel
- Department of Surgical Oncology, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France
| | - J Porcheron
- Department of Digestive Surgery, University Hospital of Saint Etienne, Saint Etienne, France
| | - G Pourcher
- Department of General Surgery, Antoine-Béclère University Hospital, Clamart, France
| | - P Rat
- Department of Digestive Surgical Oncology, University Hospital of Dijon, Dijon, France
| | - J M Regimbeau
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
| | - C Sabbagh
- Department of Digestive Surgery, University Hospital of Amiens, Amiens, France
| | - E Thibaudeau
- Department of Surgical Oncology, René Gauducheau Cancer Center, Nantes, France
| | - J J Torrent
- Department of Gynecology, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - D Tougeron
- Department of Hepato-Gastroenterology, University Hospital, Poitiers, France
| | - J J Tuech
- Department of Digestive Surgery, Charles Nicolle University Hospital, Rouen, France
| | - F Zinzindohoue
- Department of Digestive and General Surgery, G. Pompidou European Hospital, Paris, France
| | - P Lundberg
- Department of Digestive Surgery, Lyon-Sud University Hospital, Lyon, France; EMR 3738, Lyon 1 University, Lyon, France
| | - F Herin
- Department of Occupational Medicine, University Hospital, Toulouse, France
| | - L Villeneuve
- Hospices Civils de Lyon, Pôle Information Médicale Evaluation Recherche, Unité de Recherche Clinique, Lyon, France
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Okoshi K, Kobayashi K, Kinoshita K, Tomizawa Y, Hasegawa S, Sakai Y. Health risks associated with exposure to surgical smoke for surgeons and operation room personnel. Surg Today 2014; 45:957-65. [DOI: 10.1007/s00595-014-1085-z] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 10/09/2014] [Indexed: 01/02/2023]
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Khunger N. Commentary on: The Electric Household Chimney: A Cost Effective Alternative for Smoke Evacuator in the Operating Room. J Cutan Aesthet Surg 2014; 7:49-50. [PMID: 24761101 PMCID: PMC3996792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Niti Khunger
- Department of Dermatology and Sexually-Transmitted Disease, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi, India,Address for correspondence: Dr. Niti Khunger, Department of Dermatology and Sexually-Transmitted Disease, Vardhman Mahavir Medical College and Safdarjang Hospital, New Delhi-110 029, India. E-mail:
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