Surgical smoke exposure to patients and to healthcare workers in the operating room: a quantitative assessment

BACKGROUND: Surgical smoke produced by the use of an electrosurgical unit may have a negative effect to patients and healthcare workers in the operating room, but studies on this problem are insufficient. METHODS: In 100 situations in which patients were undergoing four types of surgery under general anesthesia, the count of airborne particles (in 1.415 L) was measured using a particle counter to see possible differences at the patients and at the anesthesiologists, during different types of surgery, and at several locations. RESULTS: The airborne particles during the use of an electrosurgical unit were significantly higher than before its use, both at the patient's head (median: 56/L vs 3,514/L; 95%CI for the median difference: 769-7,699/L) and at the anesthesiologist's position (230/L vs 6,907/L; 95%CI for the median difference: 2,945-13,196/L) (p < 0.0001). The airborne particles were significantly higher during cardiovascular surgery than during open abdominal surgery (median difference in increase: 8,439/L), significantly higher during open abdominal surgery than during head and neck surgery (2,654/L), and significantly higher during head and neck surgery than during laparoscopic surgery (1,442/L) (all p < 0.0001), and were high anywhere in the operating room and even outside the operating room door (always > 2,000/L). CONCLUSIONS: During the use of an electrosurgical unit, both the patients and healthcare workers are at increased risk of being exposed to high concentrations of airborne particles derived from surgical smoke.