Surgical Smoke Inhalation: Dangerous Consequences for the Surgical Team

June 18, 2020 by Mary J. Ogg, MSN, RN, CNOR

In 1996, after conducing multiple health hazard evaluations, NIOSH released a bulletin recommending the control of surgical smoke created during laser or electric surgical procedures. Since the 1990s the Association of Perioperative Registered Nurses (AORN) has recommended the evacuation of all surgical smoke. Yet, surgical smoke is still inhaled daily by nurses in the operating room. In a 2016 study, NIOSH surveyed health care personnel who were exposed to surgical smoke. Their results indicated that of respondents who worked within five feet of the source of surgical smoke only 14% reported that it was evacuated during electrosurgery and 47% during laser surgery (Steege et al.).

During surgical procedures, smoke is produced when energy generating devices such as lasers or electrosurgical units also known as cautery are used to stop bleeding or incise tissue. The energy generating devices raise the intracellular temperature to boiling (i.e., 100° C /212° F). At these high temperatures the tissue vaporizes producing surgical smoke. The smoke is often not visible and has an unpleasant odor. The smoke may contain ultra-fine particles, toxic compounds (e.g., benzene, toluene, hydrogen cyanide), viruses (e.g., human papilloma virus [HPV]), and cancer cells (Guideline for Surgical Smoke Safety).

Chemical Contents of Surgical Smoke
Acetonitrile	Acetylene	Acroloin	Acrylonitrile	Alkyl benzene
Benzaldehyde	Benzene	Benzonitrile	Butadiene	Butene
3-Butenenitrile	Carbon monoxide	Creosol	1-Decene	2,3-Dihydro indene
Ethane	Ethyl benzene	Ethylene	Formaldehyde	Furfural
Hexadecanoic acid	Hydrogen cyanide	Indole	Methane	3-Methyl butenal
6-Methyl indole	4-Methyl phenol	2-Methyl propanol	Methyl pyrazine	Phenol
Propene	2-Propylene nitrile	Pyridine	Pyrrole	Styrene
Toluene	1-Undecene	Xylene

Used with permissionUlmer BC. The hazards of surgical smoke. AORN J. 2008;87(4):721-734.

Inhaling surgical smoke may be hazardous to anyone breathing it in including the patient and all members of the surgical team—nurses, doctors, and technologists. The Occupational Safety and Health Association (OSHA) has estimated that more than half a million heath care workers are exposed to surgical smoke every year. Repeated exposure to the contents of surgical smoke may be cumulative and increases the possibility of developing adverse health effects (Alp et al.). At high concentrations the smoke causes eye and upper respiratory tract irritation in health care personnel and creates visual problems for the surgeon. The smoke also has the potential to cause gene mutation.

AORN is leading legislative efforts for surgical smoke-free operating rooms across the United States. Rhode Island and Colorado became the first U.S. states to require surgical smoke evacuation policies by law.

Mary J. Ogg, MSN, RN, CNOR, is a Senior Perioperative Practice Specialist with the Association of periOperative Registered Nurses (AORN).

This blog is part of a series hosted by NIOSH to commemorate nurses during the Year of the Nurse. The views expressed by guest authors do not necessarily reflect the views of CDC or NIOSH.

Other blogs in the series include:

Year of the Nurse

Managing Fatigue During Times of Crisis: Guidance for Nurses, Managers, and Other Healthcare Workers

Nurses’ and Other Health Professionals’ Wellness and Safety Resource Update