Archive May 2017 XVIII, No. 5

Editor's Page: Make Surgical Smoke Evacuation Mandatory

Let's clear the air and address a major health hazard facing OR staff.

Dan O

Dan O'Connor, Editor-in-Chief


Anthony K. Hedley, MD, FRCS Anthony K. Hedley, MD, FRCS

In 2013, orthopedic surgeon Anthony K. Hedley, MD, FRCS, was diagnosed with idiopathic pulmonary fibrosis (IPF), a disease that's as bad as it sounds. Irreversible and ultimately fatal, IPF causes scar tissue to grow inside your lungs. At age 70, he underwent a life-saving double lung transplant.

What else could have caused this, he thought, but 40 years of smoking? No, he'd never touched a cigarette, but he had inhaled the surgical plume from nearly 11,000 joint replacements.

"That's 30 to 40,000 hours. That's a lot of exposure," he says. "I've made a lot of Bovie smoke in my day."

Bovie smoke. That's what he calls the byproduct of high-heat electrical tools used to cut and cauterize skin and tissue during surgery.

"It's noxious. There's nothing nice about it," says Dr. Hedley. "It smells like a barbecue. Either you're burning flesh or you're burning fat. Some nasty things come out of Bovie smoke."

Nasty is a good word. Consider:

  • Surgical smoke contains about 150 chemicals, including 16 EPA priority pollutants, toxic and carcinogenic substances, and viruses and bacteria. As early as 1988, researchers published studies that revealed the presence of mutagens, carcinogens, and viable disease-causing cells in the smoke plume produced by heat destruction of human tissue.
  • The smoke produced in an OR every day can be equivalent to smoking as many as 30 unfiltered cigarettes. That's 1½ packs of Pall Malls a day.

And yet exposure to surgical smoke remains one of the largest unaddressed health hazards facing operating room staff today. Will it remain that way?

Not if Dr. Hedley can help it.

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