Authors' objectives:

This aim of this critical appraisal was to assess whether smoke plume from laser/electrical surgical procedures is a health hazard.

Authors' recommendations: The definitive evidence for the potential danger from smoke plume is provided by the National Institute for Occupational Safety and Health (NIOSH), Centre for Disease Control USA. (1996): 'Research studies have confirmed that smoke plume can contain toxic gases and vapors' Although no references are provided in the electronic version of the document, statements from this organisation have considerable authority. The consensus-based recommendations of the American Sleep Disorders Association (1994) also recognise the potential hazard of smoke plume during laser surgery: 'The smoke plume from lasers has been recognized as a biological and a chemical hazard for both the surgical personnel and the patient, particularly for patients undergoing operations involving the airway. Laser devices should be used in conjunction with an efficient smoke evacuator.' The single reference given for this statement is an animal study conducted by Baggish and Elbakry (1987). (Rats exposed to particulate matter from laser smoke obtained during tissue vaporisation had evidence of congestive interstitial pneumonia, bronchiolitis, and emphysema). Since prospective trials involving humans to evaluate the health risks of smoke plume would not be ethical, most of the studies assessing the risk of smoke plume are based on in vitro or animal experiments. In general, these studies have found smoke plume from laser/electric surgery to contain pathogens. For example, a recent prospective in vitro study conducted by Caprizzi et al (1998) confirmed the potential occupational risk from laser smoke plume. This experiment compared bacterial and viral cultures from OR air filters prior to (control culture) and during laser resurfacing surgery (2 cultures taken at different time periods). Although no pathogens were grown in samples collected from control filters, bacterial cultures were grown in samples collected during surgeries of five of the 13 patients (38%).

Authors' methods: Critical appraisal

Project Status: Completed

URL for project: http://www.med.monash.edu.au/healthservices/cce/evidence/

Year Published: 2000

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Australia

Organisation Name: Centre for Clinical Effectiveness

Contact Address: Monash Institute of Health Services Research, Block E, Monash Medical Centre, Locked Bag 29, Clayton, Victoria 3168, Australia. Tel: +61 3 9594 7505; Fax: +61 3 9594 7552.

Contact Name: cce@med.monash.edu.au.

Contact Email: cce@med.monash.edu.au.

Copyright: Centre for Clinical Effectiveness (CCE)