Surgical smoke management in the paediatric operating room 

Surgical procedures often involve the use of heat-producing tools such as electrosurgical units, lasers, and powered instruments to remove tissue. However, this common practice poses a hidden danger: the generation of surgical smoke, also known as plume.  

Surgical smoke is defined as the concentration of ultra-fine smoke particles in the air, which can contain hazardous gases and vapours such as benzene, hydrogen cyanide, and formaldehyde, along with bioaerosols, dead and live cellular material, and viruses. 

Despite the known risks associated with surgical smoke exposure, including acute symptoms like headache, cough, nausea, and long-term health issues such as lung diseases and cancer, there has been a lack of standardisation and implementation of measures to mitigate these risks in healthcare settings.  

Evidence-based recommendations for surgical smoke evacuation and filtration are consistent among professional organisations and researchers. These recommendations include strategies such as risk assessment, smoke evacuation and filtration systems, consideration of alternative energy-generating devices or surgical techniques, and the use of N95 respirators for personnel protection. While surgical masks do not provide adequate protection against surgical smoke, N95 respirators have been shown to reduce inhalation exposure effectively. 

A best practice implementation project was conducted in the paediatric perioperative setting of a large academic medical centre in the US. The project aimed to promote evidence-based surgical plume management and is published in JBI Evidence Implementation.  

Resources

Promoting surgical smoke management in a pediatric operating room: a best practice implementation project 
Moore, Hailey; Palokas, Michelle 
JBI Evidence Implementation. 22(1):26-35, February 2024.