Analysis of Surgical Smoke Generated by Electrocautery in a Simulated Neurosurgical Operating Room Using a Postmortem Porcine Model for Laminectomy and Craniotomy Exposures: A Preliminary Study

Abstract

BACKGROUND AND OBJECTIVES: Electrocautery is a widely used tool to coagulate and separate tissue during neurosurgical procedures. Surgical smoke generated by electrocautery has harmful properties if inhaled over long-term. To our knowledge, no efforts have been made within the neurosurgery field to investigate the air quality of operating rooms (ORs) where neurosurgical procedures are being performed. We analyzed the presence and quantitation of volatile organic compounds and respirable dust in surgical smoke generated by electrocautery use during a neurosurgical OR simulation for laminectomies and craniotomies and evaluated whether surgical masks can adequately prevent inhalation of such substances. METHODS: Two laminectomy exposures and two bicoronal exposures were performed in two freshly euthanized pigs using electrocautery in a simulated neurosurgical OR. In each of the four neurosurgical procedure models, air sampling media and pumps were connected to a 3D-printed human face model. In two of these models, the face was covered with a standard surgical mask; in the other two models, no masks were placed. The models were positioned at a distance of 40 cm from the surgical field. Air samples were analyzed by an independent laboratory. Analyses of total amounts of respirable dust and 31 organic volatile compounds were conducted. The mean total amounts of the samples obtained from the masked and nonmasked models were compared. RESULTS: In the two masked and two nonmasked models, all 31 organic volatile compounds were below the levels of quantitation. The total amounts of respirable dust were higher in the two nonmasked models than in the two masked models. CONCLUSION: The total amount of organic volatile compounds seems to be low at the distance measured regardless of mask use; however, further studies are needed to determine whether even small amounts can be harmful over time. Standard surgical masks reduced the amounts of inhalable respirable dust.