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Call for mandatory extraction of diathermy smoke in theatres

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Diathemy smoke carries nine hazardous compounds but some surgeons elect not to use smoke extractors during cauterisation procedures, an operating department practitioner has warned.

The electrical devices that are used to cauterise tissue during surgical operations cause plumes of smoke to arise as intense heat is applied to flesh.

“All we can practically do is agree that there are some potentially dangerous particles in there and make recommendations”

Lynda Dunn

Research has shown that these fumes – known as diathermy smoke – contain compounds that are potentially harmful to the health of the personnel participating in the operation.

Lynda Dunn, a University of Huddersfield lecturer and operating department practitioner, has published two articles analysing existing research on the topic.

They show that 45 compounds have been detected in diathermy smoke, she said. Nine are hazardous and four of them are carcinogens.

It is clear, she argues the Journal of Operating Department Practitioners, that the use of an extraction device in the operating theatre would be best practice.

But until there is more conclusive evidence on the health risks of diathermy smoke, it will be difficult to procure legislation on the need to extract it from operating theatre air, she notes.

However, she acknowledges that research to establish conclusively the health risks of the smoke would be long and costly.

“You would have to look at people’s health maybe 30 years down the line and decide whether or not any problems were due to their exposure to the smoke,” said Ms Dunn.

The lack of evidence means there is also a lack of guidance on the issue from the National Institute for Health and Care Excellence.

“All we can practically do is agree that there are some potentially dangerous particles in there and make recommendations,” said Ms Dunn.

Extractor devices are now available. Attached to the diathermy “pens” that are used during operations, they have become less cumbersome, but not all surgeons elect to use them in theatre.

Ms Dunn said she hoped that her work would help lead to much wider adoption of extractors, which in turn would bring down the cost of the devices.

“I would definitely encourage people to use extractors,” she said. “Apart from anything else, it is much more pleasant to work in an operating theatre without the smell of the smoke.”

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Readers' comments (1)

  • A surgical plume is only one of many noxious materials currently affecting perioperative staff. In a climate of financial restraint it is right to challenge for the provision of personal protective equipment and devices that assist in the removal of air borne contaminants.

    Adrian Jones
    Vice President
    The Association for Perioperative Practice

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