Application of  suction cautery

An electrocautery device is the most common heat generator in the operating room that uses a high-frequency electric current to cut tissue or blood coagulation in surgical uses. This heat causes the cell contents to evaporate, and this fume is called “surgical fume” or “surgical smoke”. The device that collects this fume through suction is named the suction cautery tube that in following connect to the suction tube and unit.

The Occupational Safety and Health Administration (OSHA) estimates that 500,000 employees in the United States are exposed to surgical fumes, and many health care professionals, such as surgeons and operating room technicians, are exposed to it for several hours a day and in several years.

The fume from burning hair or skin and tissue during electrocauterization in outpatient surgeries or surgeries that require cauterization can be a serious threat to the health of surgeons and operating room staff.

95% of surgical fumes are from water and 5% from tissue components including blood, chemicals, viruses, and bacteria.

This fume is produced because the cross-section of the active electrode (probe) is a much smaller cross-section than the passive electrode (cautery plate), so the current density would be much larger.

Risks and complications of surgical smoke

Various studies conducted in Iran and other countries in the world on the awareness level of the effects of electrocautery smoke show that people are not sufficiently aware of this field.

Today, surgeons, as well as dermatologists and hair specialists, are increasingly exposed to fume from electrocautery surgery and repair of skin and tissue lesions due to the increasing use of electrosurgery devices.

Why are surgical fumes toxic and dangerous?

According to research, more than 40 types of chemicals have been identified inside electrocautery fume. The identified substances include compounds such as hydrocarbons, nitrates, fatty acids, etc. in large quantities, but more concern is about a large amount of acrylonitrile and carbon monoxide.

Acrylonitrile not only can enter the respiratory system but can also be absorbed by the skin and release its toxicity as cyanide into the skin.

The average level estimated by the US Reference Agency for people in the operating room who are exposed to surgical fumes on a daily basis is about 1 to 1.6 particles per million. Meanwhile, the Occupational Safety and Health Administration has determined the specified amount in slightly higher at about 2 particles per million.

Carbon monoxide levels in the operating room can reach up to 10 particles per million. While one of the health organizations in Canada has determined the number of particles in the operating room to be 11 particles per million. Carbon monoxide ability to pass through the patient’s blood vessels and can cause systemic effects on the body.

Besides, electrocautery fume has low levels of released compounds such as benzene, formaldehyde (HCHO), and hydrogen cyanide and can be as dangerous as cigarette smoke. To remove these gases, suction cautery is used, which we will learn more about later.

Three important complications of surgical smoke

1. Carcinogenicity (mutagenicity)

The chemical compounds in surgical fumes include hydrocarbons, phenols, nitriles, and fatty acids. Also, acrylonitrile, hydrogen cyanide, and carbon monoxide, which are very dangerous, are found in surgical smoke.

In one study, researchers sampled mammoplasty operating room air and exposed Salmonella bacteria to the air sample. The result of the experiment was the expression of mutagenic effects on Salmonella DNA. The mutagenic effect of electrocauterization fume was equal to the mutagenic effect of smoke 3 to 6 cigarettes.

Another point is cancer cell transmission possibility; Sometimes doctors or surgeons use electrocautery or laser to destroy skin cancers such as SCC, BCC, and melanoma. In this case, the malignant cells spread out easily and alive in the operating room air, and the possibility of entering the surgeon or operating room staff’s body is not ruled out.

However, there have been no reports of such malignancies in humans, but the precautionary condition is to use filtered face masks during skin cauterization or laser skin cancer and to have an electrocautery (smoke evacuation) system.

2. Pulmonary complications

The harmful effects of electrocautery smoke have been proven in the lungs of laboratory animals. Changes in the lung parenchyma in laboratory mice have been in the form of vascular hypertrophy, alveolar congestion, and emphysema. Benzene, formaldehyde, and acrolein may be responsible for these changes.

Deposition of fine particles in the alveoli of the lungs of mice following a CO2 laser causes changes such as interstitial pneumonia, bronchiolitis, and emphysema.

Sometimes laser and electrocautery users may be allergic to particles suspended in surgical smoke (fume), while the surgical smoke contains carbon monoxide. This gas enters the bloodstream and forms carboxyhemoglobin and meta-hemoglobin, leading to hypoxia and cardiovascular problems in susceptible individuals.

3. Infection

The infection of surgical smoke has been proved for the lungs. Viruses may survive in a fume of the electrocautery or laser, and transmit the infection to the surgeon. This has been proven in Er: YAG, Nd: YAG, and CO2 laser smoke.

In a DNA test, the HIV virus was found in surgical smoke for up to 14 days after surgery. However, the pathogenicity of AIDS through inhalation has not yet been proven in humans.

The Doctors who use electrocautery, are at risk of HPV virus transmission, and the emergence of papillomatous lesions in the nasopharynx.

In addition to viruses, some bacteria survive into the cautery (or laser) smoke. For example, coagulase-negative Staphylococcus aureus, corynebacteria, and Neisseria were cultured from room air in which patients were treated with resurfacing laser. To prevent these problems, suction cautery is used.

Methods of protection against surgical smoke

There are different methods to protect surgeons, operating room staff, and even patients against surgical smoke;

1. Using filtered face mask

Unfortunately, simple surgical masks that are routinely used, have low protective power, and the Toxic particles and microbiology in surgical fume easily pass through their pores.

Simple mask filters particles larger than 5 microns, while surgical smoke particles are smaller than 1 micron, so must be used a mask with HEPA or nano filtered.

2. Central ventilation system

Another way to get rid of surgical fumes and smoke is to use a central ventilation system in all operating rooms.

This system using high power standard pumps, conditions the air, in the path of which several types of filters are placed and the operating room air is easily purified.

3. Suction set

Surgical fumes can be promptly evacuated by placing the tip of the suction pipe near the electrocautery pencil or laser. So that if the distance between the suction tip and electrosurgery site is 1 cm, suctioning success will be about %98, and if the distance increase to 2 cm, then its efficiency will decrease to %50.

Usually, in such cases, a surgeon assistant or a member of the surgical team takes the suction tube (or suction tip) in his hand and takes it close to where the surgeon is doing cauterization so that the resulting smoke is sucked and transferred to the suction device.

But this method is associated with the following problems:

• Impossible to fully coordinate with the surgeon and possibility of interfering with the surgeon’s work
• Restriction of the surgeon’s vision (on the operating field)
• Impossibility of placing the suction in a proper place for better suction

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4. Suction cautery

The best solution to solve these problems and do a perfect suction in such cases is to use a  suction cautery tube. Suction cautery tube will have the best performance in smoke suction by being installed on the cautery pencil and close to the cautery electrode head.

AJP Suction cautery set

As shown in the image below, the AJP suction cautery is made of a transparent and flexible tube that is attached to the cautery pencil and the corresponding cable by small and delicate clamps.

This product aligns with the cautery pencil and does not disturb the work of the surgeon and also does not disrupt the operation of the electrocautery device.

Its tip is installed at the closest point to the cautery pencil electrode tip to have the best performance and its end is connected to the suction tube and finally to the suction device by an interface.

Advantages of AJP suction cautery tube

• Collecting smoke, dust, and fumes resulting from electrocauterization pencil and transferring it to the suction device by AJP suction cautery tube
• AJP suction cautery set has thin clips to attach to the cautery probe and its pencil for better performance and maximum ease of use.
• The AJP suction tube is made transparent to viewing inside it and also seeing smoke suction into it.
• AJP suction cautery set is disposable and does not need to be washed, repackaged, or sterilized.
• The suction sets manufactured by Asia Jarah Pishro are sterilized with ethylene oxide gas.