Risk of airway fire with the use of KTP laser and high flow humidified oxygen delivery in a laryngeal surgery model

Airway surgery presents a unique environment for operating room fire to occur. This study aims to explore the factors of combustion when using KTP laser with high flow oxygen in an ex-vivo model. The variables tested were varying tissue type, tissue condition, oxygen concentration, laser setting, and smoke evacuation in a stainless-steel model. Outcome measures were time of lasing to the first spark and/or flame. A multivariate Cox proportional hazard model was used to determine the risk of spark and flame across the different risk factors. For every 10% increase in oxygen concentration above 60% the risk of flame increased by a factor of 2.3. Continuous laser setting at 2.6 W increased the risk by a factor of 72.8. The risk of lasing adipose tissue is 7.3 times higher than that of muscle. Charred tissue increases the risk of flame by a factor of 92.8. Flame occurred without a preceding spark 93.6% of the time. Using KTP laser in the pulsed mode with low wattages, minimising lasing time, reducing the oxygen concentration and avoiding lasing adipose or charred tissue produce a relatively low estimated risk of spark or flame.

The case for compulsory surgical smoke evacuation systems in the operating theatre

Perioperative staff are frequently exposed to surgical smoke or plume created by using heat-generating devices like diathermy and lasers. This is a concern due to mounting evidence that this exposure can be harmful with no safe level of exposure yet identified. First, I briefly summarise the problem posed by surgical smoke exposure and highlight that many healthcare organisations are not sufficiently satisfying their legal and ethical responsibilities to protect their staff from potential harm. Second, I explore the ethical case for compulsory smoke evacuation systems using the principlist framework and its four ethical principles – autonomy, beneficence, nonmaleficence, and justice. I then consider some objections and argue that surgical smoke evacuation systems – when indicated – should be made compulsory.

Risk of Airway Fire with the use of KTP Laser and High Flow Humidified Oxygen Delivery in a Laryngeal Surgery Model

Background Airway surgery presents a unique environment for operating room fire to occur. This study aims to explore the factors of combustion when using KTP laser with high flow oxygen in an ex-vivo model. MethodsThe variables tested were varying tissue type, tissue condition, oxygen concentration, laser setting, and smoke evacuation in a stainless-steel model. Outcome measures were time of lasing to the first spark and/or flame. A multivariate Cox proportional hazard model was used to determine the risk of spark and flame across the different risk factors. ResultsFor every 10% increase in oxygen concentration above 60% the risk of flame increased by a factor of 2.3. Continuous laser setting at 2.6W increased the risk by a factor of 72.8. The risk of lasing adipose tissue is 7.3 times higher than that of muscle. Charred tissue increases the risk of flame by a factor of 92.8. Flame occurred without a preceding spark 93.6% of the time. Conclusions Using KTP laser in the pulsed mode with low wattages, minimising lasing time, reducing the oxygen concentration and avoiding lasing adipose or charred tissue produce a relatively low estimated risk of spark or flame.

Smoke Evacuation in Dermatology: A National Cross-Sectional Analysis Examining the Behaviors and Perceptions of Dermatologists and Dermatologic Surgeons

Background: Despite associated hazards of surgical smoke, there is limited data regarding smoke evacuation practices among dermatologists. Such information is especially relevant at this time as dermatologic procedures often involve exposure to aerosolized particles and known carcinogens. Objective: To examine the barriers underlying historically low utilization of smoke protection among dermatologists Methods: A survey was sent to dermatologists through the Association of Professors of Dermatology (APD) list-serv and a cross-sectional analysis of responses was performed. Results: A total of 85 dermatologists responded. Twenty-four (28.2%) reported use of smoke evacuators during > 50% of dermatologic procedures. The odds of using smoke evacuation was 2.8 times higher in dermatologists with 10 or more years of experience (95% CI, 1.1-7.5; p=0.0358). The most commonly reported barriers to smoke evacuation were limited staffing (63.5%) and set-up time (61.2%). Sixty-seven (78.8%) respondents reported that a hands-free evacuator could potentially increase the use of smoke evacuation in their practices. Limitations: Survey sent on academic listserv with relatively small sample size and limited generalizability. Conclusions: Smoke evacuation remains low among dermatologists despite the risks. Identifying reasons for low utilization and receptiveness to potential solutions is necessary to improve safety practices relating to smoke evacuation.

Smoke Evacuation During Laparoscopic Surgery: A Problem Beyond the COVID-19 Period. A Quantitative Analysis of CO2 Environmental Dispersion Using Different Devices

Background. The COVID-19 pandemic leads to several debates regarding the possible risk for healthcare professionals during surgery. SAGES and EAES raised the issue of the transmission of infection through the surgical smoke during laparoscopy. They recommended the use of smoke evacuation devices (SEDs) with CO2 filtering systems. The aim of the present study is to compare the efficacy of different SEDs evaluating the CO2 environmental dispersion in the operating theater. Methods. We prospectively evaluated the data of 4 group of patients on which we used different SEDs or standard trocars: AIRSEAL system (S1 group), a homemade device (S2 group), an AIRSEAL system + homemade device (S3 group), and with standard trocars and without SED (S4 group). Quantitative analysis of CO2 environmental dispersion was carried out associated to the following data in order to evaluate the pneumoperitoneum variations: a preset insufflation pressure, real intraoperative pneumoperitoneum pressure, operative time, total volume of insufflated CO2, and flow rate index. Results. 16 patients were prospectively enrolled. The [CO2] mean value was 711 ppm, 641 ppm, 593 ppm, and 761 ppm in S1, S2, S3, and S4 groups, respectively. The comparison between data of all groups showed statistically significant differences in the measured ambient CO2 concentration. Conclusion. All tested SEDs seem to be useful to reduce the CO2 environmental dispersion respect to the use of standard trocars. The association of AIRSEAL system and a homemade device seems to be the best solution combining an adequate smoke evacuation and a stable pneumoperitoneum during laparoscopic surgery.

Guidelines for otorhinolaryngologists and head neck surgeons in coronavirus disease 2019 pandemic

Background Coronavirus disease 2019 was first identified in Wuhan, the capital of China’s Hubei province, in December 2019. India has witnessed a massive surge of coronavirus cases. Main text This study details the measures to be taken by the clinicians involved in doing otorhinolaryngology and head neck surgery in light of the recent coronavirus disease 2019 pandemic. All COVID-positive patients should be admitted in a separate COVID ward, and patients should be screened for COVID-19 before admission. Only emergent ENT surgeries should be done in an operating room having a negative pressure environment with high-frequency air changes, and all staff must wear personal protective equipment. The anesthetist intubates the patient while the surgical team waits outside the operation theater post-intubation for 21 min. For otology surgery, double draping of the microscope should be done; for rhinology surgery, concept of negative-pressure otolaryngology viral isolation drape (NOVID) system should be used. Smoke evacuation system is set up inside the tent to evacuate any smoke produced during the surgery. Tracheostomy should be done at least after 10 days of mechanical ventilation with cuffed, non-fenestrated tracheal tube inserted through the tracheal window, and a separate closed suction system is used for suctioning. After the surgery is completed, disposal of PPE kit needs to be done according to local guidelines. After completion of the surgery, the full anesthesia unit should be disinfected for 2 h with 12 % hydrogen peroxide. Chlorine-containing disinfectant (2000 mg/L) is used to clean the floor of the operation theater and clean all the reusable medical equipment. Ultra-low volume 20 to 30 mL/m of 3% hydrogen peroxide is used to fumigate the OT for 2 h. Conclusions COVID-19 is a newly discovered infectious disease. Measures need to be taken to prevent transmission and attain a plateau and decline in the disease. Otorhinolaryngologists and head neck surgeons are at high risk of this infection. This review summarizes the protocol for otorhinolaryngologists and head neck surgeons caring for patients in this current scenario. Protocols need to be strictly followed to prevent the spread of this disease.