Distribution of ultrafine aerosols and volatile organic compounds from surgical smoke during electrocauterization

Electrocauterization causes foul smells and surgical smoke that affect operating room (OR) air quality. This study analyzed the concentration distribution of 87 volatile organic compounds (VOCs) in surgical smoke generated during head and neck surgeries and evaluated their size and concentration using pig skin and pork tissues. Surgical smoke from 22 head and neck surgeries were collected; VOC concentrations were analyzed using a gas chromatography–mass spectrometry. In vitro experiments utilized an electrosurgical model to burn pig skin and pork tissues; thereafter, the particle size and concentration of surgical smoke in different sampling areas were analyzed. High methanol and carcinogen levels were observed in the surgical smoke generated by head and neck surgeries. The concentrations of 87 identified VOCs in surgical smoke were affected by human tissues and electrosurgical units. Moreover, the median concentrations of particulate matter from the electrical burning of pig skin measured in the breathing area of simulated surgical personnel were significantly higher than those in pork tissue. High VOC levels in surgical smoke from head and neck surgeries were affected by human tissues and electrosurgical units. Ultrafine aerosols primarily existed in surgical smoke from the smoke generation area. Human oral mucosa tissues treated with carbon dioxide (CO 2 ) lasers produced higher VOC concentrations than craniofacial adipose tissues that were treated using conventional electrosurgical knives. Medical staff in ORs should be informed of the hazards of exposure to VOCs and ultrafine aerosols in surgical smoke.