The potential alveolar hazard of carbon dioxide laser-induced smoke

Carbon dioxide laser is a continuous wave laser, it is well known for its capacity of tremendous smoke production while contact with tissue. Smoke may cause nausea, vomiting, headache and airway irritation. Smoke particles 0.5-2 micrometers in diameter usually travel down the tracheobronchial tree and lodge in the alveoli posing a health hazard. The objectives of this study were to evaluate possible health hazards of carbon dioxide laser smoke in the operating room environment, by determining the size and density of smoke particles also determine the efficacy of surgical masks as a smoke protectant. Ten fresh specimens of papillomatous tissue obtained from the patients were lased by carbon dioxide laser in a continuous mode. The plume generated was collected by 0.45 micrometers pore size microfilter which was attached to the tip of a suction hose connecting the smoke evacuator. The effectiveness of 2 types of commonly used surgical masks were also determined by trapping the smoke after passing through each mask using the same model. Smoke particles were evaluated by scanning electron microscope. The smoke particle density of microfilter that directly trap plume averaged 6 particles/mm2, particles ranging in size from 0.5-27 micrometers, of which 70 per cent were 0.8 micrometers. For the particles trapped after passing through both cotton and paper surgical mask, the size were ranging from 1.6-37 micrometers where 65 per cent were 3.7 micrometers and the particle density average 2.7/mm2. We concluded that the smoke particles derived from carbon dioxide laser application are within the alveolar hazard zone. The conventional surgical masks may not be an effective tool against laser smoke hazard.