Conference Coverage

Mask provides effective, cheap protection from hazardous electrocautery plumes

 

Key clinical point: Electrocautery smoke is bad news, and wearing an N95 mask affords protection.

Major finding: The N95 mask was significantly more effective than basic procedural or laser masks at filtering particulate matter less than 1 mcm in size contained in electrocautery smoke.

Study details: This study utilized highly sensitive airborne particle counting devices to assess the relative protective filtration afforded by three types of masks.

Disclosures: The presenter reported no financial conflicts regarding this study, which was conducted free of commercial support.


 

REPORTING FROM THE ACMS ANNUAL MEETING

– Routine use of an N95 mask during electrocautery is an effective and inexpensive way for dermatologic surgeons to protect themselves from toxic, airborne particulate matter in the smoke generated during the procedure, Emily de Golian, MD, said at the annual meeting of the American College of Mohs Surgery.

“Our data suggest clear dominance of N95 masks at filtering electrocautery particulate matter over commonly utilized basic procedural masks, as well as superiority to the laser masks that are used in hair removal procedures and ablative procedures in cosmetic clinics,” commented Dr. de Golian, a Mohs micrographic surgery fellow at the University of California, San Diego.

Dr. Emily de Golian of the University of California, San Diego Bruce Jancin/MDedge News

Dr. Emily de Golian

This is an inexpensive protective strategy, and Dr. de Golian priced N95 masks on Amazon at 94 cents each. While that’s more than the 11 cents per standard procedural mask with earloops or 83 cents for a laser mask on Amazon, it’s still small potatoes considering the enhanced protection she documented in her study. Of note, all of the masks cost more when purchased from medical supply companies.

This matter of self-protection from the effects of electrocautery smoke plumes deserves greater attention from the dermatologic community, according to Dr. de Golian. There is solid evidence that these plumes contain high concentrations of known carcinogens, including benzene, acetonitrile, and butadiene – indeed, concentrations far in excess of what’s found in second-hand cigarette smoke. Moreover, many of these airborne carcinogens and other toxins have been linked to leukemia, neurologic disorders, lung cancer, thrombotic disorders, lung disease, and infectious disease transmission, albeit not convincingly so to date in dermatologic surgeons. But why wait for definitive evidence to accrue?

“In light of these hazards – and according to governmental guidelines – dermatologic surgeons would be wise to adopt protective measures during surgical procedures,” Dr. de Golian said.

But they haven’t. She cited a national survey conducted several years ago by a colleague in which 79% of the 316 responding dermatologic surgeons indicated they use no smoke management whatsoever, neither masks nor a local exhaust evacuation system. Only 10% employed smoke management 25%-50% of the time during electrocautery, and a scant 11% of dermatologic surgeons did so at least 75% of the time (Dermatol Surg. 2014 Dec;40[12]:1373-7).

Given the far more substantial expense of installing an office smoke evacuation system, mask filtration becomes an attractive alternative. But the relative efficacy of the various types of masks in blocking fine and ultrafine particulate matter contained in electrocautery plumes hadn’t previously been systematically studied. This created the impetus for Dr. de Golian’s study.

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