Inhalation of surgical smoke: cohort of signs and symptoms in residents

Prospective cohort study with resident doctors exposed to surgical smoke in a teaching hospital. There was 17-month follow-up of residents from the years 2015 and 2016, who met the criteria of being regularly enrolled in a surgery or anesthesiology residency and not being a smoker. The data collection instrument was composed of sociodemographic, academic data and the signs and symptoms related to the inhalation of surgical smoke, cited in the literature. The data analysis was descriptive and inferential, by statistical tests and measures of effect.

Results

The sample consisted of 39 residents, of which most were male (56.4%) and below 30 years old (74.3%). There was a prevalence of gynecology and obstetrics residents (30.8%), followed by general surgery (28.2%) and anesthesiology (20.5%). Burning in the pharynx (p=0.030), nausea and vomiting (p=0.018) and eye irritation (p=0.050) occurred in the first year of residence. The risk of developing burning in the pharynx was 7.765 times greater (p=0.019) in females when compared to males.

Conclusion

The signs and symptoms analyzed occurred within 12 months of the beginning of the course and the risk of burning in the pharynx was higher in females, which indicates exposure to the risks of inhalation of surgical smoke and, therefore, points to the need for the adoption of individual and collective protection measures.

Smoke; Electrosurgery; Signs and symptoms; Occupational risks; Medical staff, hospital; Operating room

Signs and Symptoms	Follow-up			p-value**
	T0 (3 months)*	T3 (12 months)*	T6 (24 months)*
	n(%)	n(%)	n(%)
Foreign body sensation in the throat	4(10.3)	3(7.7)	0(0)	0.156
Burning in the pharynx	1(2.6)	5(12.8)	0(0)	0.030
Nausea and vomiting	4(10.3)	0(0)	0(0)	0.018
Nasal congestion	6(15.4)	5(12.8)	1(2.6)	0.148
Headache	7(17.9)	2(5.1)	3(7.7)	0.174
Irritation of the eyes	6(15.4)	6(15.4)	0(0)	0.050
Irritation of other mucous membranes	5(12.8)	1(2.6)	1(2.6)	0.102
Sneezing	4(10.3)	2(5.1)	1(2.6)	0.368
Dizziness	2(5.1)	1(2.6)	2(5.1)	0.368
Weakness	0(0)	1(2.6)	0(0)	0.368

Variables		Signs and Symptoms		p-value^*	Relative Risk (95% Confidence Interval)
Variables		No	Yes	p-value^*	Relative Risk (95% Confidence Interval)
Foreign body sensation in the throat
Age	≤30 years	25(86.2)	4(13.8)	0.490	0.690(0.148-3.210)
Age	≥31 years	8(80.0)	2(20.0)
Gender	female	14(82.4)	3(17.6)	0.535	1.294(0.298-5.627)
Gender	male	19(86.4)	3(13.6)
Time since training	≤3 years	23(82.1)	5(17.9)	0.447	1.964(0.258-14.965)
Time since training	≥4 years	10(90.9)	1(9.1)
Specialty	Surgery	27(87.1)	4(12.9)	0.358	0.516(0.114-2.334)
Specialty	Anesthesiology	6(75.0)	2(25.0)
Burning in the pharynx
Age	≤30 years	24(82.8)	5(17.2)	0.590	0.862(0.197-3.764)
Age	≥31 years	8(80.0)	2(20.0)
Gender	female	11(64.7)	6(35.3)	0.019	7.765(1.030-58.543)
Gender	male	21(95.5)	1(4.5)
Time since training	≤3 years	21(75.0)	7(25.0)	0.077	**
Time since training	≥4 years	11(100.0)	0(0.0)
Specialty	Surgery	24(77.4)	7(22.6)	0.171	**
Specialty	Anesthesiology	8(100.0)	0(0.0)
Nausea and/or vomiting
Age	≤30 years	24(82.8)	5(17.2)	0.206	**
Age	≥31 years	10(100.0)	0(0.0)
Gender	female	14(82.4)	3(17.6)	0.375	1.941(0.364-10.348)
Gender	male	20(90.9)	2(9.1)
Time since training	≤3 years	24(85.7)	4(14.3)	0.562	1.571(0.197-12.545)
Time since training	≥4 years	10(90.9)	1(9.1)
Specialty	Surgery	28(90.3)	3(9.7)	0.268	0.387(0.077-1.940)
Specialty	Anesthesiology	6(75.0)	2(25.0)
Nasal congestion
Age	≤30 years	21(72.4)	8(27.6)	0.493	1.379(0.350-5.443)
Age	≥31 years	8(80.0)	2(20.0)
Gender	female	14(82.4)	3(17.6)	0.265	0.555(0.168-1.833)
Gender	male	15(68.2)	7(31.8)
Time since training	≤3 years	20(71.4)	8(28.6)	0.409	1.571(0.394-6.269)
Time since training	≥4 years	9(81.8)	2(18.2)
Specialty	Surgery	24(77.4)	7(22.6)	0.329	0.602(0.199-1.821)
Specialty	Anesthesiology	5(62.5)	3(37.5)
Headache
Age	≤30 years	18(62.1)	11(37.9)	0.264	1.897(0.505-7.129)
Age	≥31 years	8(80.0)	2(20.0)
Gender	female	11(64.7)	6(35.3)	0.543	1.109(0.456-2.696)
Gender	male	15(68.2)	7(31.8)
Time since training	≤3 years	20(71.4)	8(28.6)	0.262	0.629(0.263-1.505)
Time since training	≥4 years	6(54.5)	5(45.5)
Specialty	Surgery	23(74.2)	8(25.8)	0.064	0.413(0.185-0.921)
Specialty	Anesthesiology	3(37,5)	5(62,5)
Irritation of the eyes
Age	≤30 years	18(62.1)	11(37.9)	0.264	1.897(0.505-7.129)
Age	≥31 years	8(80.0)	2(20.0)
Gender	female	11(64.7)	6(35.3)	0.543	1.109(0.456-2.696)
Gender	male	15(68.2)	7(31.8)
Time since training	≤3 years	17(60.7)	11(39.3)	0.191	2.161(0.568-8.215)
Time since training	≥4 years	9(81.8)	2(18.2)
Specialty	Surgery	21(67.7)	10(32.3)	0.544	0.860(0.307-2.409)
Specialty	Anesthesiology	5(62.5)	3(37.5)
Irritation of other mucous membranes
Age	≤30 years	23(79.3)	6(20.7)	0.410	2.069(0.282-15.155)
Age	≥31 years	9(90.0)	1(10.0)
Gender	female	14(82.4)	3(17.6)	0.650	0.971(0.250-3.769)
Gender	male	18(81.8)	4(18.2)
Time since training	≤3 years	21(75.0)	7(25.0)	0.077	**
Time since training	≥4 years	11(100.0)	0(0.0)
Specialty	Surgery	24(77.4)	7(22.6)	0.171	**
Specialty	Anesthesiology	8(100.0)	0(0.0)
Sneezing
Age	≤30 years	23(79.3)	6(20.7)	0.410	2.069(0.282-15.155)
Age	≥31 years	9(90.0)	1(10.0)
Gender	female	15(88.2)	2(11.8)	0.326	0.518(0.114-2.350)
Gender	male	17(77.3)	5(22.7)
Time since training	≤3 years	22(78.6)	6(21.4)	0.346	2.357(0.319-17.397)
Time since training	≥4 years	10(90.9)	1(9.1)
Specialty	Surgery	27(87.1)	4(12.9)	0.137	0.344(0.096-1.237)
Specialty	Anesthesiology	5(62.5)	3(37.5)
Weakness
Age	≤30 years	29(100.0)	0(0.0)	0.256	**
Age	≥31 years	9(90.0)	1(10.0)
Gender	female	17(100.0)	0(0.0)	0.564	1.048(0.956-1.148)
Gender	male	21(95.5)	1(4.5)
Time since training	≤3 years	28(100.0)	0(0.0)	0.282	**
Time since training	≥4 years	10(90.9)	1(9.1)
Specialty	Surgery	31(100.0)	0(0.0)	0.205	**
Specialty	Anesthesiology	7(87.5)	1(12.5)
Dizziness
Age	≤30 years	25(86.2)	4(13.8)	0.289	**
Age	≥31 years	10(100.0)	0(0.0)
Gender	female	15(88.2)	2(11.8)	0.593	1.294(0.202-8.271)
Gender	male	20(90.9)	2(9.1)
Time since training	≤3 years	25(89.3)	3(10.7)	0.687	1.179(0.137-10.149)
Time since training	≥4 years	10(90.9)	1(9.1)
Specialty	Surgery	28(90.3)	3(9.7)	0.617	0.774(0.092-6.486)
Specialty	Anesthesiology	7(87.5)	1(12.5)

Escola Paulista de Enfermagem, Universidade Federal de São Paulo R. Napoleão de Barros, 754, 04024-002 São Paulo - SP/Brasil, Tel./Fax: (55 11) 5576 4430 - São Paulo - SP - Brazil
E-mail: actapaulista@unifesp.br

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[1] Corresponding author Nathanye Crystal Stanganelli E-mail: kany_stanganelli@hotmail.com