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Journal of Surgery
Friedrich M, et al. J Surg: JSUR-1148.
Research Article DOI: 10.29011/2575-9760. 001148
Influence of Surgical Suction Tip Flow-Optimisation
on Suction-Induced Noise Pollution
Martin Friedrich1*, Theodor Tirilomis1, Jost M. Kollmeier2, Yong Wang3, Gerd Gunnar Hanekop4
1
Department of Thoracic, Cardiac and Vascular Surgery, University Medical Center Göttingen, Germany
2
Biomedical NMR Research Ltd, Max Planck Institute for Biophysical Chemistry, Göttingen, Germany
3
Max Planck Institute for Dynamics and Self-Organization, Göttingen, Germany
4
Department of Anaesthesiology, University Medical Center Göttingen, Germany
*
Corresponding author: Martin Friedrich, University Medical Center Göttingen, Department of Thoracic and Cardiovascular Sur-
gery, Robert-Koch-Str. 40, 37075 Göttingen, Germany. Tel: +495513966015; Fax: +49 32121288944; Email: martin.friedrich@med.
uni-goettingen.de
Citation : Friedrich M, Tirilomis T, Kollmeier JM, Wang Y, Hanekop GG (2018) Influence of Surgical Suction Tip Flow-Optimisa-
tion on Suction-Induced Noise Pollution. J Surg: JSUR-1148. DOI: 10.29011/2575-9760. 001148
Received Date: 25 June, 2018; Accepted Date: 04 July, 2018; Published Date: 09 July, 2018
Abstract
Introduction: Suction devices for clearing the surgical field are among the most commonly used tools of every surgeon because
a better view of the surgical field is essential. Forced suction may produce disturbingly loud noise (up to 120 dBA 10 cm), which
acts as a non-negligible stressor. Especially in emergency situations with heavy bleeding this loud noise has been described as
an impeding factor in the medical decision-making process. In addition, there are reports of inner ear damage in patients due to
suction noises during operations in the head area. These problems have not been solved yet. The purpose of this study was to
analyse flow dependent suction noise effects of different surgery suction tips. Furthermore, we developed design-improvements
to these devices.
Methods: We compared five different geometries of suction tips using an in-vitro standardised setup. Two commercially avail-
able standard suction tips were compared to three adapted new devices regarding their flow-dependent (10 - 2000 mL/min) noise
emission (dB, weighting filter (A), distance 10 cm) and acoustic quality of resulting noises (Hamilton Fast Fourier Analysis)
during active suction at the liquid-air boundary. Noise maps at different flow rates were created for all five suction devices and
the proportion of extracted air was measured. The geometries of the three customly made suction tips (new models 1, 2 and 3)
were designed considering the insights after determining the key characteristics of the two standard suction models.
Results: The geometry of a suction device tip has significant impact on its noise emission. For the standard models the frequen-
cy spectrum at higher flow rates significantly changes to high-frequency noise patterns (> 3 kHz). A number of small side holes
designed to prevent tissue adhesion lead to increased levels of high frequency noise. Due to modifications of the tip geometry in
our new models we are able to achieve a highly significant reduction of noise level at low flow rates (new model 2 vs. standard
model’s p < 0.001) also the acoustic quality improved. Additionally, we attain a highly significant reduction of secondary air
intake (new model 2 vs. the other model’s p < 0.001).
Conclusion: Improving flow-relevant features of the geometry of suction heads is a suitable way to reduce noise emissions. Op-
timized suction tips are significantly quieter. This may help to reduce noise-induced hearing damage in patients as well as stress
of medical staff during surgery and should lead to quieter operation theatres overall. Furthermore, the turbulence reduction and
reduced secondary air intake during the suction process are expected to result in protective effects on the collected blood and
thus could improve the quality of autologous blood re-transfusions. We are on the way to evaluate potential benefits.
1 Volume 2018; Issue 11
J Surg, an open access journal
ISSN: 2575-9760
Citation : Friedrich M, Tirilomis T, Kollmeier JM, Wang Y, Hanekop GG (2018) Influence of Surgical Suction Tip Flow-Optimisation on Suction-Induced Noise Pollution. J
Surg: JSUR-1148. DOI: 10.29011/2575-9760. 001148
Keywords: Flow-Optimisation; Noise Pollution; Noise and [3-5]. Loud noise is a significant stressor in the Operation Theatre
Suction; Operating Room, Operating Theatre; Surgical Suction; (OT) [6]. This is aggravated during emergencies with massive
Turbulences bleeding, where it is important to rapidly achieve a clear and dry
surgical field to stop blood loss as fast as possible. In contradiction
Background to that, it has been shown that quiet working environments help to
work more efficiently and reduce the rates of error [7].
Suction devices for clearing the surgical field are used by
surgeons during almost every type of surgical procedure to obtain Furthermore, loud suction noises near the inner ear may
a better view of the surgical field. The suction device may also be result in permanent hearing loss in patients undergoing surgery in
used as a hook, for dissection, and removal of excess tissue. There the ear and temporal head area [1,8,9]. It is not evident why the
are different types of suction devices for different types of surgical most often used tool in the OT has not been optimized yet. This
procedures. As disposables they are cheap and effective although study therefore aims to demonstrate that even small modifications
not yet optimized regarding their noise emissions. of the geometry of suction tips are able to significantly reduce
harmful noise emissions.
Tissue adhesion of the suction head to delicate tissues is a
well-known problem, especially during forced suction, and can Methods
result in severe tissue damage [1,2]. To prevent this, several rows
of supplementary holes were introduced in commercially available The noise data of two commercially available standard
suction tubes. The fact that this leads to massive noise increases, suction heads (A: Hex Handle Adult Sump Sucker, NovoSci,
however, has been accepted up to now, although it is well known Conroe, Texas, USA; B: Argyle Yankauer, Covidien, Mansfield,
that forced suction at the liquid-air boundary results in a massive Massachusetts, USA) were analysed. Based on data derived from
increase of noise emissions with levels up to 120 dB(A) (100 cm) an interim analysis, three new devices ware developed (Table 1).
Table 1: Suction tips of different models: standard models A and B, industrially manufactured disposable articles of daily use; new models 1, 2 and
3 are our newly developed prototypes. Please notice, devices are patent protected. (first line: image; second line: CAD 3D model, third line: technical
drawing).
2 Volume 2018; Issue 11
J Surg, an open access journal
ISSN: 2575-9760
Citation : Friedrich M, Tirilomis T, Kollmeier JM, Wang Y, Hanekop GG (2018) Influence of Surgical Suction Tip Flow-Optimisation on Suction-Induced Noise Pollution. J
Surg: JSUR-1148. DOI: 10.29011/2575-9760. 001148
Then the devices were compared regarding to their flow-dependent (10 - 2000 mL/min) noise emission (dB(A) 10 cm) and
acoustic quality (Hamilton Fast Fourier Analysis) during active suction at the liquid-air boundary (100, 200, 400, 2000 mL/min) using an
in-vitro setup (Figure 1) with a roller pump (Polystan, Type Modular No. 1603, Vaerlose, Denmark) and ¼ - inch (6.3 mm) tube system
(HMT-Medizintechnik GmbH, Maisach, Germany).
Figure 1: In vitro setup for noise mapping and measurement of aeration (mixing air in fluid); for a given liquid pumping rate (roller pump 1, rotation
clockwise), the flow is increased by roller pump 2 (rotation counter clockwise) until the liquid column in the riser pipe is constant (equilibration). The
pump rate of roller pump 2 corresponds to the proportion of pumped air. Adjustment of depth under water surface of the suction tip: set at maximum
noise level at 1000 mL/min.
Noise emissions were measured at a 10-cm distance from the the liquid column constant at ± 1 cm (cf. Figure 1). The adjustment
suction head and recorded in a standardised fashion over a period of the underwater diving depth of every suction tip was carried
of 10 sec (electret condenser capsule microphone, ultra linear out by adjusting the maximum noise level at 1000 mL/min. The
frequency range: 20 Hz - 20 kHz; 32 Channel Mixer CM8000, experimental data from this setup was used to optimize suction tip
Behringer Music Group, Germany; TASCAM DR-100 Digital geometry regarding noise emission. Necessary side holes should
Recorder, stored as uncompressed WAV-file in 96kHz, 24Bit; absorb less air at the liquid-air boundary. As shown in Table1,
edited in Hi-Res Editor software, TEAC Corporation, Tokyo, three new models were developed. In new model 1, the angles
Japan). Noise levels were also measured and recorded over 10 sec of the supplementary holes are oriented towards the mainstream
intervals (dB(A), Voltcraft sound level recorder SL-451, 125 ms axis. The model 2 has the angles of the supplementary holes even
peaks, 31.5 Hz - 8 kHz, distance 10 cm). The frequency spectra more closely aligned to the mainstream axis. The geometry of the
were graphically displayed as a noise map (Fast Fourier Analysis inlet area of the mainstream channel resembles that of a trumpet,
as spectroscopy and spectrograph during 5 sec, Hamming-filter, to achieve continuous acceleration of flow. Additionally, the
20 Hz - 20 kHz, FFT Size 8192, Sequoia 14.1.0.157 DC2, 64 bit, supplementary holes are located in close proximity to the edge of
Magix Software GmbH, Berlin, Germany). the trumpet like tip. The model 3 are especially designed for usage
in cavities (e.g. between the intestines in the abdominal cavity).
Flow-dependant secondary air intake was measured using a
For this purpose, the size of the suction head surface contacting the
modified experimental setup, where the fluid was sucked up from a
tissue is increased and supplementary holes are evenly distributed
basin and returned via a large-bore Y-tube. At one arm of the Y‑tube
at the surface. The bigger hollow cavity inside the suction head
another identical roller-pump was used to separate the amount of
is filled with an open-pored polyurethane sponge to diminish
secondary air from the liquid-air-mixture by keeping the level of
turbulence in this area (cf. Table 1).
3 Volume 2018; Issue 11
J Surg, an open access journal
ISSN: 2575-9760
Citation : Friedrich M, Tirilomis T, Kollmeier JM, Wang Y, Hanekop GG (2018) Influence of Surgical Suction Tip Flow-Optimisation on Suction-Induced Noise Pollution. J
Surg: JSUR-1148. DOI: 10.29011/2575-9760. 001148
All three new models (1, 2 and 3) were tested using the same all pump rates over all other models (p < 0.001). * The standard A model is
standardized in-vitro setup, and the resulting flow-dependant noise significant louder against standard model B, new model 1 and 2 (p < 0.05).
emissions, noise maps and the different amounts of secondary air The frequency spectrum starts to show a level increase above
intake were compared. 3 kHz (Figures 3,4). The optimized suction head tip, new model 2,
is significantly quieter in all aspects. The frequencies above 3 kHz
Results
are significantly reduced (p < 0.001) and the overall improvement
Considerable differences were ascertained regarding the is apparent throughout the whole examined frequency range
quantity and quality of emitted noises. As shown in (Figure 2), (Figures 2-4).
the commercially available standard suction tips A and B emitted
considerable noise with model A producing the highest noise levels
due to its 22 side holes. For instance, model A produced 70 dB(A)
(10 cm) even at low suction rates of 600 mL/min.
Figure 3: The spectroscopy corresponds to a snapshot of
the frequency spectrum of the sound (“sound” of noise). The
Figure 2: Sound pressure levels at different flow rates. An increase spectrograph shows the noise over a longer period, even slower
in the sound pressure level by 10 dB corresponds to a doubling of the frequency developments can be represented (“power” of noise).
perceived volume. ** The new model 2 is highly significantly quieter at
4 Volume 2018; Issue 11
J Surg, an open access journal
ISSN: 2575-9760
Citation : Friedrich M, Tirilomis T, Kollmeier JM, Wang Y, Hanekop GG (2018) Influence of Surgical Suction Tip Flow-Optimisation on Suction-Induced Noise Pollution. J
Surg: JSUR-1148. DOI: 10.29011/2575-9760. 001148
Figure 4: Noise maps for all five suction head models. The standard model A is noisy at low flow rates (full spectrum), the new models 1 and 2 show
highly significant lower noise, especially at frequencies above 300 Hz, the standard model B is in lower flowrates significant quieter than the standard
model A. (Fast Fourier Analysis as spectroscopy and spectrography during 5 sec, Hamming, 20 Hz - 20 kHz, FFT Size 8192, Sequoia 14.1.0.157 DC2,
64 bit, Magix Software GmbH, Berlin, Germany), noise map legend see (Figure 3).
Along with increasingly more audible noise emissions for
increasing pump rates, the intake of secondary air also grows to
significant portions (standard models A, B: flow at 1000 mL/min /
air = 70 %; at 2000 mL/min / air = 75 ‑ 90 %; Fig. 5). The standard
models A, B and new model 1 behave significantly difference
compared to the new model 3 (p < 0.05), with the latter starting a
massive intake of secondary air at flow rates of 500 ml/min. Only
the new model 2 has shown a significantly reduction of secondary
air even at higher suction rates (p < 0.001). The side holes that are
oriented downward alter the inflow characteristics at the liquid-air
boundary. Such modification results in a significant later onset of
flow disruptions (> 1000 mL/min), (Table 1, Figure 5).
Figure 5: Percentages of pumped air at different flow rates. ** Compared
to the other models, the new model 2 sucks air only at a pumping rate of
5 Volume 2018; Issue 11
J Surg, an open access journal
ISSN: 2575-9760
Citation : Friedrich M, Tirilomis T, Kollmeier JM, Wang Y, Hanekop GG (2018) Influence of Surgical Suction Tip Flow-Optimisation on Suction-Induced Noise Pollution. J
Surg: JSUR-1148. DOI: 10.29011/2575-9760. 001148
more than 1000 mL/min (p < 0.001). * model B vs. models A, 1 und 3 within the OT-team. Persistent, high levels of noise are known to
significant (p < 0.05). lead to health problems [23-26]. Noise is regarded as a general
stressor [18] and a pervasive and influential source of stress [27],
Discussion that may affect the cardiovascular system [28]. The volume level
Conventional suction devices have a series of side holes to and the frequency of noise (sound quality) can have negative
avoid tissue adhesion. However, these additional holes can cause repercussions on the ability to concentrate [4,27,29], it may
air admixture during suctioning at the liquid-air boundary. Since represent a significant source of distraction [20,30], although
parts of the additional holes are located above the liquid level, this is not unequivocal [31]. High levels of sound pollution may
air is sucked in, and leads to flow interruptions and considerable therefore influence outcome of surgical procedures [11,32,33]
turbulences within the multiphase flow. and provoke human errors [34], inexperienced subjects are more
prone to negative noise impact than experienced ones, particularly
Physical Aspects during difficult tasks [30]. Higher volumes of noise were correlated
The interrupted flow is caused by immiscible blood and directly with higher surgeons stress response (physiological
air with different viscosities (blood: η = 3 - 25 µPa ∙ s; air: η = and self-reported), as well as levels of surgical errors, putting
17 µPa ∙ s) [10]. The flow is also turbulent in most cases (such patients at increased risks for postoperative complications [35],
as the Reynolds number is more than 2500 in standard model A although the causal relation between noise and complications is
at flow rate 250 ml/min). Flow stoppages and turbulence lead to hard to prove [36]. The US Agency for Healthcare Research and
audible vibrations. The sound pollution of suctioning increases up Quality mandates a “high level priority” to reduce noise-induced
to 120 dB(A) (100 cm) [4-6,11], sound levels in suction devices distraction in the OT to improve patient safety although so far little
peaked with smaller diameter (2 mm) between 4 and 6 kHz, with reliable and systematic information exists of the sound levels in the
wider diameter (4 mm) around 3 kHz [12], although the diameter operating room environment [32]. Due to its inherently complex
was positively correlated with sound energy [13], all perceived as structure, errors can be catastrophic for patients and healthcare
noise. Noise is defined as “unwanted or undesirable sound” as well institutions alike [37]. Noise levels during operations have been
as “wrong sound in wrong place at wrong time” [14] it may cause correlated with Surgical Site Infection (SSI) [38,39], attributed
annoyance and decrease work efficiency. In physics it is regarded to noise induced distraction leading to lapses in compliance with
as random, fluctuating, inharmonious wave forms [15]. aseptic principles.
Aspects of Noise Pollution As a result, it is advantageous for surgeons and patients to
use a continuous quieter suction device. We were able to show that
The impact of noise on human performance depends on even small modifications in the geometry of suction heads make
the type of noise and the task to be performed. Especially during them significantly quieter.
critical periods and tasks it may reduce mental efficiency and
short term memory [14]. Although there is a wide variability in Suction noise near the inner ear (> 100 dB(A), [13],
individual sensitivity to noise [16], a normal healthy adult may especially in children during ear- and neurosurgical procedures,
tolerate about 50-55 dB(A) sound relatively well [17]. The World has been described to result in lasting hearing loss [40]. However,
Health Organization (WHO) “Guidelines for community Noise” tracheal suctioning in children (4 -10 kHz, peak 96 dB) has not
suggests that sound levels in hospital should not exceed 35 dB(A) lead to measurable restrictions in hearing capacity/capability (24).
LAeq [17], which is far less than the sounds evoked by suctioning. In a prospective study [8] were not able to demonstrate lasting
Studies have shown that noise in the OT is even louder during hearing loss correlated to ear canal suctioning as well as [41].
critical components of the case, and is related to equipment and However, noise induced hearing impairment may be more common
staff, resulting in negative impact on patient safety [18]. It is said, than normally assumed [42], as the deterioration of hearing is
that the most important source of noise in the OT is the use of hard to detect in the high-frequency range [43-45]. In our study
particular surgical tools [19]. Noise in health care settings has frequencies above the audible range (> 16 kHz) were recorded
increased during the last 50 years [20]. (Figure 4). These high-frequency flow stoppages in particular are
responsible for hemolysis and mal-activation of leukocytes and
At frequencies of 2.0 - 8.0 kHz (especially 3.0 - 4.5 kHz), platelets [46], although the exact mechanisms for the damage of
the human ear has a higher sensitivity (Fletcher-Munson curves of blood cells are controversial [47-49]. The foaming or admixing
equal volume levels ISO 226: 2003), and sounds are perceived as of air (“aeration”) can adversely affect the integrity of the blood
being 10-20 dB more noisy than those outside this range, at same cells by direct oxygen contact. By reduction of air admixtures,
intensity [21]. Furthermore, in this frequency range essential parts membrane damage, oxidation of various blood components and
of speech information are located [22], impeding communication the formation of radicals can be avoided or reduced [50,51].
6 Volume 2018; Issue 11
J Surg, an open access journal
ISSN: 2575-9760Citation : Friedrich M, Tirilomis T, Kollmeier JM, Wang Y, Hanekop GG (2018) Influence of Surgical Suction Tip Flow-Optimisation on Suction-Induced Noise Pollution. J
Surg: JSUR-1148. DOI: 10.29011/2575-9760. 001148
Other Aspects the University Medical Center Göttingen (PCT/EP/2011/006330;
US 9,402,937 B2; Aug 2, 2016). The idea of optimizing the flow
Air admixtures can also cause infection problems. In animal
of the suction heads has been filed as a patent. The authors report
experiments it has been shown that bacterial air contamination
no conflicts of interest. The authors alone are responsible for the
can be transported with the suction of secondary air [52]. That
content and writing of this report.
means that infectious complications may result from increased air
mixing. In this respect we present first improvements with our new References
model 2. Whereas the other modified models, 1 and 3 do not show
significant changes in the proportion of extracted air. Nevertheless, 1. Wang CW, Lee CL, Soong YK (1995) Bowel injury by the suction-irri-
gator during operative laparoscopy. J Am Assoc Gynecol Laparosc 2:
the high-frequency vibrations are significantly reduced here as 353-354.
well. The new model 2 is very quiet (p < 0.001) and has shown a
low level of aeration (p < 0.001). Our working group has shown 2. Agrawal D, Ang KL, Mittal T, Prasad S (2008) Mitral valve injury by car-
diotomy suction during aortic valve replacement--a near miss. Interact
that it is possible to reduce flow-induced noise and air admixture Cardiovasc Thorac Surg 7: 136-137.
using a poly pragmatic approach. The Turbulence Controlled
Suction System (TCSS) adjusts the rotational speed of the roller 3. Pante HJ, Reuter P (1977) [Reduction of noise in suction devices].
Dtsch Zahnarztl Z 32: 490-492.
pump system via a vibration sensor in the suction handle [53]. We
can assume that the combination of TCSS and optimized suction 4. Shankar N, Malhotra KL (1999) Noise in the operation theatre: inten-
sity and sources. Indian J Physiol Pharmacol 43: 263-266.
head geometry should further reduce the noise level. The protective
effect on integrity of blood cells has also been shown [54]. 5. Singh SA, Trikha A (2006) Noise levels in the operation theatre envi-
ronment. Natl Med J India 19: 112-113.
Conclusion
6. Ray CD, Levinson R (1992) Noise pollution in the operating room: a
The flow-induced noise is correlated to the suction tip hazard to surgeons, personnel, and patients. J Spinal Disord 5: 485-
geometry. Parameters of the suction tip relevant to stream-flow 488.
can be improved. The optimized suction heads are significantly 7. Engelmann CR, Neis JP, Kirschbaum C, Grote G, Ure BM (2014) A
quieter, as shown in our experimental results. Such optimization noise-reduction program in a pediatric operation theatre is associated
may reduce noise related hearing loss und reduce stress during with surgeon’s benefits and a reduced rate of complications: a pro-
spective controlled clinical trial. Ann Surg 259: 1025-1033.
surgery as it leads to a quieter operation theatre. A noise optimized
suction device can improve the performance of the surgical team, 8. Nelson JJ, Giraud A, Walsh R, Mortelliti AJ (2011) Impact on hearing
reduce complications, improve the quality of collected blood, of routine ear suctioning at the tympanic membrane. Am J Otolaryngol
32: 100-104.
reduce the need for allogenic transfusion and organ damage,
and finally increase patient safety. Further studies and advanced 9. Wetmore RF, Henry WJ, Konkle DF (1993) Acoustical factors of noise
techniques, such as computational fluid dynamics simulation, are created by suctioning middle ear fluid. Arch Otolaryngol Head Neck
Surg 119: 762-766.
necessary to continue the optimization on suction heads for various
applications. 10. Girolami A, Martino R, Procidano M, Saltarin P (1982) Integral vis-
cosity: a useful parameter in evaluating whole blood and plasma vis-
Acknowledgement cosities in health and disease. Folia Haematol Int Mag Klin Morphol
Blutforsch 109: 488-494.
We thank Mr. Rudolf Freckmann for making the CAD 3D 11. Hodge B, Thompson JF (1990) Noise pollution in the operating the-
models and prototypes of suction cups according to our ideas. atre. Lancet 335: 891-894.
Summary of Author Contributions 12. Luxenberger W, Lahousen T, Walch C (2012) Suction-generated noise
in an anatomic silicon ear model. Eur Arch Otorhinolaryngol 269:
Martin G. Friedrich, MD is the corresponding author 2291-2293.
responsible for the concept/design of new suction heads and the 13. Hansen S, Stupp A, Schwarze S, Schipper J (2012) [Suction-generat-
drafting of this report. Gunnar Hanekop MD, PhD is the senior ed noise levels during aural toilet]. Laryngorhinootologie 91: 103-108.
author. Jost M. Kollmeier and Yong Wang helped or assisted with 14. Murthy VS, Malhotra SK, Bala I, Raghunathan M (1995) Detrimental
the measurements in the In vitro setup. Theodor Tirilomis helped effects of noise on anaesthetists. Can J Anaesth 42: 608-11.
to create the draft of this manuscript.
15. Hood LJ, Berlin CI, Parkins CW (1991) Measurement of sound. Otolar-
Disclosure yngol Clin North Am 24: 233-251.
16. Topf M (1985) Personal and environmental predictors of patient distur-
Martin Friedrich is the inventor of the TCSS and all bance due to hospital noise. J Appl Psychol 70: 22-28.
included features. The TCSS is patented and the patent holder is
7 Volume 2018; Issue 11
J Surg, an open access journal
ISSN: 2575-9760Citation : Friedrich M, Tirilomis T, Kollmeier JM, Wang Y, Hanekop GG (2018) Influence of Surgical Suction Tip Flow-Optimisation on Suction-Induced Noise Pollution. J
Surg: JSUR-1148. DOI: 10.29011/2575-9760. 001148
17. Berglund B, Lindvall T, Schwela D (1999) Guidelines for community 35. Moorthy K, Munz Y, Dosis A, Bann S, Darzi A (2003) The effect of
noise. WHO 1999. stress-inducing conditions on the performance of a laparoscopic task.
Surg Endosc 17: 1481-1484.
18. Hasfeldt D, Laerkner E, Birkelund R (2010) Noise in the operating
room--what do we know?. A review of the literature. J Perianesth Nurs 36. Yoong W, Khin A, Ramlal N, Loabile B, Forman S (2015) Interruptions
25: 380-386. and distractions in the gynaecological operating theatre: irritating or
dangerous? Ergonomics 58: 1314-1319.
19. Ginsberg SH, Pantin E, Kraidin J, Solina A, Panjwani S, et al. (2013)
Noise levels in modern operating rooms during surgery. J Cardiotho- 37. Wheelock A, Suliman A, Wharton R, Babu ED, Hull L, et al. (2015)
rac Vasc Anesth 27: 528-530. The Impact of Operating Room Distractions on Stress, Workload, and
Teamwork. Ann Surg 261: 1079-84.
20. McNeer RR, Bennett CL, Horn DB, Dudaryk R (2017) Factors Affect-
ing Acoustics and Speech Intelligibility in the Operating Room: Size 38. Dholakia S, Jeans JP, Khalid U, Dholakia S, D’Souza C, et al. (2015)
Matters. Anesth Analg 124: 1978-1985. The association of noise and surgical-site infection in day-case hernia
repairs. Surgery 157: 1153-1156.
21. Kam PC, Kam AC, Thompson JF (1994) Noise pollution in the anaes-
thetic and intensive care environment. Anaesthesia 49: 982-986. 39. Kurmann A, Peter M, Tschan F, Muhlemann K, Candinas D, et al.
(2011) Adverse effect of noise in the operating theatre on surgical-site
22. Sang J, Hu H, Zheng C, Li G, Lutman ME, et al. (2015) Speech qual-
infection. Br J Surg 98: 1021-1025.
ity evaluation of a sparse coding shrinkage noise reduction algorithm
with normal hearing and hearing-impaired listeners. Hear Res 327: 40. Katzke D, Sesterhenn G (1982) Suction-generated noise in the exter-
175-185. nal meatus and sensorineural hearing loss. J Laryngol Otol 96: 857-
863.
23. Andren L, Lindstedt G, Bjorkman M, Borg KO, Hansson L (1982) Ef-
fect of noise on blood pressure and ‘stress’ hormones. Clin Sci (Lond) 41. Snelling JD, Smithard A, Waddell A (2009) Noise levels generated
62: 137-141. within the external auditory canal during microsuction aural toilet and
the effect on hearing: a prospective controlled series. Clin Otolaryngol
24. Babisch W (2002) The Noise/Stress Concept, Risk Assessment and
34: 21-25.
Research Needs. Noise Health 4: 1-11.
42. Ahmed HO, Ali WJ (2017) Noise levels, noise annoyance, and hear-
25. Babisch W, Fromme H, Beyer A, Ising H (2001) Increased catecho-
ing-related problems in a dental college. Arch Environ Occup Health
lamine levels in urine in subjects exposed to road traffic noise: the role
72: 159-165.
of stress hormones in noise research. Environ Int 26: 475-481.
43. Brusis T (2014) [From the expert’s office: Hearing loss of middle and
26. Burns KN, Sun K, Fobil JN, Neitzel RL (2016) Heart Rate, Stress, and
high -frequencies in noise induced hearing loss?]. Laryngorhinootolo-
Occupational Noise Exposure among Electronic Waste Recycling
gie 93: 197.
Workers. Int J Environ Res Public Health 13.
44. Brusis T (2015) [From the expert’s office: When is a hearing loss in
27. Szalma JL, Hancock PA (2011) Noise effects on human performance:
the high tone range with coexisting hearing loss in all frequencies con-
a meta-analytic synthesis. Psychol Bull 137: 682-707.
sequence of professional noise exposure? Frequent false evaluation
28. Hasfeldt D, Maindal HT, Toft P, Birkelund R (2014) Patients’ percep- of consultants, consulting physicians and professional unions]. Laryn-
tion of noise in the operating room--a descriptive and analytic cross- gorhinootologie 94: 39-41.
sectional study. J Perianesth Nurs 29: 410-417.
45. Moore BC, Glasberg BR, Stoev M, Fullgrabe C, Hopkins K (2012)
29. Shankar N, Malhotra KL, Ahuja S, Tandon OP (2001) Noise pollution: The influence of age and high-frequency hearing loss on sensitivity to
a study of noise levels in the operation theatres of a general hospital temporal fine structure at low frequencies (L). J Acoust Soc Am 131:
during various surgical procedures. J Indian Med Assoc 99: 6-7. 1003-1006.
30. Mentis HM, Chellali A, Manser K, Cao CG, Schwaitzberg SD (2016) A 46. Paul R, Apel J, Klaus S, Schugner F, Schwindke P, et al. (2003) Shear
systematic review of the effect of distraction on surgeon performance: stress related blood damage in laminar couette flow. Artif Organs 27:
directions for operating room policy and surgical training. Surg Endosc 517-529.
30: 1713-1724.
47. Jhun CS, Stauffer MA, Reibson JD, Yeager EE, Newswanger RK, et
31. Bennett CL, Dudaryk R, Ayers AL, McNeer RR (2015) Simulating envi- al. (2018) Determination of Reynolds Shear Stress Level for Hemoly-
ronmental and psychological acoustic factors of the operating room. J sis. ASAIO J 64: 63-69.
Acoust Soc Am 138: 3855-3863.
48. Sallam AM, Hwang NH (1984) Human red blood cell hemolysis in a
32. Kracht JM, Busch-Vishniac IJ, West JE (2007) Noise in the operating turbulent shear flow: contribution of Reynolds shear stresses. Biorhe-
rooms of Johns Hopkins Hospital. J Acoust Soc Am 121: 2673-2680. ology 21: 783-797.
33. Love H (2003) Noise exposure in the orthopaedic operating theatre: a 49. Yen JH, Chen SF, Chern MK, Lu PC (2014) The effect of turbulent
significant health hazard. ANZ J Surg 73: 836-838. viscous shear stress on red blood cell hemolysis. J Artif Organs 17:
178-185.
34. Mendel LL, Gardino JA, Atcherson SR (2008) Speech understanding
using surgical masks: a problem in health care?. health care?. J Am 50. Aldea GS, Soltow LO, Chandler WL, Triggs CM, Vocelka CR, et al.
Acad Audiol 19: 686-695. (2002) Limitation of thrombin generation, platelet activation, and in-
flammation by elimination of cardiotomy suction in patients undergoing
8 Volume 2018; Issue 11
J Surg, an open access journal
ISSN: 2575-9760Citation : Friedrich M, Tirilomis T, Kollmeier JM, Wang Y, Hanekop GG (2018) Influence of Surgical Suction Tip Flow-Optimisation on Suction-Induced Noise Pollution. J
Surg: JSUR-1148. DOI: 10.29011/2575-9760. 001148
coronary artery bypass grafting treated with heparin-bonded circuits. J 53. Friedrich MG, Bougioukas I, Wenig P, Vormfelde S, Tirilomis T (2018)
Thorac Cardiovasc Surg 123: 742-755. New device for intraoperative blood suction avoiding turbulences BMJ
Innov 4.
51. El-Sabbagh AM, Toomasian CJ, Toomasian JM, Ulysse G, Major T, et
al. (2013) Effect of air exposure and suction on blood cell activation 54. Budde H, Riggert J, Vormfelde S, Tirilomis T, MG (2018) Effect of a
and hemolysis in an In vitro cardiotomy suction model. ASAIO J 59: novel turbulence controlled suction system on prevention of hemoly-
474-479. sis and platelet dysfunction in autologous surgery blood. submitted to
“Perfusion” for publication 2018.
52. van Oeveren W, Dankert J, Boonstra PW, Elstrodt JM, Wildevuur CR
(1986) Airborne contamination during cardiopulmonary bypass: the
role of cardiotomy suction. Ann Thorac Surg 41: 401-406.
9 Volume 2018; Issue 11
J Surg, an open access journal
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