The use of exhaust suit systems is commonplace in arthroplasty surgery where isolation of the surgical team is desirable in an attempt to reduce the risk of infection transmission. Elevated carbon dioxide levels have been reported in the non-clinical setting with such systems the consequences of which can include fatigue, diaphoresis, nausea, headache and irritability.

The aim of our study was to determine the levels of carbon dioxide present within an exhaust suit system during hip arthroplasty and to compare these with the recommended occupational exposure limit levels published by the Health and Safety Executive (HSE).

Data was collected during ten primary hip replacements performed by the same surgeon whilst wearing the Stryker Steri-Shield Helmet Exhaust System. This is a self-contained unit with an integrated blower used in conjunction with a full-length gown. In addition the helmet was fitted with an air-sampling probe connected to a portable infrared CO₂ monitor and also a temperature probe. Thus continuous monitoring of both CO₂ and temperature level during surgery was possible.

The mean initial CO₂ concentration in the helmet at the beginning of surgery was 3000 parts per million (ppm) and the mean maximum CO₂ level recorded was 13,000 ppm. The mean time the surgeon was within an exhaust suit to perform a primary hip replacement was 1 hr 54 mins and for 86% of this time period the CO₂ level within the helmet exceeded the recommended level of 5000 ppm as stipulated by the HSE.

In conclusion we have demonstrated significantly elevated CO₂ levels within the Stryker Steri-shield Exhaust Suit System during hip surgery. Surgeons who use this system should be aware of this together with the physical symptoms that may result.