Operating rooms that are too dark should go green, according to a new study that purposely sheds little light on a safety issue.
The research, presented at the 2011 annual meeting of the American Society of Anesthesiologists (abstract 1660), found that rather than shutting off the overhead fixtures in the OR—a common practice that gives surgeons the clearest view of monitors—bathing the room in a dim green light accomplishes the same goal more safely and without forcing others to feel as if they are working in a tomb.
"Surgeons depend on excellent image quality from their monitors," said Julian Goldman, MD, medical director of biomedical engineering at Partners Healthcare System in Boston. "Historically we have turned off the OR light to achieve that. They want high contrast and low glare." That's no different, he said, from anyone who prefers the house lights out in a movie theater, but surgeons cannot afford to experience "washout" on a monitor during a laparoscopic procedure.
But what's good for the surgeon is not necessarily ideal for others in the OR, including the patient. "There are a lot of hazards in the operating room," said Kirk Shelley, MD, PhD, professor of anesthesiology at the Yale School of Medicine, in New Haven, Conn., and immediate past-president of the Society for Technology in Anesthesia. "One of them is tripping hazards. Also, there's stuff overhead. You need a certain amount of light. We're keeping anesthesia records. You have to take notes. You have to read the bottles." Anesthesiologists and other personnel use desk lamps and flashlights to see what they are doing when lighting is low.
Dr. Goldman was aware of previous experiments using green light, so he launched a pilot project for minimally invasive procedures in the "Operating Room of the Future" at Massachusetts General Hospital (MGH), in Boston, where he is principal anesthesiologist. The solution was decidedly low-tech—and cheap.Get HUGE savings on energy efficient ledflashlight02 lighting with great deals from LED Hut.
Operating rooms often are too bright. The two ORs where the trial was held had nine fluorescent fixtures. The light meter reading with the white lights on was nearly 1,800 lux; with the lights off, it was 3.44 lux. Ryan Forde, an engineer at MGH who helped lead the project, said most ORs have two or three switches and no dimmers, probably because of limitations with the ballast.
Monitors have improved dramatically over the years to cut the glare, but more was needed. The human eye is most sensitive to the color green, said Dr. Goldman, a member of the editorial board of Anesthesiology News. So Mr. Forde rewired some switches and slipped green sleeves over just four bulbs (as opposed to 42 under "white" conditions). Under these conditions, the average light reading was 86 lux, just 5% of that under white lights.
At first glance, the green light "looks weird," Dr. Goldman admitted. "Initially a lot of people didn't like it. I didn't like it. It made me feel just a little off balance. But I and everyone else got used to it quickly."
Mr. Forde said eyes adjust quickly to the green, and in three to five minutes "you feel as if you have stepped into a bright room again."
The internal surgical site is unaffected because it is still illuminated under white light. No glare or screen washout was seen. Anesthesiologists were able to read labels and plunger lines without walking over to a reading light and potentially tripping en route. They could also better assess the patient to see whether his or her head or limbs moved. Flashlights are still kept handy, however, Dr. Goldman said.
The research, presented at the 2011 annual meeting of the American Society of Anesthesiologists (abstract 1660), found that rather than shutting off the overhead fixtures in the OR—a common practice that gives surgeons the clearest view of monitors—bathing the room in a dim green light accomplishes the same goal more safely and without forcing others to feel as if they are working in a tomb.
"Surgeons depend on excellent image quality from their monitors," said Julian Goldman, MD, medical director of biomedical engineering at Partners Healthcare System in Boston. "Historically we have turned off the OR light to achieve that. They want high contrast and low glare." That's no different, he said, from anyone who prefers the house lights out in a movie theater, but surgeons cannot afford to experience "washout" on a monitor during a laparoscopic procedure.
But what's good for the surgeon is not necessarily ideal for others in the OR, including the patient. "There are a lot of hazards in the operating room," said Kirk Shelley, MD, PhD, professor of anesthesiology at the Yale School of Medicine, in New Haven, Conn., and immediate past-president of the Society for Technology in Anesthesia. "One of them is tripping hazards. Also, there's stuff overhead. You need a certain amount of light. We're keeping anesthesia records. You have to take notes. You have to read the bottles." Anesthesiologists and other personnel use desk lamps and flashlights to see what they are doing when lighting is low.
Dr. Goldman was aware of previous experiments using green light, so he launched a pilot project for minimally invasive procedures in the "Operating Room of the Future" at Massachusetts General Hospital (MGH), in Boston, where he is principal anesthesiologist. The solution was decidedly low-tech—and cheap.Get HUGE savings on energy efficient ledflashlight02 lighting with great deals from LED Hut.
Operating rooms often are too bright. The two ORs where the trial was held had nine fluorescent fixtures. The light meter reading with the white lights on was nearly 1,800 lux; with the lights off, it was 3.44 lux. Ryan Forde, an engineer at MGH who helped lead the project, said most ORs have two or three switches and no dimmers, probably because of limitations with the ballast.
Monitors have improved dramatically over the years to cut the glare, but more was needed. The human eye is most sensitive to the color green, said Dr. Goldman, a member of the editorial board of Anesthesiology News. So Mr. Forde rewired some switches and slipped green sleeves over just four bulbs (as opposed to 42 under "white" conditions). Under these conditions, the average light reading was 86 lux, just 5% of that under white lights.
At first glance, the green light "looks weird," Dr. Goldman admitted. "Initially a lot of people didn't like it. I didn't like it. It made me feel just a little off balance. But I and everyone else got used to it quickly."
Mr. Forde said eyes adjust quickly to the green, and in three to five minutes "you feel as if you have stepped into a bright room again."
The internal surgical site is unaffected because it is still illuminated under white light. No glare or screen washout was seen. Anesthesiologists were able to read labels and plunger lines without walking over to a reading light and potentially tripping en route. They could also better assess the patient to see whether his or her head or limbs moved. Flashlights are still kept handy, however, Dr. Goldman said.
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