Ho-ho-ho! Gather ’round, my little elves, for a tale not of toys and reindeer, but of something quite different that’s stirring in the air—surgical smoke, to be precise! Now, in the bustling workshop of the operating room, where surgeons, like skilled toymakers, craft health and healing, there’s a bit of a fog rolling in. This isn’t the magical mist of the North Pole, oh no. It’s a concoction brewed from energy-based surgical instruments, a not-so-jolly mix of polycyclic aromatic hydrocarbons (PAHs), volatile organic compounds (VOCs), particulate matter, and even some viable microorganisms that could make Santa’s beard curl!

The curious elves of science have been busy, moving their experiments from the lab to the real-world workshop of surgery. But, by my white whiskers, they’ve found that measuring this surgical smoke is as varied as the snowflakes at Christmas. With samplers placed hither and thither, and all sorts of tissues and surgeries to consider, the results are as mixed as a batch of Mrs. Claus’s famous cookies.

Now, some of the states, with lists they are checking, have started to say, “Let’s clear the air!” with local smoke evacuators. But a national rule, as overarching as my list of who’s naughty or nice, is still but a wish upon the Christmas star.

Most studies, peeking into this foggy affair, haven’t found naughty levels of these by-products, just short bursts that could give an elf a scare. This review, like a letter to Santa, points out the gaps in the research and the conclusions that are as unsupported as a sleigh without magic. It’s a call for more focus, more study, and better guidelines from the Occupational Safety and Health Administration (OSHA), to ensure that the operating room remains a place of joy and not one where the air is as murky as a blizzard on Christmas Eve.

So, let’s jingle all the way to clearer skies in the OR, for the health of all the good girls and boys, and the surgeons and nurses too!