Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-19T08:11:35.105Z Has data issue: false hasContentIssue false
  • English
  • Français

Exposure of personnel to sevoflurane during paediatric anaesthesia: influence of professional role and anaesthetic procedure

Published online by Cambridge University Press:  23 December 2004

A. Gentili ,
A. Accorsi ,
A. Pigna ,
V. Bachiocco ,
I. Domenichini ,
S. Baroncini  and
F. S. Violante
A. Gentili
Affiliation:
S. Orsola-Malpighi Hospital, Department of Paediatric Anaesthesia and Intensive Care, Bologna, Italy
A. Accorsi
Affiliation:
S. Orsola-Malpighi Hospital, Occupational Medicine Service, University of Bologna, Bologna, Italy
A. Pigna
Affiliation:
S. Orsola-Malpighi Hospital, Department of Paediatric Anaesthesia and Intensive Care, Bologna, Italy
V. Bachiocco
Affiliation:
S. Orsola-Malpighi Hospital, Department of Paediatric Anaesthesia and Intensive Care, Bologna, Italy
I. Domenichini
Affiliation:
S. Orsola-Malpighi Hospital, Safety, Hygiene and Occupational Medicine Service, Bologna, Italy
S. Baroncini
Affiliation:
S. Orsola-Malpighi Hospital, Department of Paediatric Anaesthesia and Intensive Care, Bologna, Italy
F. S. Violante
Affiliation:
S. Orsola-Malpighi Hospital, Occupational Health Unit, Bologna, Italy
Get access

Abstract

Summary

Background and objective: This study was performed to determine the individual exposure of paediatric operating theatre personnel to sevoflurane and to evaluate the impact of inhalation induction and various airway approaches on exposure to airborne sevoflurane.

Methods: Mean individual environmental (workplace air) exposure to sevoflurane and a biomarker of exposure (urinary sevoflurane) were monitored in 36 subjects (10 anaesthetists, 10 surgeons, 12 nurses and 4 auxiliary personnel) working in two paediatric operating rooms.

Results: Environmental and urinary values were significantly greater in anaesthetists compared with other groups, with median values of 0.65 ppm (interquartile range 1.36; 95th percentile 4.36) for breathing zone sevoflurane and 2.1 μg L−1 urine (interquartile range 2.6; 95th percentile 7.6) for urinary sevoflurane. Anaesthetists exceeded the 2 ppm maximum allowed environmental concentration recommended by the National Institute for Occupational Safety and Health in 4 of 22 cases (18.1%). A positive correlation was found between the number of patients undergoing inhalational induction each day and mean values of breathing zone and urinary sevoflurane. An increase in the number of daily laryngeal mask insertions, or the use of rigid bronchoscopy, are statistically related to higher environmental and urinary values (P < 0.01 and <0.00001 for breathing zone sevoflurane, P < 0.05 and <0.01 for urinary sevoflurane, respectively).

Conclusions: Anaesthesia with sevoflurane can pose a hazard of chronic exposure with anaesthetists having the highest risk. Endotracheal intubation offers considerable protection against exposure. Routine anaesthesia using a standard facemask, a laryngeal mask or rigid bronchoscopy are risk factors for increased anaesthetic exposure.

Keywords

AIRWAY MANAGEMENT, tracheal tube, laryngeal mask, bronchoscopeANAESTHESIA, paediatricANAESTHETICS EXPOSUREMEASUREMENTANAESTHETICS, INHALATION, sevofluraneOPERATING ROOM, personnelTECHNIQUES
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 21 , Issue 8 , August 2004 , pp. 638 - 645
Copyright
2004 European Society of Anaesthesiology

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Caldwell CB. Induction, maintenance and emergence. In: Gregory GA, ed. Pediatric Anesthesia.New York, USA: Churchill Livingstone Inc, 2002: 217–248.
Sigston PE, Jenkins AM, Jackson EA, Sury MR, Mackersie AM, Hatch DJ. Rapid inhalation induction in children: 8% sevoflurane compared with 5% halothane. Br J Anaesth 1997; 78: 362–365.Google Scholar
Krenzischek DA, Shaefer J, Nolan M, et al. Phase I collaborative pilot study: waste anesthetic gas level in the PACU. J Perianesth Nurs 2002; 17: 227–239.Google Scholar
Byhahn C, Heller K, Lischke V, Westphal K. Surgeon's occupational exposure to nitrous oxide and sevoflurane during pediatric surgery. World J Surg 2001; 25: 1109–1112.Google Scholar
Saurel-Cubizolles M, Hays MJ, Estryn-Behar M. Work in operating rooms and pregnancy outcome among nurses. Int Arch Occup Environ Health 1994; 66: 235–241.Google Scholar
Boivin JF. Risk of spontaneous abortion in women occupationally exposed to anaesthetic gases: a meta-analysis. Occup Environ Med 1997; 54: 541–548.Google Scholar
Mei Pang L, Liu LMP, Cotè CJ. Premedication and induction of anesthesia. In: Cotè CJ, Todres ID, Ryan JF, Goudsouzian NG, eds. A Practice of Anesthesia for Infants and Children. Philadelphia, USA: WB Saunders Company, 2001: 493–521.
Accorsi A, Barbieri A, Raffi GB, Violante FS. Biomonitoring of exposure to nitrous oxide, sevoflurane, isoflurane and halothane by automated GC/MS headspace urinalysis. Int Arch Occup Environ Health 2001; 74: 541–548.Google Scholar
Ikeda M. Solvents in urine as exposure markers. Toxicol Lett 1999; 108: 99–106.Google Scholar
DHEW Pub. No. (NIOSH) 77-140, March 1977.
Brodsky JB, Cohen EN. Health experiences of operating room personnel. Anesthesiology 1985; 63: 461–464.Google Scholar
Udasin IG. Health care workers. Prim Care 2000; 27: 1079–1102.Google Scholar
Hoerauf K, Lierz M, Wiesner G, et al. Genetic damage in operating room personnel exposed to isoflurane and nitrous oxide. Occup Environ Med 1999; 56: 433–437.Google Scholar
Hoerauf K, Wallner T, Akca O, Taslimi R, Sessler DI. Exposure to sevoflurane and nitrous oxide during four different methods of anesthetic induction. Anesth Analg 1999; 88: 925–929.Google Scholar
Davenport HT, Halsey MJ, Wardley-Smith B, Batemann PE. Occupational exposure to anesthetics in 20 hospitals. Anaesthesia 1980; 35: 354–359.Google Scholar
Hoerauf K, Harth M, Wild K, Hobbhahn J. Occupational exposure to desflurane and isoflurane during cardiopulmonary bypass: is the gas outlet of the membrane oxygenator an operating theatre pollution hazard? Br J Anaesth 1997; 78: 378–380.Google Scholar
Sessler DI, Badgwell JM. Exposure of postoperative nurses to exhaled anesthetic gases. Anesth Analg 1998; 87: 1083–1088.Google Scholar
Raj N, Henderson KA, Hall JE, et al. Evaluation of personal, environmental and biological exposure of paediatric anaesthetists to nitrous oxide and sevoflurane. Anaesthesia 2003; 58: 630–636.Google Scholar
Byhahn C, Strouhal U, Westphal K. Exposition des Anästhesisten gegenüber Sevofluran und Lachgas während inhalativ eingeleiteter Narkosen in der Kinderanästhesie. Anaesthesiol Reanim 2000; 25: 12–16.Google Scholar
Wood C, Ewen A, Goresky G, Sheppard S. Exposure of operating room personnel to nitrous oxide during paediatric anaesthesia. Can J Anesth 1992; 39: 682–686.Google Scholar
Accorsi A, Valenti S, Barbieri A, Raffi GB, Violante FS. Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels. Int Arch Occup Environ Health 2003; 76: 129–136.Google Scholar
Haufroid V, Gardinal S, Licot C, et al. Biological monitoring of exposure to sevoflurane in operating room personnel by the measurement of hexafluoroisopropanol and fluoride in urine. Biomarkers 2000; 5: 141–151.Google Scholar
Accorsi A, Morrone B, Domenichini I, Barbieri A, Raffi GB, Violante FS. Urinary sevoflurane and hexafluoroisopropanol as biomarkers of low level occupational exposure to sevoflurane. Toxicol Ind Health 2003; (Accepted).Google Scholar
Meier A, Jost M, Ruegger M, Knutti R, Schlatter C. Narkosegasbelastung des Personals in pädiatrischer Anästhesie. Anaesthesist 1995; 44: 154–162.Google Scholar
Walker I, Lockie J. Basic techniques for anaesthesia. In: Sumner E, Hatch DJ, eds. Paediatric Anaesthesia.London, UK: Arnold, 1999: 165–210.
Fisher DM. Anesthesia equipment for pediatrics. In: Gregory GA, ed. Pediatric Anesthesia.New York, USA: Churchill Livingstone, 2002: 191–216.
Panni MK, Corn SB. The use of a uniquely designed anesthetic scavenging hood to reduce operating room anesthetic gas contamination during general anesthesia. Anesth Analg 2002; 95: 656–660.Google Scholar
Rieder J, Keller C, Brimacombe J, et al. Monitoring pollution by proton-transfer-reaction mass spectrometry during paediatric anaesthesia with positive pressure ventilation via the laryngeal mask airway or uncuffed tracheal tube. Anaesthesia 2002; 57: 663–666.Google Scholar
Jenstrup M, Fruergaard KO, Mortensen CR. Pollution with nitrous oxide using laryngeal mask or face mask. Acta Anaesthesiol Scand 1999; 43: 663–666.Google Scholar
Hoerauf K, Koller C, Jakob W, Taeger K, Hobbhahn J. Isoflurane waste gas exposure during general anesthesia: the laryngeal mask compared with tracheal intubation. Br J Anaesth 1996; 77: 189–193.Google Scholar
O'Hare K, Kerr WJ. The laryngeal mask as an antipollution device. Anaesthesia 1998; 53: 51–54.Google Scholar
Gustorff B, Lorenzl N, Aram L, Krenn CG, Jobst BP, Hoerauf K. Environmental monitoring of sevoflurane and nitrous oxide using the cuffed oropharyngeal airway. Anesth Analg 2002; 94: 1244–1248.Google Scholar
Westphal K, Strouhal U, Kessler P, Schneider J. Arbeitsplatzbelastung durch Sevofluran. Konzentrationsmessungen während Bronchoskopien bei Kindern. Anaesthesist 1997; 46: 677–682.Google Scholar
Westphal K, Lischke V, Aybeck T, Kessler P. Narkosegasbelastung des pädiatrischen Pneumologen während kinderbronchoskopischer Eingriffe. Pneumologie 1997; 51: 1123–1126.Google Scholar