Surgical smoke resulting from electrocauterization is a health risk for operating room personnel. The U.S. National Institute for Occupational Safety and Health recommends the use of local exhaust ventilation such as a portable smoke evacuation system to reduce surgical smoke, but its efficiency has never been assessed under experimental conditions. In this study, particle filtration efficiencies of five commercially available smoke evacuation systems were investigated in a model operating room. Two cutting angles, the devices' suction capacities, three unidirectional displacement flow rates, and the noise exposures were considered. Results demonstrated that portable smoke evacuation systems reduce surgical smoke up to 99% under optimal conditions. A cutting angle of 45°, the device's maximum suction capacity, and a unidirectional displacement flow rate of 10,500 m³/hr were advantageous. Sound levels ranged between 51-69 dBA and exceeded recommended threshold limits, if used with medium or maximum suction capacity. Hence, portable smoke evacuation systems are beneficial and are recommended. However, a combination with general unidirectional room ventilation and a strict limitation of the use of electrocauterization is strongly advised.

There is a growing interest in the use of volatile anesthetics for inhalational sedation of adult critically ill patients in the ICU. Its safety and efficacy has been demonstrated in various studies and technical equipment such as the anaesthetic conserving device (AnaConDa™; Sedana Medical, Uppsala, Sweden) or the MIRUS™ system (Pall Medical, Dreieich, Germany) have significantly simplified the application of volatile anesthetics in the ICU. However, the personnel's exposure to waste anesthetic gas during daily work is possibly disadvantageous, because there is still uncertainty about potential health risks. The fact that average threshold limit concentrations for isoflurane, sevoflurane and desflurane either differ significantly between countries or are not even defined at all, leads to raising concerns among ICU staff. In this review, benefits, risks, and technical aspects of inhalational sedation in the ICU are discussed. Further, the potential health effects of occupational long-term low-concentration agent exposure, the staffs' exposure levels in clinical practice, and strategies to minimize the individual gas exposure are reviewed.

Anesthesiologists are chronically exposed to trace concentrations of sevoflurane during work. Inhalational inductions, LMA™, and TF air-conditioning systems in particular are associated with higher sevoflurane exposure. However, the amount of inhaled sevoflurane per day was lower than expected, perhaps because concentrations in previous measurements could be overestimated (10%-15%) because of the cross-sensitivity reaction.