A follow-up study on occupational exposure to inhaled anaesthetics in Eastern European surgeons and circulating nurses

Wiesner, Gunther; Harth, Marion; Szulc, R.; Jurczyk, W; Sobczyński, Paweł; Hoerauf, Klaus; Hobbhahn, J.; Taeger, K.

doi:10.1007/s004200000189

Cited by 20 publications

(8 citation statements)

References 13 publications

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“…Even though occupational exposure to airborne chemicals (such as N 2 O, sevoflurane or other halogenated agents, and phenols from propofol or related compounds) in operating theatres is nowadays generally reduced by modern waste-gas scavenging systems, anaesthetic pollution remains today a source of concern (Wiesner et al 2001). The latest trends in anaesthesiology are to lower N 2 O use, using low-flow anaesthesia whenever possible, and to adopt new halide agents with favourable pharmacokinetics for induction and maintenance.…”

Section: Discussionmentioning

confidence: 99%

Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels

Accorsi

Valenti

Barbieri

et al. 2003

Int Arch Occup Environ Health

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Objectives: Assessment of individual exposures to sevoflurane plus nitrous oxide (N 2 O) by biological monitoring of unmodified analytes in post-shift urine of exposed personnel. Methods: Anaesthetics in urine and breathing area were monitored in 124 subjects in 11 operating theatres. Passive samplers were collected after 2.5-7 h of exposure, at the same time as post-shift urinary samples, to evaluate the individual timeweighted average (TWA) exposures to sevoflurane and N 2 O. A static headspace sampler coupled with a gas chromatograph mass spectrometer was used for analytical determinations (sensitivity sufficient to reveal biological/environmental exposures of 0.1 lg/l urine and 50 ppb for sevoflurane, and 1 lg/l urine and 80 ppb for N 2 O). Results: Median (range) post-shift urinary and environmental values were 1.2 lg/l urine (0.1-5.0) and 0.4 ppm (0.05-3.0) for sevoflurane (n=107) and 10.9 lg/ l urine (0.5-74.9) and 8.6 ppm (0.2-123.4) for N 2 O (n=121) (all low-exposure range). At log-log regression, urinary levels closely correlated with environmental data (sevoflurane, r 2 =0.7538; N 2 O, r 2 =0.8749). Biological equivalent limits (BELs) based on National Institute for Occupational Safety and Health (NIOSH) TWA exposure limits, calculated as means of regression slope and y-intercept, were 3.6 lg/l urine for sevoflurane (corresponding to 2 ppm) and 22.3 lg/l urine for N 2 O (corresponding to 25 ppm). Individual ''mixture BELs'', which we calculated by applying the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value (TLV)mix formula to biomarker values and using the obtained NIOSH-based BELs as a reference, closely correlated with mixture TLVs (q=0.816, Lin's concordance test). Conclusions: We propose urinary sevoflurane as a new, specific, internal dose biomarker for routine biological monitoring of personal exposures among operating-theatre personnel, and use of reliable ''mixture BELs'' to provide safer levels of internal exposure for workers exposed to mixtures of sevoflurane and N 2 O, and conceivably also to other mixtures of toxicants with possible additive effects.

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Section: Discussionmentioning

confidence: 99%

Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels

Accorsi

Valenti

Barbieri

et al. 2003

Int Arch Occup Environ Health

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“…[22] Data on occupational exposure to inhaled anaesthetics in Eastern Europe operating room personnel are rare. [27] Earlier studies performed by NIOM in the same Polish hospitals showed that the highest sevoflurane concentration in the atmosphere of the operating rooms provided with a gas scavenging system was 3.2 mg/m 3 . [28] This study suggests adopting a factor of 10 as 'safety factor' to incorporate model uncertainty and inherent exposure variability in the risk assessment process.…”

Section: Discussionmentioning

confidence: 99%

Application of predictive models for estimation of health care workers exposure to sevoflurane

Jankowska

Czerczak

Kucharska

et al. 2015

International Journal of Occupational Safety and Ergonomics

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“…Several studies have, indeed, indicated that operating room personnel are at risk from such increased occupational exposure. This risk is increased in situations of insufficient scavenging of waste gases and operating room ventilation and in situations where the operating room personnel work close to places where the spillage occurs 4,5,7,[17][18][19][20] .…”

Section: Discussionmentioning

confidence: 99%

Occupational exposure to sevoflurane during cardiopulmonary bypass

2011

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Volatile anaesthetic agents are widely used for maintenance of anaesthesia in all kinds of surgical procedures. Despite the implementation of measures such as adequate ventilation of the operating room and the use of efficient scavenging systems, concern remains about the risks for occupational exposure, especially in situations associated with an increased risk of anaesthetic gas waste, such as with the use of volatile anaesthetic agents on cardiopulmonary bypass. The present contribution reports the results of a preliminary safety assessment involving measurements of sevoflurane concentrations in the ambient air of a cardiac surgery operating room. In 22 cardiac surgical procedures with cardiopulmonary bypass (11 with open and 11 with closed venous reservoir), measurements of trace concentrations were obtained every 10 min at the following sites: at the outlet of the oxygenator, at the outlet of the cardiotomy reservoir, in the breathing zone of the perfusionist and above the surgical field. The concentrations were measured on-line using a photoacoustic infrared spectrometer. Mean sevoflurane waste concentrations remained consistently below the recommended target value of 4.68 ppm throughout the observation period at the different measurement sites. These results indicate that, with the use of sevoflurane on cardiopulmonary bypass, the recommended levels for occupational exposure are not exceeded, provided adequate operation room ventilation and waste gas scavenging is performed.

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A follow-up study on occupational exposure to inhaled anaesthetics in Eastern European surgeons and circulating nurses

Cited by 20 publications

References 13 publications

Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels

Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels

Application of predictive models for estimation of health care workers exposure to sevoflurane

Occupational exposure to sevoflurane during cardiopulmonary bypass

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