Air Quality in Operating Theatres: The Effect of Waste Anaesthetics on Personnel and Exposure Prevention Measures

Abstract

The use of gaseous anaesthetics and vapours for narcosis in operating theatres means that inevitably some fraction of these is breathed by the surgical team. The amount will depend on the anaesthetic method, the duration of the operation, and the condition of the equipment used for anaesthesia and for overall ventilation. The greatest concentrations of anaesthetics are found in the working zone of the anaesthetist, then the surgeon and the scrub nurse. Until the middle of the 1960s there was little interest in air quality in operating theatres and the occupational effect of waste anaesthetic agents on the surgical team. The situation has improved considerably since then and many studies have now been carried out.

Anesthesia : Contributing to pollution?

“…Nitrous oxide has been implicated to cause several general and systemic dysfunctions. [ 4 – 6 ] It can lower the neuropsychological performance and cause generalized symptoms such as fatigue, headaches, dizziness, nervousness, nausea, concentration impairment, and lack of fitness. Peripheral neuropathy and medullary depression with megaloblastic anemia, leucopenia, reduction in number of B-lymphocytes, and thrombocytopenia may also occasionally occur.…”

A case study on the air distribution in an operating room at Sarawak General Hospital Heart Centre (SGHHC) in Malaysia

“…In terms of ventilating waste anaesthetic agents emanating from narcosis, the air conditioning systems in ORs should be designed using vertical laminar flow systems. 2 Inevitably, the existence of obstacles in the flow field of the laminar flow will distort the flow pattern in a small area around the obstacle. With the aid from techniques of computational fluid dynamics (CFD), designer can ensure that there is no inappropriate air mixing, and that air velocities do not adversely affect the operation and finally, provide a thermally comfort condition.…”

A comprehensive computational fluid dynamics simulation on the air distribution in an operating room at University of Malaya Medical Centre Malaysia

“…Inevitably, the application of these gases to surgical procedure will cause a rise in concentration of narcotic gases within the surgeon's working zone as well as delivering the anaesthetic to the patient. In order to aid the entrainment of remaining anaesthetics, besides the use of low-leakage anaesthesia equipment and scavenging system, Dobrovolsky 2 advocates the use of vertical laminar flow systems rather than the horizontal laminar flow system. In order to establish a more functioning OR in terms of ventilation efficiency, Loomans et al 3 suggest the use of the performance-based approach via CFD simulations and tracer gas measurements.…”