Abstract
Purpose: To determine occupational exposure of the anesthesiologist and surgeon to nitrous oxide and desflurane during general anesthesia for ear-nose-throat (ENT) surgery in children and adults.
Methods: An observational clinical trial was performed in ten children (C) and ten adults (A). Tracheas were intubated, in adults, with cuffed tubes and in children with uncuffed tubes. The operating room was equipped with modern air conditioning and waste anesthetic gas scavengers. Gas samples were obtained during the operative procedure every 90 sec from the breathing zone of subjects. Time-weighted averages (TWA) over the time of exposure were calculated for nitrous oxide and desflurane.
Results: Nitrous oxide TWAs for anesthesiologists were 0.41±0.23 ppm (A) and 1.20±0.32 ppm (C,P<0.0001), and 2.24±1.93 ppm (A) and 5.30±0.60 ppm (C,P=0.0001) for the surgeon who worked dose to the patient’s airway and thus had higher exposure (P<0.05 [A],P<0.0001 [C]). With regard to desflurane, the anesthesiologists’ TWAs were 0.02±0.03 ppm for both adults and children. The surgeon was exposed to 0.21±0.24 ppm desflurane (A) and 0.30±0.14 ppm (C,P: n.s.). Although the surgeon’s exposure was greater (P<0.05 [A],P<0.0001 [C]), the threshold limits of 25 ppm for nitrous oxide and 2 ppm for desflurane recommended by the National Institute of Occupational Safety and Health were not exceeded.
Conclusions: Under modern air conditioning, occupational exposure to inhalational anesthetics is low, and inhalational anesthesia is safe from the standpoint of modern workplace laws and health-care regulations.
Résumé
Objectif: Déterminer le niveau d’exposition professionnelle de l’anesthésiololgiste et du chirurgien au protoxyde d’azote et au desflurane pendant l’anesthésie générale pour une intervention ORL chez des enfants et des adultes.
Méthode: Un essai clinique d’observation a été réalisé auprès de dix enfants (E) et dix adultes (A). L’intubation aété réalisée avec des sondes à ballonnets chez les adultes et avec des sondes sans ballonnets chez les enfants. La salle d’opération bénéficiait d’un système moderne de conditionnement de l’air et de récupération des gaz anesthésiques. Les échantillons gazeux peopératoires ont été prélevés à toutes les 90 s, dans la zone de respiration des sujets. Les moyennes temporelles pondérés (MTP) selon le temps d’exposition ont été calculées pour le protoxyde d’azonte et le desflurane.
Résultats: Les MTP du protoxyde d’azonte ont été de 0,41±0,23 ppm (A) et de 1,20±0,32 ppm (E,P<0,0001) pour l’anesthésiologiste, et de 2,24±1,93 ppm (A) et de 5,30±0,60 ppm (E,P=0,0001 pour le chirurgien qui travaille près des voies aériennes du sujet et est ainsi plus exposé (P<0,05 [A],P<0,0001 [E]). Quant au desflurane, les MTP de l’anesthésiologiste ont été de 0,02±0,03 ppm pour les adultes et les enfants et celles du chirurgien de 0,21±0,24 ppm de desflurane (A) et de 0,30±0,14 ppm (E,P: n.s.). Même si l’exposition du chirurgien a été plus grande (P<0,05 [A],P<0,0001 [E]), les limites de 25 ppm pour le protoxyde d’azote et de 2 ppm pour le desflurane, recommandées par l’institut national de la santé et de la sécurité au travail, n’ont pas été dépassées.
Conclusion: Dans des conditions modernes de conditionnement de l’air, l’exposition professionnelle aux anesthésiques d’inhaltion est faible et l’anesthésie par inhalation est sans danger et conforme aux lois concernant les lieux de travail et les soins de santé.
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Byhahn, C., Wilke, H.J., Strouhal, U. et al. Occupational exposure to nitrous oxide and desflurane during ear-nose-throat-surgery. Can J Anesth 47, 984–988 (2000). https://doi.org/10.1007/BF03024870
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DOI: https://doi.org/10.1007/BF03024870