Abstract
This study was undertaken to quantify the exposure of operating room staff to nitrous oxide during routine paediatric otolaryngeal surgery and to determine the influence of the method of induction of anaesthesia on this exposure. The nitrous oxide exposure of the anaesthetist, the surgeon and the circulating nurse were measured, using body-worn passive atmospheric samplers, during twelve routine paediatric otolaryngeal surgical lists. During six of the lists an inhalational technique, with nitrous oxide, oxygen and halothane, was used for the induction of anaesthesia. During the other six lists anaesthesia was induced using intravenous thiopentone. In all cases, anaesthesia was maintained using nitrous oxide, oxygen and halothane. Regardless of the induction technique used, the mean nitrous oxide exposures of the anaesthetist, the surgeon and the nurse all exceeded the maximum level of 25 ppm · hr−1 recommended by the United States National Institute for Occupational Safety and Health (NIOSH). The use of an intravenous technique for the induction of anaesthesia reduced the nitrous oxide exposure of the anaesthetist and the circulating nurse. This suggests that, although the use of an intravenous induction may reduce exposure to nitrous oxide, the NIOSH recommendations for maximum exposure of operating room personnel to nitrous oxide are currently unattainable in practice.
Résumé
Ce travail a pour objectif de mesurer le degré d’exposition du personnel des salles d’opération pendant la chirurgie otorhinolaryngologique pédiatrique et l’influence de la méthode d’induction de l’anesthesie sur cette exposition. L’exposition au protoxyde d’azote pour l’anesthésiste, le chirurgien et l’infirmière de service externe est évaluée par l’analyse des échantillons de l’air ambiant pendant le déroulement de douze programmes opératoires otorhinolaryngologiques de pédiatrie. Durant six de ces programmes, une technique inhalatoire comprenant protoxyde d’azote, oxygène et halothane est utilisée pour l’induction. Pendant les six autres, le thiopental intraveineux est utilisé pour l’induire l’anesthésie. Quelque soit la technique utilisée, l’anesthésiste, le chirurgien et l’infirmière sont contact avec des concentrations dépassant le niveau maximum de 25ppm· hr−1 recommandé par le United States National Institute for Occupational Safety and Health (NIOSH). L’utilisation de la technique d’induction intraveineuse a diminué l’exposition au protoxyde d’azote pour l’anesthésiste et l’infirmière. Ceci suggère que, bien que l’utilisation d’une technique d’induction intraveineuse puisse réduire l’exposition au protoxyde d’azote dans les salles d’opération, les recommandation, du NIOSH concernant l’exposition maximale du personnel sont en pratique impossible à atteindre.
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Wood, C., Ewen, A., Goresky, G. et al. Exposure of operating room personnel to nitrous oxide during paediatric anaesthesia. Can J Anaesth 39, 682–686 (1992). https://doi.org/10.1007/BF03008230
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DOI: https://doi.org/10.1007/BF03008230