Abstract
Health hazards from occupational exposure to trace concentrations of anesthetic gases cannot be definitively excluded. The aim of the study was to determine the surgeon’s occupational exposure to nitrous oxide and sevoflurane during pediatric surgical procedures. Twenty young children (age <10 years) and five teenagers (age > 10 years) underwent elective abdominal surgery under general inhalational anesthesia. The operating room was equipped with modern air conditioning and waste anesthetic gas scavenger. Levels of both nitrous oxide and sevoflurane were determined in the breathing zone of the surgeon and the anesthesiologist during the operative procedures by means of a direct-reading photoacoustic infrared spectrometer. Both the surgeon and the anesthesiologist were exposed to low concentrations of the inhalational agents used. Exposure to sevoflurane and nitrous oxide was clearly higher during surgery in young children than during operative procedures in teenagers. Nonetheless, the concentrations of these agents were well below the threshold limits of 25 ppm for nitrous oxide and 2 ppm for sevoflurane recommended by the National Institute of Occupational Safety and Health. General anesthesia results in operating room air pollution with inhalational anesthetics. Under modern air conditioning, personnel’s occupational exposure is low, and inhalational anesthesia is safe from the standpoint of modern workplace laws and health care regulations. Nonetheless, all efforts must be taken to maintain occupational exposure at this low level.
Résumé
Objectives: Des risques en rapport avec l’exposition à des gaz d’anesthésie ne peuvent étre totalement écartés. Le but de cette étude a été de déterminer le risque qu’encourt le chirurgien avec le protoxyde d’azote et le sevoflurane pendant des procédés chirurgicaux pédiatriques. Méthodes: 20 enfants (âge≥ 10 ans) et cinq adolescents (âge≥ 10 ans) ont eu une intervention abdominale élective sous anesthésie générale par inhalation. La salle d’opération était équipée d’un système de ventilation moderne et d’une cartouche filtrante pour les gaz anesthésiques non utilisés. Les niveaux de protoxyde d’azote et de sevoflurane ont été déterminés dans l’environnement respiré par les chirurgiens et les anesthésistes pendant les opérations par un spectromètre infrarouge photo-acoustique de lecture directe. Résultats: Et le chirurgien et l’anesthésiste ont été exposés à des concentrations basses des agents utilisés. L’exposition au sevoflurane et au protoxyde d’azote était fortement plus élevée lorsqu’il s’agissait d’enfants plus jeunes par rapport aux adolescents. Néanmoins, les concentrations de ces agents étaient bien plus basses que les valeurs seuils de 25 ppm pour le protoxyde d’azote et de 2 ppm pour le sevoflurane, recommandées par le National Institute of Occupational Safety and Health. Conclusions: L’anesthésie générale provoque une certaine pollution de la salle d’opération par des produits d’anesthésie d’inhalation. Dans les conditions modernes de ventilation, l’exposition aux gaz est trés réduite et l’anesthésie d’inhalation peut être considérée comme un procédé sur d’un point de vue médico-légal et selon les réglementations des conditions de travail. Néanmoins, toutes les précautions doivent être prises pour maintenir les niveaux d’exposition à des niveaux les plus bas possibles.
Resumen
No puede excluirse con certeza que la exposición, por motivos laborales a pequeñas concentraciones de gases anestésicos, pueda poner en peligro la salud de los profesionales. El objetivo de este trabajo fue determinar el grado de exposición de los cirujanos al óxido nitroso y al sevoflurano durante intervenciones quirúrgicas pediátricas. Métodos: 20 niños (menores de 10 años) y 5 adolescentes (mayores de 10 años) sufrieron una intervención quirúrgica abdominal bajo anestesia general por inhalación. El quirófano estaba equipado con una moderna instalación de aire acondicionado y un sistema eliminador de los gases anestésicos sobrantes. Utilizando un espectrómetro infrarrojo con lectura directa foto-acústica se determinaron los niveles de óxido nitroso y de sevoflurano en la zona en la que respiraban, durante la intervención, tanto el cirujano como el anestesista. Resultados: ambos, anestesista y cirujano, estuvieron expuestos a la inhalación a baja concentración de los agentes anestésicos utilizados. La exposición tanto al sevoflurano como al óxido nitroso fue significativamente superior durante la cirugía infantil que en las intervenciones quirúrgicas en adolescentes; sin embargo, ninguna de las concentraciones de los agentes anestésicos estuvieron por encima del umbral recomendado por el Instituto Nacional de Seguridad Laboral y Salud (25 ppm para el óxido nitroso y 2 ppm para el sevoflurano). Conclusiones: la anestesia general produce una polución del aire del quirófano cuando se utilizan anestésicos por inhalación. Si existe una moderna instalación de aire acondicionado, la exposición del personal laboral es muy baja y la anestesia por inhalación es segura, tanto desde el punto de vista de las modernas leyes laborales como de las regulaciones sobre atención sanitaria; a pesar de ello, no debe ahorrarse ningún esfuerzo para mantener la polución a estos bajos niveles.
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Byhahn, C., Heller, K., Lischke, V. et al. Surgeon’s occupational exposure to nitrous oxide and sevoflurane during pediatric surgery. World J. Surg. 25, 1109–1112 (2001). https://doi.org/10.1007/BF03215855
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DOI: https://doi.org/10.1007/BF03215855