Does standing or sitting position of the anesthesiologist in the operating theatre influence sevoflurane exposure during craniotomies?

Abstract

BackgroundExposure of the OR staff to inhalational anesthetics has been proven by numerous investigators, but its potential adverse effect under the present technical circumstances is a debated issue. The aim of the present work was to test whether using a laminar flow air conditioning system exposure of the team to anesthetic gases is different if the anesthetist works in the sitting as compared to the standing position.MethodsSample collectors were placed at the side of the patient and were fixed at two different heights: at 100 cm (modelling sitting position) and 175 cm (modelling standing position), whereas the third collector was placed at the independent corner of the OR. Collected amount of sevoflurane was determined by an independent chemist using gas chromatography.ResultsAt the height of the sitting position the captured amount of sevoflurane was somewhat higher (median and IQR: 0.55; 0.29–1.73 ppm) than that at the height of standing (0.37; 0.15–0.79 ppm), but this difference did not reach the level of statistical significance. A significantly lower sevoflurane concentration was measured at the indifferent corner of the OR (0.14; 0.058–0.36 ppm, p < 0.001).ConclusionsOpen isolation along with the air flow due to the laminar system does not result in higher anesthetic exposure for the sitting anesthetist positioned to the side of the patient. Evaporated amount of sevoflurane is below the accepted threshold limits in both positions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12871-016-0284-0) contains supplementary material, which is available to authorized users.

Occupational Exposure to Halogenated Anaesthetic Gases in Hospitals: A Systematic Review of Methods and Techniques to Assess Air Concentration Levels

“…Despite the constant search for safer anaesthetic methods, nowadays occupational exposure to anaesthetic gases still represents a significant risk within hospitals [20][21][22].…”

“…Environmental monitoring is the most standardized way to assess exposures to WAGs and to determine the compliance with occupational limit values, while biological monitoring assumes importance because it provides additional information on the body burden of anaesthetic gases and early effects. However, the occupational exposure to WAGs can be measured through the use of different environmental monitoring techniques, following more or less complex monitoring protocols, during different types of operating sessions and with respect to various temporal resolutions [8,20,[24][25][26].…”

Validation of Waste Anaesthetic Gas Exposure Limits When Using a Closed Vaporizer Filling System: A Laboratory-Based Study

“…The effects of anaesthetic gas exposure are dependent on the concentration of the agent and the duration of exposure. Sevoflurane is one of the most widely used inhaled anaesthetic agents [9,12,13]. Although no US federal regulatory standard exists for sevoflurane exposure limits [9], NIOSH guidelines advise that occupational exposure limits to halogenated gases should not exceed a 60-min ceiling of 2 ppm over the period of anaesthetic administration [2,12].…”

Aerogenic contamination control in operating theatres

“…112 In a UDF system the position (standing or sitting) of the anaesthesiologist had no significant influence on the inhaled concentration of isoflurane. 113 The main source of sevoflurane in the operating room is sevoflurane vaporisation in the patient's mouth.…”