Evaluation of Waste Anesthetic Gas in the Postanesthesia Care Unit within the Patient Breathing Zone

Abstract

Potential health hazards from waste anesthetic gases (WAGs) have been a concern since the introduction of inhalational anesthetics into clinical practice. The potential to exceed recommended exposure levels (RELs) in the postanesthesia care unit (PACU) exists. The aim of this pilot study was to assess sevoflurane WAG levels while accounting for factors that affect inhalational anesthetic elimination. In this pilot study, 20 adult day surgery patients were enrolled with anesthesia maintained with sevoflurane. Following extubation, exhaled WAG from the patient breathing zone was measured 8 inches from the patient's mouth in the PACU. Maximum sevoflurane WAG levels in the patient breathing zone exceeded National Institute for Occupational Safety and Health (NIOSH) RELs for every 5-minute time interval measured during PACU Phase I. Observed WAGs in our study were explained by inhalational anesthetic pharmacokinetics. Further analysis suggests that the rate of washout of sevoflurane was dependent on the duration of anesthetic exposure. This study demonstrated that clinically relevant inhalational anesthetic concentrations result in sevoflurane WAG levels that exceed current RELs. Evaluating peak and cumulative sevoflurane WAG levels in the breathing zone of PACU Phase I and Phase II providers is warranted to quantify the extent and duration of exposure.

Evaluation and control of waste anesthetic gas in the postanesthesia care unit within patient and caregiver breathing zones

“…During this time, the most intensive bedside nursing is required, thus constituting an underestimated period of occupational risk for PACU nurses. 11 Another study concluded that peak WAG levels were detected 1 hour after patient arrival to the PACU, contrary to the initial hypothesis in which investigators expected peak WAG levels to occur at admission. 12 The location where the airway device is removed should also be considered; patients whose device is removed in the PACU versus the operating room yield higher initial concentrations of WAG than those who arrive to the PACU without a device.…”

“…Hiller et al provide further discussion on the pharmacokinetics of volatile anesthetics. 11 Studies have demonstrated that to maximize effectiveness in controlling WAG exposure, practices such as appropriate mask size selection and adjustment, minimal talking, mouth breathing by the patient, and use of a vacuum scavenging system must be implemented. 14 We strongly encourage investigators and government agencies to work in conjunction to update existing protocols related to occupational WAG exposure and include the PACU setting as a potential hazard location in which standard scavenging measurements should be practiced.…”

Occupational Risk Awareness of Anesthesiologists: A Survey Study

“…Ortamdaki AAG değerlerinin, havalandırmanın iyi olmadığı koşullarda toksik düzeylerin üstüne çıkma riski vardır (21) . Bu nedenle PACU ünitelerinde, ortamdaki AAG'yi azaltmak için havalandırmanın düzenlenmesi ile birlikte ek stratejilere ihtiyaç duyulmaktadır (22) . (23) .…”

Evaluation of a novel waste anaesthetic gas scavenger device for use during recovery from anaesthesia

“…Traditionally, scavenging devices have not been used in the theatre recovery unit, exposing staff and patients to relatively high inspired levels of waste anaesthetic agents [11].…”

“…To date, observational studies have measured occupational waste anaesthetic agents exposure only in operating theatres [5][6][7][8][9][10], where scavenging is available. Traditionally, scavenging devices have not been used in the theatre recovery unit, exposing staff and patients to relatively high inspired levels of waste anaesthetic agents [11].…”