Exposure of operating room personnel to nitrous oxide during paediatric anaesthesia

Abstract

From the Department of Anaesthesia, Alberta Children's Hospital at the University of Calgary, Calgary, Alberta.This paper was presented in part at the Canadian Anaesthetists' Society Annual Meeting in Ottawa, June 1989.Address correspondence to: Dr. C. Wood, Department of Anaesthesia, Alberta Children's Hospital, 1820 Richmond Road SW., Calgary, Alberta.Accepted for publication 15th May, 1992. Contamination of the operating theatre with trace concentrations of waste anaesthetic gases is an inevitable consequence of the use of inhalational anaesthetic agents. The health risk to operating theatre personnel resulting from chronic exposure to trace concentrations of these agents has been the subject of numerous studies during the last 20 yr. Among the agents studied, the toxic effects of nitrous oxide have been the focus of much attention. Horace Wells first demonstrated the anaesthetic properties of nitrous oxide in 1844, but it was not until 1956 that the first adverse side effects from its use were reported. In that year, Lassen described bone marrow surpression in patients sedated with nitrous oxide for long-term ventilation) Since then, possible adverse effects on bone marrow, psychomotor function, and reproductive function have been described. 2-8 This has led to concerns regarding possible ill effects from the chronic occupational exposure CAN J ANAESTH 1992 / 39:7 / pp 682-6

Evaluation of personal, environmental and biological exposure of paediatric anaesthetists to nitrous oxide and sevoflurane*

“…Median [interquartile range] 1 h postoperative nitrous oxide concentrations (ppm) in oncology, dental theatre, day surgery unit and MRI suite were: blood, 6 [3][4][5][6][7] [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. .............................................................................................................................................................................................................. Unpaired t-test was applied to determine if there were any significant relationships between blood sevoflurane and nitrous oxide concentration and the type of induction technique, airway management, circuit used or presence of scavenging.…”

Der Microcuff P�diatrietubus

“…Z. bei Kindern unter 8-10 Jahren noch zurückhaltend eingesetzt. Wenn sie zum Einsatz kommen,bleibt der Cuff oft ungeblockt, außer bei großer Leckage und ineffizienter mechanischer Beatmung [9,31].Sollten jedoch in Zukunft gecuffte Tuben bei Kindern häufiger verwendet werden und sollte aus den gleichen ökonomischen Gründen sowie umweltentlastenden Überlegungen wie beim Erwachsenen geblockt werden [18,42], so ist die adäquate Ausgestaltung von Tuben von außerordentlicher Wichtigkeit, um Schäden an den Luftwegen und insbesondere am Larynx zu vermeiden [17,22].…”

Occupational exposure to sevoflurane, halothane and nitrous oxide during paediatric anaesthesia Waste gas exposure during paediatric anaesthesia

“…This may be due to mask induction, noncuffed tracheal tubes, open, high-flow breathing systems and ineffective air conditioning or waste gas scavenging. In previous studies occupational exposure was expressed as mean values over the whole time of anaesthesia [4]. The monitoring methods (diffusive sampling tubes) used in these studies could not perform differentiated analysis of the time course of the trace concentrations during paediatric anaesthesia.…”

“…Occupational exposure to waste anaesthetic gases is higher during anaesthesia in children than in adults [2][3][4]. This may be due to mask induction, noncuffed tracheal tubes, open, high-flow breathing systems and ineffective air conditioning or waste gas scavenging.…”