Investigations of Some Aspects of Atmospheric Pollution by Anaesthetic Gases. Ii: Aspects of Adsorption and Emission of Halothane by Different Charcoals

Enderby, D.H.; Bushman, J.A.; Askill, S.

doi:10.1093/bja/49.6.567

Cited by 9 publications

(2 citation statements)

References 6 publications

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“…Charcoal filters are often used as the final capture device to prevent halogenated anesthetic agents from dispersing into the atmosphere. 5,[64][65][66] Use of a closed filling system for vaporizers has also been shown to decrease ambient air contamination by inhaled anesthetics. One vaporizer system with an integral valve filling adaptor that connects directly into the vaporizer reduced sevoflurane contamination of ambient air by approximately 60% compared with other systems that used screw cap closures and vaporizer-specific adaptors for filling.…”

Section: Anesthesia and Analgesiamentioning

confidence: 99%

Environmental and Occupational Considerations of Anesthesia: A Narrative Review and Update

Varughese

Ahmed

2021

Anesthesia &Amp; Analgesia

104

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With an estimated worldwide volume of 266 million surgeries in 2015, the call for general inhalation anesthesia is considerable. However, widely used volatile anesthetics such as N 2 O and the highly fluorinated gases sevoflurane, desflurane, and isoflurane are greenhouse gases, ozone-depleting agents, or both. Because these agents undergo minimal metabolism in the body during clinical use and are primarily (≥95%) eliminated unchanged via exhalation, waste anesthetic gases (WAGs) in operating rooms and postanesthesia care units can pose a challenge for overall elimination and occupational exposure. The chemical properties and global warming impacts of these gases vary, with atmospheric lifetimes of 1−5 years for sevoflurane, 3−6 years for isoflurane, 9−21 years for desflurane, and 114 years for N 2 O. Additionally, the use of N 2 O as a carrier gas for the inhalation anesthetics and as a supplement to intravenous (IV) anesthetics further contributes to these impacts. At the same time, unscavenged WAGs can result in chronic occupational exposure of health care workers to potential associated adverse health effects. Few adverse effects associated with WAGs have been documented, however, when workplace exposure limits are implemented. Specific measures that can help reduce occupational exposure and the environmental impact of inhaled anesthetics include efficient ventilation and scavenging systems, regular monitoring of airborne concentrations of waste gases to remain below recommended limits, ensuring that anesthesia equipment is well maintained, avoiding desflurane and N 2 O if possible, and minimizing fresh gas flow rates (eg, use of low-flow anesthesia). One alternative to volatile anesthetics may be total intravenous anesthesia (TIVA). While TIVA is not associated with the risks of occupational exposure or atmospheric pollution that are inherent to volatile anesthetic gases, clinical considerations should be weighed in the choice of agent. Appropriate procedures for the disposal of IV anesthetics must be followed to minimize any potential for negative environmental effects. Overall, although their contributions are relatively low compared with those of other human-produced substances, inhaled anesthetics are intrinsically potent greenhouse gases and pose a risk to operating-room personnel if not properly managed and scavenged. Factors to reduce waste and minimize the future impact of these substances should be considered.

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Section: Anesthesia and Analgesiamentioning

confidence: 99%

Environmental and Occupational Considerations of Anesthesia: A Narrative Review and Update

Varughese

Ahmed

2021

Anesthesia &Amp; Analgesia

104

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“…Charcoal filter showed adsorptive capacity of halothane3,4,6 and isoflurane,6,7 and enhanced the recovery from anesthesia mostly in low flow systems. However, these previous studies were performed without an aid of anesthetic depth monitor such as BIS.…”

Section: Discussionmentioning

confidence: 99%

Effect of Charcoal Filter on the Emergence from Sevoflurane Anesthesia in a Semi-Closed Rebreathing Circuit

Chang

Choi

et al. 2011

Yonsei Med J

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PurposeA charcoal filter attached within the anesthetic circuit has been shown to efficiently adsorb halothane or isoflurane, thus hastening anesthetic recovery in low or minimal flow system. This study was intended to demonstrate whether the charcoal filter enhances the recovery time from sevoflurane anesthesia using a semi-closed circuit system.Materials and MethodsThirty healthy patients scheduled for elective surgery under sevoflurane anesthesia were randomly assigned to the charcoal filter or control group. Upon completion of surgery, the end-tidal concentration of sevoflurane was maintained at 2.0 vol%. A charcoal filter was attached to the expiratory limb of the breathing circuit of charcoal filter group subjects. After sevoflurane was discontinued, ventilation was controlled with the same minute volume as the intra-operative period at a fresh gas flow rate of 5 L·min-1 with 100% O2. The elimination kinetics of sevoflurane from end-tidal concentration, Bispectral index and times of eye opening and extubation were obtained.ResultsThe exponential time constant (τ) of alveolar sevoflurane concentration in the charcoal filter group was significantly shorter than that in the control group (1.7±0.5 vs. 2.5±1.1 min, p=0.008). The charcoal filter hastened rapid eye opening (11.1±3.8 vs. 14.8±3.0 min, p=0.007) and extubation (11.9±3.9 vs. 15.3±3.2 min, p=0.014), compared to the control group.ConclusionA charcoal filter enhances the recovery from sevoflurane anesthesia with a semi-closed rebreathing circuit.

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Toxicologische aspecten van vluchtige anesthetica

Winkel¹

1979

Pharmaceutisch Weekblad Scientific Edition

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In de laatste jaren wordt duidelijk gewezen op de schadelijke invloed van subnarcotische hoeveelheden vluchtige anesthetica die door anesthesie-personeel dagelijks gedurende jaren worden ingeademd. Dit in tegenstelling tot de periode hiervoor, toen alleen het risico van een narcose bij de patient werd bekeken.De oorzaken van de luchtverontreiniging in operatiekamers worden besproken. Als voornaamste bron van verontreiniging komt het door de patient uitgeademde gasmengsel in aanmerking. Dit komt geheel of gedeelteijk terecht in de atmosfeer van de operatiekamer. Ook lekkage in de anesthesie-apparatuur kan bijdragen tot de verontreiniging. Ten derde kan door een lout in de anesthesie-teehniek gas ontsnappen.Om een indruk te krijgen van de verontreinigingen (voornamelijk komen de meest gebruikte anestetica halothaan en lachgas aan de orde) heeft een literatuurstudie plaatsgevonden. Uit bepalingen door gaschromatografie, m-spectroscopie en massaspectrometrie kan worden geconcludeerd dat de concentraties aan halothaan tussen ca. z tot ca. 50 ppm liggen, met enkele uitschieters naar boven. Voor lachgas worden waarden gevonden die Ioomaal hoger liggen, overeenkomend met de hogere concentraties in de uitademingslucht van de patient. De grote spreiding 'in bovengenoemde concentraties kan worden verklaard door verschillen in de luchtverversing en in de anesthesie-apparatuur.Algemeen wordt nu aangenomen dat deze waarden te hoog liggen. Het National Institute for Occupational Safety and Health (NIOSH) in de Verenigde Staten heeft in I975 als maximumconcentratie 0,5 ppm van halothaan voorgesteld. Het is dus noodzakelijk dat de bovengenoemde concentraties van halothaan en lachgas drastisch worden verminderd. Dit kan via adsorptie met behulp van koolfilters. Daar het zeer goed mogelijk is deze koolfilters te regenereren, lijkt dit een goedkope en eenvoudig aan te brengen oplossing. Het percentage geadsorbeerd halothaan bedraagt tot 78% (lachgas wordt echter vrijwel niet geadsorbeerd). Ook afvoersystemen, die zorgen vo0r her opvangen en afvoeren van de overtollige anesthetica naar de buitenlucht, geven zeer goede resultaten (85-90% vermindering van de concentratie aan narcosegassen).De schadelijke gevolgen bij personeel dat chronisch is blootgesteld aan sub-anesthetische concentraties narcosegassen, worden besproken. Aan de orde komen lever-en nierbeschadigingen, teratogene afwijkingen, hematologische stoornissen, carcinogene en mutagene aspecten, psychische stoornissen en pathologisehe effeeten op de hersenen en het optreden van spontane ab0rtus.De vroegere opvatting dat yluehtige anesthetica niet worden gemetaboliseerd, is achterhaald. De biotransformatie van de vluchtige anesthetica is belangrijk voor hun werking als toxische substantie. Belangrijk is ook de vaststelling dat ehronische blootstelling aan bijv0orbeel'd halothaan en lachgas de microsomale enzymw.erking stimuleert. Bij anesthetische concentraties remt halothaan zijn eigen metabolisme. Dit heeft waarsehijnlijk tot gevolg dat chronische blootstelling aan sub-anesth...

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Investigations of Some Aspects of Atmospheric Pollution by Anaesthetic Gases. Ii: Aspects of Adsorption and Emission of Halothane by Different Charcoals

Cited by 9 publications

References 6 publications

Environmental and Occupational Considerations of Anesthesia: A Narrative Review and Update

Environmental and Occupational Considerations of Anesthesia: A Narrative Review and Update

Effect of Charcoal Filter on the Emergence from Sevoflurane Anesthesia in a Semi-Closed Rebreathing Circuit

Toxicologische aspecten van vluchtige anesthetica

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