Narkosegasbelastung des Personals in der Kinderan�sthesie

Abstract

The exposure levels of anaesthetic gases are generally higher during anaesthesia in children up to 10 years of age than in older patients. Nevertheless, the measurements showed that exposure during paediatric anaesthesia can be kept below the recommended limit (8-h TWA in Switzerland) of 100 ppm nitrous oxide and 5 ppm halothane or 10 ppm enflurane or isoflurane. Causes of high exposures were particularly high fresh gas flows often applied without scavenging or together with inefficient scavenging devices and the high part of mask anaesthesia and inhalation induction with a loosely held mask. To achieve an effective reduction of occupational exposure, well-adjusted and maintained scavenging systems and low-leakage work practices are of primary importance. As leakage can never be completely avoided, a ventilation rate of at least ten air changes per h should be maintained in operating rooms and rooms where anaesthesia is induced to keep down concentrations of waste anaesthetic gases. High exposure during mask anaesthesia and inhalation induction can be prevented by further measures. Using a LMA instead of a standard mask reduces the exposure to the same level as endotracheal intubation.

Air Quality in Operating Theatres: The Effect of Waste Anaesthetics on Personnel and Exposure Prevention Measures

“…Keeping fresh gas flows low reduces not only the exposure levels of hospital personnel, but also contributes less to the environmental burden (by their chemical nature anaesthetic gases can contribute to the ''greenhouse effect'' and/or ozone layer destruction). Some 42% of scavengers inspected in 25 Swiss hospitals were found to be inefficient and reduced exposures on average by only 30% instead of the designed 85% [80].…”

Exposition des Personals gegenüber Sevofluran

“…Die Ex po si ti on ge gen über In ha la ti ons an äs-the ti ka ist be reits viel fach Ge gen stand von Un ter su chun gen ge we sen [3,4,5,6,8,9,10,11,12,13,14,17,18,19]. Da bei be stand aber fast im mer eine Misch ex po si ti on gegen über vo la ti len An äs the ti ka und N 2 O. Stu di en zur al lei ni gen Ex po si ti on ge genüber Sevoflu ran, also ohne N 2 O, lie gen für Bron cho sko pi en bei Kin dern [17] und für Se die run gen über eine Na sen mas ke [10] vor.…”

“…Es ist al ler dings zu be achten, dass sich zum einen der An äs the sist oder auch an de re Mit ar bei ter wäh rend der Un ter su chung über wie gend nicht in die sem Raum be fin den, zum an de ren die Pa ti en ten am Ende der Un ter su chung im Un ter su chungs raum vom Be at mungs gerät dis kon nek tiert und im Vor raum mit einem zwei ten Be at mungs ge rät die Nar ko se aus ge lei tet wird. Hin zu kommt noch, dass wäh rend un se rer Mes sun gen nur Kin dernar ko sen durch ge führt wur den und diese be kann ter ma ßen mit ei ner hö he ren Arbeits platz be las tung ver bun den sind [14]. Im aus ge la ger ten Ope ra ti ons saal der Au gen kli nik, der die glei che tech ni sche Aus stat tung wie die Säle des zent ra len Ope ra ti ons be rei ches auf weist, fan den sich er war tungs ge mäß eben falls nied ri ge Werte.…”