Occupational Chronic Sevoflurane Exposure in the Everyday Reality of the Anesthesia Workplace

Abstract

Anesthesiologists are chronically exposed to trace concentrations of sevoflurane during work. Inhalational inductions, LMA™, and TF air-conditioning systems in particular are associated with higher sevoflurane exposure. However, the amount of inhaled sevoflurane per day was lower than expected, perhaps because concentrations in previous measurements could be overestimated (10%-15%) because of the cross-sensitivity reaction.

The child's behavior during inhalational induction and its impact on the anesthesiologist's sevoflurane exposure

“…Mean and maximum sevoflurane concentrations in the anesthesiologists’ breathing zones were 4.38‐12.63 p.p.m and 70.06‐242.86 p.p.m on average. These values are higher than described in previous studies, in which sevoflurane exposures were 2.43‐5.40 p.p.m and 6.59‐43.08 p.p.m during induction . Reasons might be that we focused on a very short period, in which measurements started with the administration of sevoflurane (period of risk) and not with the first doctor‐patient contact.…”

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

“…Therefore attention should be paid to measures that decrease the hazard of exposure . Among other things, type of surgical intervention, technique of the inhalational anesthesia, airway device used during surgery, positioning of the anesthesia team as well as type and capacity of the the air-conditioning and scavanging system are factors that can modify anesthetic exposure [1, 9]. …”

“…The concept of this hypothesis arose from the observation of Herzog-Niescery et al [9], who stated that using a laminar flow air-conditioning system may lead to higher exposure of the anesthetist than using a turbulent system. We therefore hypothesited that, as shown in Fig.…”

“…On purpose we intended to exclude the effect of higher pollution occuring during induction (intravenous induction was used, followed by inhalational maintanance), because we wanted to assess the effect of standing or seating position. Previously many authors have reported on higher amounts of evaporated anesthetic gases when laryngeal masks were used [9, 11] or during inhalational inductions [9, 12]. As the amount of sevoflurane that escapes through the mouth of the patients in intratracheal anesthesia is much lower than that observed during administration of a laryngeal mask airway, it is conceivable that the exposure differences between the sitting and standing positions may be clinically important in certain scenarios.…”

“…However, in some institutions anesthetists insist on positioning anesthesia team at the side because, in their judgment, the patient is better accessible this way. However, as is known from previous studies, laminar flow air conditioning systems – although they more potently decrease sevoflurane concentrations in the OR in general - direct air flow toward the anesthetist and consequently, exposure may be higher [9]. …”