Occupational exposure to sevoflurane during cardiopulmonary bypass

Abstract

Volatile anaesthetic agents are widely used for maintenance of anaesthesia in all kinds of surgical procedures. Despite the implementation of measures such as adequate ventilation of the operating room and the use of efficient scavenging systems, concern remains about the risks for occupational exposure, especially in situations associated with an increased risk of anaesthetic gas waste, such as with the use of volatile anaesthetic agents on cardiopulmonary bypass. The present contribution reports the results of a preliminary safety assessment involving measurements of sevoflurane concentrations in the ambient air of a cardiac surgery operating room. In 22 cardiac surgical procedures with cardiopulmonary bypass (11 with open and 11 with closed venous reservoir), measurements of trace concentrations were obtained every 10 min at the following sites: at the outlet of the oxygenator, at the outlet of the cardiotomy reservoir, in the breathing zone of the perfusionist and above the surgical field. The concentrations were measured on-line using a photoacoustic infrared spectrometer. Mean sevoflurane waste concentrations remained consistently below the recommended target value of 4.68 ppm throughout the observation period at the different measurement sites. These results indicate that, with the use of sevoflurane on cardiopulmonary bypass, the recommended levels for occupational exposure are not exceeded, provided adequate operation room ventilation and waste gas scavenging is performed.

Multi-capillary column-ion mobility spectrometry (MCC-IMS) as a new method for the quantification of occupational exposure to sevoflurane in anaesthesia workplaces: an observational feasibility study

“…Chronic occupational exposure to low concentrations of sevoflurane has been discussed to have adverse effects on the health of health care workers [ 3 ]. Even though evidence is not clear on that issue occupational exposure limits and other ceiling value recommendations were published by governmental and health care organizations [ 4 - 7 ]. To answer the question if MCC-IMS could be a fast and reliable alternative to other analytical methods we calibrated the device to sevoflurane concentrations of 10 – 250 ppbv.…”

“…The calibration of the MCC-IMS showed very low LOD and LOQ. Previously, PIS, PTR-MS and PTR-ToF-MS were used for assessing sevoflurane room air concentrations [ 4 , 8 , 9 , 12 , 13 ]. In our study MCC-IMS showed detection limits lower than all these methods – even when compared to PTR-ToF-MS [ 13 ].…”

“…Governmental organisations of most countries defined occupational exposure limits (OEL) for the first generation of volatile anaesthetics (N 2 O, Halothane). To our knowledge only the Netherlands with 18,700 parts per billion by volume (ppbv) defined an OEL for sevoflurane, by means of a time-weighted average over an 8-hour working day (TWA-S) [ 4 ]. For the whole group of halogenated inhaled anaesthetics different countries recommended different TWA-S values between 2,000 and 50,000 ppbv [ 5 , 6 ].…”

“…The contamination of workplaces by sevoflurane has been assessed previously. Most authors used photoacoustic infrared spectrometry (PIS) and lower detection limits were indicated in a range between 9 ppbv and 20 ppbv [ 4 , 8 - 11 ]. Other authors used proton transfer reaction-mass spectrometry (PTR-MS) for measuring sevoflurane [ 12 - 14 ].…”

Riscos e doenças ocupacionais relacionados ao exercício da anestesiologia

“…Several factors are related to OR contamination by waste inhalational anesthetics (Box 1) 8 . The halogenated volatile anesthetics in OR atmosphere contribute to the pollution of the place and are related to occupational diseases, although investigations of its effects are not yet conclusive 9 . Chronic exposure has the potential to develop sensitivity to hepatitis, headaches, nausea, drowsiness, fatigue, and irritability 3 .…”