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Ziegler M, Seipp HM, Steffens T, Walter D, Büttner-Janz K, Rodger D, Herzog-Niescery J. Infection Prevention and the Protective Effects of Unidirectional Displacement Flow Ventilation in the Turbulent Spaces of the Operating Room. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2024:19375867241228609. [PMID: 38403977 DOI: 10.1177/19375867241228609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
BACKGROUND Unidirectional displacement flow (UDF) ventilation systems in operating rooms are characterized by a uniformity of velocity ≥80% and protect patients and operating room personnel against exposure to hazardous substances. However, the air below the surgical lights and in the surrounding zone is turbulent, which impairs the ventilation system's effect. AIM We first used the recovery time (RT) as specified in International Organization for Standardization 14644 to determine the particle reduction capacity in the turbulent spaces of an operating room with a UDF system. METHODS The uniformity of velocity was analyzed by comfort-level probe grid measurements in the protected area below a hemispherical closed-shaped and a semi-open column-shaped surgical light (tilt angles: 0°/15°/30°) and in the surrounding zone of a research operating room. Thereafter, RTs were calculated. RESULTS At a supply air volume of 10,500 m3/h, the velocity, reported as average uniformity ± standard deviation, was uniform in the protected area without lights (95.8% ± 1.7%), but locally turbulent below the hemispherical closed-shaped (69.3% ± 14.6%), the semi-open column-shaped light (66.9% ± 10.9%), and in the surrounding zone (51.5% ± 17.6%). The RTs ranged between 1.1 and 1.7 min below the lights and 3.5 ± 0.28 min in the surrounding zone and depended exponentially on the volume flow rate. CONCLUSIONS Compared to an RT of ≤20 min as required for operating rooms with mixed dilution flow, particles here were eliminated 12-18 times more quickly from below the surgical lights and 5.7 times from the surrounding zone. Thus, the effect of the lights was negligible and the UDF's retained its strong protective effect.
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Affiliation(s)
- Mareike Ziegler
- Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Hans-Martin Seipp
- Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Thomas Steffens
- Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Dirk Walter
- Institute and Outpatient Clinic for Occupational and Social Medicine, Justus-Liebig University, Giessen, Germany
| | | | - Daniel Rodger
- School of Allied and Community Health, Institute of Health and Social Care, London South Bank University
| | - Jennifer Herzog-Niescery
- Department of Anesthesiology, Katholisches Klinikum Bochum, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany
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Keller M, Cattaneo A, Spinazzè A, Carrozzo L, Campagnolo D, Rovelli S, Borghi F, Fanti G, Fustinoni S, Carrieri M, Moretto A, Cavallo DM. Occupational Exposure to Halogenated Anaesthetic Gases in Hospitals: A Systematic Review of Methods and Techniques to Assess Air Concentration Levels. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:514. [PMID: 36612837 PMCID: PMC9819674 DOI: 10.3390/ijerph20010514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/16/2022] [Accepted: 12/23/2022] [Indexed: 06/17/2023]
Abstract
Objective During the induction of gaseous anaesthesia, waste anaesthetic gases (WAGs) can be released into workplace air. Occupational exposure to high levels of halogenated WAGs may lead to adverse health effects; hence, it is important to measure WAGs concentration levels to perform risk assessment and for health protection purposes. Methods A systematic review of the scientific literature was conducted on two different scientific databases (Scopus and PubMed). A total of 101 studies, focused on sevoflurane, desflurane and isoflurane exposures in hospitals, were included in this review. Key information was extracted to provide (1) a description of the study designs (e.g., monitoring methods, investigated occupational settings, anaesthetic gases in use); (2) an evaluation of time trends in the measured concentrations of considered WAGs; (3) a critical evaluation of the sampling strategies, monitoring methods and instruments used. Results Environmental monitoring was prevalent (68%) and mainly used for occupational exposure assessment during adult anaesthesia (84% of cases). Real-time techniques such as photoacoustic spectroscopy and infrared spectrophotometry were used in 58% of the studies, while off-line approaches such as active or passive sampling followed by GC-MS analysis were used less frequently (39%). Conclusions The combination of different instrumental techniques allowing the collection of data with different time resolutions was quite scarce (3%) despite the fact that this would give the opportunity to obtain reliable data for testing the compliance with 8 h occupational exposure limit values and at the same time to evaluate short-term exposures.
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Affiliation(s)
- Marta Keller
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Andrea Cattaneo
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Andrea Spinazzè
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Letizia Carrozzo
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Davide Campagnolo
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Sabrina Rovelli
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Francesca Borghi
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Giacomo Fanti
- Department of Science and High Technology, University of Insubria, 22100 Como, Italy
| | - Silvia Fustinoni
- IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, 20122 Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Mariella Carrieri
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padova, Italy
| | - Angelo Moretto
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, 35122 Padova, Italy
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Gaya da Costa M, Kalmar AF, Struys MMRF. Inhaled Anesthetics: Environmental Role, Occupational Risk, and Clinical Use. J Clin Med 2021; 10:1306. [PMID: 33810063 PMCID: PMC8004846 DOI: 10.3390/jcm10061306] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 12/17/2022] Open
Abstract
Inhaled anesthetics have been in clinical use for over 150 years and are still commonly used in daily practice. The initial view of inhaled anesthetics as indispensable for general anesthesia has evolved during the years and, currently, its general use has even been questioned. Beyond the traditional risks inherent to any drug in use, inhaled anesthetics are exceptionally strong greenhouse gases (GHG) and may pose considerable occupational risks. This emphasizes the importance of evaluating and considering its use in clinical practices. Despite the overwhelming scientific evidence of worsening climate changes, control measures are very slowly implemented. Therefore, it is the responsibility of all society sectors, including the health sector to maximally decrease GHG emissions where possible. Within the field of anesthesia, the potential to reduce GHG emissions can be briefly summarized as follows: Stop or avoid the use of nitrous oxide (N2O) and desflurane, consider the use of total intravenous or local-regional anesthesia, invest in the development of new technologies to minimize volatile anesthetics consumption, scavenging systems, and destruction of waste gas. The improved and sustained awareness of the medical community regarding the climate impact of inhaled anesthetics is mandatory to bring change in the current practice.
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Affiliation(s)
- Mariana Gaya da Costa
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, 9713GZ Groningen, The Netherlands;
| | - Alain F. Kalmar
- Department of Anesthesia and Intensive Care Medicine, Maria Middelares Hospital, 9000 Ghent, Belgium;
- Department of Basic and Applied Medical Sciences, Ghent University, 9000 Ghent, Belgium
| | - Michel M. R. F. Struys
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, 9713GZ Groningen, The Netherlands;
- Department of Basic and Applied Medical Sciences, Ghent University, 9000 Ghent, Belgium
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4
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Dehghani F, Kamalinia M, Omidi F, Fallahzadeh RA. Probabilistic health risk assessment of occupational exposure to isoflurane and sevoflurane in the operating room. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2021; 207:111270. [PMID: 32949927 DOI: 10.1016/j.ecoenv.2020.111270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/26/2020] [Accepted: 08/28/2020] [Indexed: 06/11/2023]
Abstract
Risk assessment is an important tool in predicting the possible risk to health. It heightens awareness by estimating the probability of adverse health effects in humans who are exposed to chemicals in the course of their work. Therefore, the present work aims to determine the occupational exposure of operating room staff to the volatile anesthetic gases, isoflurane and sevoflurane, and estimates non-cancer risk using the United States Environmental Protection Agency method. Air samples from the breathing zone of staff members were collected using the Occupational Safety and Health Administration Method 103 and analyzed using gas chromatography-mass spectroscopy. The results indicate that the measured concentrations of isoflurane and sevoflurane are below the National Institute of Occupational Safety and Health standard (2 ppm) for technicians and nurses, but not for anesthesiologists and surgeons. Moreover, the estimated non-cancer risk due to isoflurane is above the acceptable value for anesthesiologists (but acceptable for other occupational categories). A sensitivity analysis indicates that exposure time has the most effect on calculated risk (53.4%). Occupational exposure to anesthetic gases may endanger the health of operating room personnel. Therefore, control measures, such as daily testing of anesthetic devices, ensuring the effectiveness of ventilation systems, advanced scavenging methods, and regular training of staff are highly recommended.
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Affiliation(s)
- Fatemeh Dehghani
- Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mojtaba Kamalinia
- Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Fariborz Omidi
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Reza Ali Fallahzadeh
- Genetic and Environmental Adventures Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Magnavita N, Di Prinzio RR, Soave PM. Systemic sclerosis in an anaesthetist. Occup Med (Lond) 2020; 70:442-444. [DOI: 10.1093/occmed/kqaa068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Introduction
Systemic sclerosis is a potentially devastating disease in which the aetiology and pathogenesis has not yet been fully understood. It has been associated with occupational exposure to silica, vinyl chloride, solvents and other chemical agents.
Case summary
In this paper, we present the case of an anaesthetist who developed scleroderma after an occupational exposure to volatile anaesthetic gases (halothane, sevoflurane, isoflurane and enflurane) in operating theatres with poor scavenging systems and we discuss the possible causal link between occupational exposure and the disease.
Conclusions
The case reported is the second that we are aware of in recent years. Reporting scleroderma cases in workers may be the first step in assessing the causal link between occupational exposure to anaesthetic gases and the disease.
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Affiliation(s)
- N Magnavita
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman/Child & Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - R R Di Prinzio
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P M Soave
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Poison Control Centre, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Herzog-Niescery J, Seipp HM, Bellgardt M, Herzog T, Belyaev O, Uhl W, Gude P, Weber TP, Vogelsang H. Comparison of 3 Methods to Assess Occupational Sevoflurane Exposure in Abdominal Surgeons: A Single-Center Observational Pilot Study. Anesth Analg 2020; 131:537-543. [PMID: 31295179 DOI: 10.1213/ane.0000000000004301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Studies demonstrated that operating room personnel are exposed to anesthetic gases such as sevoflurane (SEVO). Measuring the gas burden is essential to assess the exposure objectively. Air pollution measurements and the biological monitoring of urinary SEVO and its metabolite hexafluoroisopropanol (HFIP) are possible approaches. Calculating the mass of inhaled SEVO is an alternative, but its predictive power has not been evaluated. We investigated the SEVO burdens of abdominal surgeons and hypothesized that inhaled mass calculations would be better suited than pollution measurements in their breathing zones (25 cm around nose and mouth) to estimate urinary SEVO and HFIP concentrations. The effects of potentially influencing factors were considered. METHODS SEVO pollution was continuously measured by photoacoustic gas monitoring. Urinary SEVO and HFIP samples, which were collected before and after surgery, were analyzed by a blinded environmental toxicologist using the headspace gas chromatography-mass spectrometry method. The mass of inhaled SEVO was calculated according to the formula mVA = cVA·(Equation is included in full-text article.)·t·ρ VA aer. (mVA: inhaled mass; cVA: volume concentration; (Equation is included in full-text article.): respiratory minute volume; t: exposure time; and ρ VA aer.: gaseous density of SEVO). A linear multilevel mixed model was used for data analysis and comparisons of the different approaches. RESULTS Eight surgeons performed 22 pancreatic resections. Mean (standard deviation [SD]) SEVO pollution was 0.32 ppm (0.09 ppm). Urinary SEVO concentrations were below the detection limit in all samples, whereas HFIP was detectable in 82% of the preoperative samples in a mean (SD) concentration of 8.53 µg·L (15.53 µg·L; median: 2.11 µg·L, interquartile range [IQR]: 4.58 µg·L) and in all postoperative samples (25.42 µg·L [21.39 µg·L]). The mean (SD) inhaled SEVO mass was 5.67 mg (2.55 mg). The postoperative HFIP concentrations correlated linearly to the SEVO concentrations in the surgeons' breathing zones (β = 216.89; P < .001) and to the calculated masses of inhaled SEVO (β = 4.17; P = .018). The surgeon's body mass index (BMI), age, and the frequency of surgeries within the last 24 hours before study entry did not influence the relation between HFIP concentration and air pollution or inhaled mass, respectively. CONCLUSIONS The biological SEVO burden, expressed as urinary HFIP concentration, can be estimated by monitoring SEVO pollution in the personnel's individual breathing zone. Urinary SEVO was not an appropriate biomarker in this setting.
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Affiliation(s)
- Jennifer Herzog-Niescery
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Hans-Martin Seipp
- Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Martin Bellgardt
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Torsten Herzog
- Department of Surgery, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Orlin Belyaev
- Department of Surgery, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Waldemar Uhl
- Department of Surgery, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Philipp Gude
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Thomas P Weber
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Heike Vogelsang
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
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Afra A, Mollaei Pardeh M, Saki H, Farhadi M, Geravandi S, Mehrabi P, Dobaradaran S, Momtazan M, Dehkordi Z, Mohammadi MJ. Anesthetic toxic isoflurane and health risk assessment in the operation room in Abadan, Iran during 2018. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2019.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
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8
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Validation of Waste Anaesthetic Gas Exposure Limits When Using a Closed Vaporizer Filling System: A Laboratory-Based Study. Adv Ther 2020; 37:450-456. [PMID: 31802392 PMCID: PMC6979454 DOI: 10.1007/s12325-019-01159-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Indexed: 12/20/2022]
Abstract
Introduction It is desirable to minimise exposure of personnel to halogenated inhaled anaesthetics in the operating room to avoid deleterious short-term and long-term health effects. The objective of this study was to determine whether, while filling anaesthetic vaporizers with sevoflurane using AbbVie’s closed vaporizer filling system (Quik-Fil™), concentrations of sevoflurane in ambient air remained at or below recommended levels when measured at different operator heights. Methods Nine filling runs were conducted, with measurement heights of 95, 130, 140, 150, 160, and 185 cm. Within each 15-min run, five vaporizers were sequentially filled from bottles of sevoflurane with the closed valving system. Ambient-air sevoflurane concentration in the breathing zone was continuously measured once per second by using a MIRAN SapphIRe 205BXL portable ambient air analyser. Results The use of the closed filling system maintained a level of waste anaesthetic gas exposure that was well below (mean, 0.10 ppm; maximum, 0.16 ppm) the recommended short-term value of 20 ppm average for 15 min provided by the Swedish Work Environment Authority and also fell below the US limit of a time-weighted average of 2 ppm provided by the National Institute for Occupational Safety and Health. Exposure to sevoflurane appeared to be independent of the height at which the measurement was made. Conclusions The presence of sevoflurane in the work environment while using the closed filling system maintains a level of waste anaesthetic gas exposure well below the recommended levels at all tested operator heights.
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9
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Herzog-Niescery J, Steffens T, Bellgardt M, Breuer-Kaiser A, Gude P, Vogelsang H, Weber TP, Seipp HM. Photoacoustic gas monitoring for anesthetic gas pollution measurements and its cross-sensitivity to alcoholic disinfectants. BMC Anesthesiol 2019; 19:148. [PMID: 31399025 PMCID: PMC6689173 DOI: 10.1186/s12871-019-0822-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 08/06/2019] [Indexed: 11/14/2022] Open
Abstract
Background Real-time photoacoustic gas monitoring is used for personnel exposure and environmental monitoring, but its accuracy varies when organic solvents such as alcohol contaminate measurements. This is problematic for anesthetic gas measurements in hospitals, because most disinfectants contain alcohol, which could lead to false-high gas concentrations. We investigated the cross-sensitivities of the photoacoustic gas monitor Innova 1412 (AirTech Instruments, LumaSense, Denmark) against alcohols and alcoholic disinfectants while measuring sevoflurane, desflurane and isoflurane in a laboratory and in hospital during surgery. Methods 25 mL ethyl alcohol was distributed on a hotplate. An optical filter for isoflurane was used and the gas monitor measured the ‘isoflurane’ concentration for five minutes with the measuring probe fixed 30 cm above the hotplate. Then, 5 mL isoflurane was added vaporized via an Anesthetic Conserving Device (Sedana Medical, Uppsala, Sweden). After one-hour measurement, 25 mL isopropyl alcohol, N-propanol, and two alcoholic disinfectants were subsequently added, each in combination with 5 mL isoflurane. The same experiment was in turn performed for sevoflurane and desflurane. The practical impact of the cross-sensitivity was investigated on abdominal surgeons who were exposed intraoperatively to sevoflurane. A new approach to overcome the gas monitor’s cross-sensitivity is presented. Results Cross-sensitivity was observed for all alcohols and its strength characteristic for the tested agent. Simultaneous uses of anesthetic gases and alcohols increased the concentrations and the recovery times significantly, especially while sevoflurane was utilized. Intraoperative measurements revealed mean and maximum sevoflurane concentrations of 0.61 ± 0.26 ppm and 15.27 ± 14.62 ppm. We replaced the cross-sensitivity peaks with the 10th percentile baseline of the anesthetic gas concentration. This reduced mean and maximum concentrations significantly by 37% (p < 0.001) and 86% (p < 0.001), respectively. Conclusion Photoacoustic gas monitoring is useful to detect lowest anesthetic gases concentrations, but cross-sensitivity caused one third falsely high measured mean gas concentration. One possibility to eliminate these peaks is the recovery time-based baseline approach. Caution should be taken while measuring sevoflurane, since marked cross-sensitivity peaks are to be expected.
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Affiliation(s)
- Jennifer Herzog-Niescery
- Department of Anesthesiology, Katholisches Klinikum Bochum, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany.
| | - Thomas Steffens
- Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Martin Bellgardt
- Department of Anesthesiology, Katholisches Klinikum Bochum, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Andreas Breuer-Kaiser
- Department of Anesthesiology, Katholisches Klinikum Bochum, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Philipp Gude
- Department of Anesthesiology, Katholisches Klinikum Bochum, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Heike Vogelsang
- Department of Anesthesiology, Katholisches Klinikum Bochum, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Thomas Peter Weber
- Department of Anesthesiology, Katholisches Klinikum Bochum, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Hans-Martin Seipp
- Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany
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Herzog-Niescery J, Bartz H, Vogelsang H, Bunse J, Maier-Hasselmann A, Bellgardt M, Gude P, Weber TP, Seipp HM. Kinetics of isoflurane and sevoflurane in a unidirectional displacement flow and the relevance to anesthetic gas exposure by operating room personnel. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:294-301. [PMID: 30852983 DOI: 10.1080/15459624.2019.1577965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
International guidelines recommend the use of ventilation systems in operating rooms to reduce the concentration of potentially hazardous substances such as anesthetic gases. The exhaust air grilles of these systems are typically located in the lower corners of the operating room and pick up two-thirds of the air volume, whereas the final third is taken from near the ceiling, which guarantees an optimal perfusion of the operating room with a sterile filtered air supply. However, this setup is also employed because anesthetic gases have a higher molecular weight than the components of air and should pool on the floor if movement is kept to a minimum and if a ventilation system with a unidirectional displacement flow is employed. However, this anticipated pooling of volatile anesthetics at the floor level has never been proven. Thus, we herein investigated the flow behaviors of isoflurane, sevoflurane, and carbon dioxide (for comparison) in a measuring chamber sized 2.46 × 1.85 × 5.40 m with a velocity of 0.3 m/sec and a degree of turbulence <20%. Gas concentrations were measured at 1,728 measuring positions throughout the measuring chamber, and the flow behaviors of isoflurane and sevoflurane were found to be similar, with an overlap of 90%. The largest spread of both gases was 55 cm at 5.4 m from the emission source. Interestingly, neither isoflurane nor sevoflurane was detected at floor level, but a continuous cone-like spreading was observed due to gravity. In contrast, carbon dioxide accumulated at floor level in the form of a gas cloud. Thus, floor level exhaust ventilation systems are likely unsuitable for the collection and removal of anesthetic gases from operating rooms.
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Affiliation(s)
- Jennifer Herzog-Niescery
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Horst Bartz
- b Department of Life Science Engineering , University of Applied Sciences , Giessen , Germany
| | - Heike Vogelsang
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Jörg Bunse
- c Department of Surgery , Sana Hospital Lichtenberg , Berlin , Germany
| | | | - Martin Bellgardt
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Philipp Gude
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Thomas P Weber
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Hans-Martin Seipp
- b Department of Life Science Engineering , University of Applied Sciences , Giessen , Germany
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Neisi A, Albooghobeish M, Geravandi S, Adeli Behrooz HR, Mahboubi M, Omidi Khaniabad Y, Valipour A, Karimyan A, Mohammadi MJ, Farhadi M, Yari AR, Ghomeishi A. Investigation of health risk assessment sevoflurane on indoor air quality in the operation room in Ahvaz city, Iran. TOXIN REV 2018. [DOI: 10.1080/15569543.2018.1434796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Affiliation(s)
- Abdolkazem Neisi
- Department of Environmental Health Engineering, School of Public Health and Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Masoumeh Albooghobeish
- Department of Anesthesiology, Paramedical School, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | | | - Yusef Omidi Khaniabad
- Health Care System of Karoon, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | | | - Mohammad Javad Mohammadi
- Department of Environmental Health Engineering, School of Public Health and Environmental Technologies Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Farhadi
- Nutrition Health Research Center, Department of Environmental Health, School of Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Ahmad Reza Yari
- Research Center for Environmental Pollutants, Qom University of Medical Sciences, Qom, Iran
| | - Ali Ghomeishi
- Department of Anesthesiology, Faculty of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Deng HB, Li FX, Cai YH, Xu SY. Waste anesthetic gas exposure and strategies for solution. J Anesth 2018; 32:269-282. [PMID: 29404778 DOI: 10.1007/s00540-018-2448-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/02/2018] [Indexed: 12/15/2022]
Abstract
As inhaled anesthetics are widely used, medical staff have inevitably suffered from exposure to anesthetic waste gases (WAGs). Whether chronic exposure to WAGs has an impact on the health of medical staff has long been a common concern, but conclusions are not consistent. Many measures and equipment have been proposed to reduce the concentration of WAGs as far as possible. This review aims to dissect the current exposure to WAGs and its influence on medical staff in the workplace and the environment, and summarize strategies to reduce WAGs.
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Affiliation(s)
- Hai-Bo Deng
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, 253 Gongye Ave, Guangzhou, 510282, China
| | - Feng-Xian Li
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, 253 Gongye Ave, Guangzhou, 510282, China
| | - Ye-Hua Cai
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, 253 Gongye Ave, Guangzhou, 510282, China.
| | - Shi-Yuan Xu
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, 253 Gongye Ave, Guangzhou, 510282, China.
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13
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Herzog-Niescery J, Vogelsang H, Bellgardt M, Botteck NM, Seipp HM, Bartz H, Weber TP, Gude P. The child's behavior during inhalational induction and its impact on the anesthesiologist's sevoflurane exposure. Paediatr Anaesth 2017; 27:1247-1252. [PMID: 29071770 DOI: 10.1111/pan.13269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/20/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sevoflurane is commonly used for inhalational inductions in children, but the personnel's exposure to it is potentially harmful. Guidance to reduce gas pollution refers mainly to technical aspects, but the impact of the child's behavior has not yet been studied. AIMS The purpose of this study was to determine how child behavior, according to the Frankl Behavioral Scale, affects the amount of waste sevoflurane in anesthesiologists' breathing zones. METHODS Sixty-eight children aged 36-96 months undergoing elective ENT surgery were recruited for this prospective, observational investigation. After oral midazolam premedication (0.5 mg/kg body weight), patients obtained sevoflurane using a facemask with an inspiratory concentration of 8 Vol.% in 100% oxygen (flow 10 L/min). Ventilation was manually supported and a venous catheter was placed. The inspiratory sevoflurane concentration was reduced, and remifentanil and propofol were administered before the facemask was removed and a cuffed tracheal tube inserted. The child's behavior toward the operating room personnel during induction was evaluated by the anesthesiologist (Frankl Behavioral Scale: 1-2 = negative behavior, 3-4 = positive behavior). During induction mean (c¯mean) and maximum (c¯max), sevoflurane concentrations were determined in the anesthesiologist's breathing zone by continuous photoacoustic gas monitoring. RESULTS Mean and maximum sevoflurane concentrations were c¯mean = 4.38 ± 4.02 p.p.m and c¯max = 70.06 ± 61.08 p.p.m in patients with positive behaviors and sufficient premedications and c¯mean = 12.63 ± 8.66 p.p.m and c¯max = 242.86 ± 139.91 p.p.m in children with negative behaviors and insufficient premedications (c¯mean: P < .001; c¯max: P < .001). CONCLUSION Negative behavior was accompanied by significantly higher mean and maximum sevoflurane concentrations in the anesthesiologist's breathing zone compared with children with positive attitudes. Consequently, the status of premedication influences the amount of sevoflurane pollution in the air of operating rooms.
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Affiliation(s)
- Jennifer Herzog-Niescery
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany
| | - Heike Vogelsang
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany
| | - Martin Bellgardt
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany
| | - Nikolaj Matthias Botteck
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany
| | - Hans-Martin Seipp
- Department of life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Horst Bartz
- Department of life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Thomas Peter Weber
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany
| | - Philipp Gude
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany
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14
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Herzog-Niescery J, Seipp HM, Weber TP, Bellgardt M. Inhaled anesthetic agent sedation in the ICU and trace gas concentrations: a review. J Clin Monit Comput 2017; 32:667-675. [PMID: 28861655 DOI: 10.1007/s10877-017-0055-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 08/15/2017] [Indexed: 12/12/2022]
Abstract
There is a growing interest in the use of volatile anesthetics for inhalational sedation of adult critically ill patients in the ICU. Its safety and efficacy has been demonstrated in various studies and technical equipment such as the anaesthetic conserving device (AnaConDa™; Sedana Medical, Uppsala, Sweden) or the MIRUS™ system (Pall Medical, Dreieich, Germany) have significantly simplified the application of volatile anesthetics in the ICU. However, the personnel's exposure to waste anesthetic gas during daily work is possibly disadvantageous, because there is still uncertainty about potential health risks. The fact that average threshold limit concentrations for isoflurane, sevoflurane and desflurane either differ significantly between countries or are not even defined at all, leads to raising concerns among ICU staff. In this review, benefits, risks, and technical aspects of inhalational sedation in the ICU are discussed. Further, the potential health effects of occupational long-term low-concentration agent exposure, the staffs' exposure levels in clinical practice, and strategies to minimize the individual gas exposure are reviewed.
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Affiliation(s)
- Jennifer Herzog-Niescery
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany.
| | - Hans-Martin Seipp
- Department of Life Science Engineering, University of Applied Sciences, Wiesenstr. 14, 35390, Giessen, Germany
| | - Thomas Peter Weber
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
| | - Martin Bellgardt
- Department of Anesthesiology, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany
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15
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Sárkány P, Tankó B, Simon É, Gál J, Fülesdi B, Molnár C. Does standing or sitting position of the anesthesiologist in the operating theatre influence sevoflurane exposure during craniotomies? BMC Anesthesiol 2016; 16:120. [PMID: 27908275 PMCID: PMC5134222 DOI: 10.1186/s12871-016-0284-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 11/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exposure of the OR staff to inhalational anesthetics has been proven by numerous investigators, but its potential adverse effect under the present technical circumstances is a debated issue. The aim of the present work was to test whether using a laminar flow air conditioning system exposure of the team to anesthetic gases is different if the anesthetist works in the sitting as compared to the standing position. METHODS Sample collectors were placed at the side of the patient and were fixed at two different heights: at 100 cm (modelling sitting position) and 175 cm (modelling standing position), whereas the third collector was placed at the independent corner of the OR. Collected amount of sevoflurane was determined by an independent chemist using gas chromatography. RESULTS At the height of the sitting position the captured amount of sevoflurane was somewhat higher (median and IQR: 0.55; 0.29-1.73 ppm) than that at the height of standing (0.37; 0.15-0.79 ppm), but this difference did not reach the level of statistical significance. A significantly lower sevoflurane concentration was measured at the indifferent corner of the OR (0.14; 0.058-0.36 ppm, p < 0.001). CONCLUSIONS Open isolation along with the air flow due to the laminar system does not result in higher anesthetic exposure for the sitting anesthetist positioned to the side of the patient. Evaporated amount of sevoflurane is below the accepted threshold limits in both positions.
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Affiliation(s)
- Péter Sárkány
- Faculty of Medicine, Department of Anesthesiology and Intensive Care, University of Debrecen, H-4032, Debrecen, Nagyerdei krt. 98., Hungary
| | - Béla Tankó
- Faculty of Medicine, Department of Anesthesiology and Intensive Care, University of Debrecen, H-4032, Debrecen, Nagyerdei krt. 98., Hungary
| | - Éva Simon
- Faculty of Medicine, Department of Anesthesiology and Intensive Care, University of Debrecen, H-4032, Debrecen, Nagyerdei krt. 98., Hungary
| | - Judit Gál
- Faculty of Medicine, Department of Anesthesiology and Intensive Care, University of Debrecen, H-4032, Debrecen, Nagyerdei krt. 98., Hungary
| | - Béla Fülesdi
- Faculty of Medicine, Department of Anesthesiology and Intensive Care, University of Debrecen, H-4032, Debrecen, Nagyerdei krt. 98., Hungary
| | - Csilla Molnár
- Faculty of Medicine, Department of Anesthesiology and Intensive Care, University of Debrecen, H-4032, Debrecen, Nagyerdei krt. 98., Hungary.
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16
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Herzog-Niescery J, Gude P, Gahlen F, Seipp HM, Bartz H, Botteck NM, Bellgardt M, Dazert S, Weber TP, Vogelsang H. Surgeons' exposure to sevoflurane during paediatric adenoidectomy: a comparison of three airway devices. Anaesthesia 2016; 71:915-20. [DOI: 10.1111/anae.13515] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2016] [Indexed: 12/01/2022]
Affiliation(s)
- J. Herzog-Niescery
- Department of Anaesthesiology; St. Josef Hospital, Ruhr-University Bochum; Bochum Germany
| | - P. Gude
- Department of Anaesthesiology; St. Josef Hospital, Ruhr-University Bochum; Bochum Germany
| | - F. Gahlen
- Department of Otorhinolaryngology; Head and Neck Surgery; St. Elisabeth Hospital; Ruhr-University Bochum; Bochum Germany
| | - H.-M. Seipp
- Department of Life Science Engineering; University of Applied Sciences; Giessen Germany
| | - H. Bartz
- Department of Life Science Engineering; University of Applied Sciences; Giessen Germany
| | - N. M. Botteck
- Department of Anaesthesiology; St. Josef Hospital, Ruhr-University Bochum; Bochum Germany
| | - M. Bellgardt
- Department of Anaesthesiology; St. Josef Hospital, Ruhr-University Bochum; Bochum Germany
| | - S. Dazert
- Department of Otorhinolaryngology; Head and Neck Surgery; St. Elisabeth Hospital; Ruhr-University Bochum; Bochum Germany
| | - T. P. Weber
- Department of Anaesthesiology; St. Josef Hospital, Ruhr-University Bochum; Bochum Germany
| | - H. Vogelsang
- Department of Anaesthesiology; St. Josef Hospital, Ruhr-University Bochum; Bochum Germany
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