Submitted Successfully!
To reward your contribution, here is a gift for you: A free trial for our video production service.
Thank you for your contribution! You can also upload a video entry or images related to this topic.
Version Summary Created by Modification Content Size Created at Operation
1
Andrea Cattaneo
 -- 2843 2023-03-09 15:26:26 |
2 Reference format revised.
Lindsay Dong
Meta information modification 2843 2023-03-13 01:50:50 |

Video Upload Options

Do you have a full video?
Send video materials Upload full video

Confirm

Are you sure to Delete?
Yes No
Cite
If you have any further questions, please contact Encyclopedia Editorial Office.
Keller, M.; Cattaneo, A.; Spinazzè, A.; Carrozzo, L.; Campagnolo, D.; Rovelli, S.; Borghi, F.; Fanti, G.; Fustinoni, S.; Carrieri, M.; et al. Occupational Exposure to Halogenated Anaesthetic Gases in Hospitals. Encyclopedia. Available online: https://encyclopedia.pub/entry/42030 (accessed on 26 April 2024).
Keller M, Cattaneo A, Spinazzè A, Carrozzo L, Campagnolo D, Rovelli S, et al. Occupational Exposure to Halogenated Anaesthetic Gases in Hospitals. Encyclopedia. Available at: https://encyclopedia.pub/entry/42030. Accessed April 26, 2024.
Keller, Marta, Andrea Cattaneo, Andrea Spinazzè, Letizia Carrozzo, Davide Campagnolo, Sabrina Rovelli, Francesca Borghi, Giacomo Fanti, Silvia Fustinoni, Mariella Carrieri, et al. "Occupational Exposure to Halogenated Anaesthetic Gases in Hospitals" Encyclopedia, https://encyclopedia.pub/entry/42030 (accessed April 26, 2024).
Keller, M., Cattaneo, A., Spinazzè, A., Carrozzo, L., Campagnolo, D., Rovelli, S., Borghi, F., Fanti, G., Fustinoni, S., Carrieri, M., Moretto, A., & Cavallo, D.M. (2023, March 09). Occupational Exposure to Halogenated Anaesthetic Gases in Hospitals. In Encyclopedia. https://encyclopedia.pub/entry/42030
Keller, Marta, et al. "Occupational Exposure to Halogenated Anaesthetic Gases in Hospitals." Encyclopedia. Web. 09 March, 2023.
Occupational Exposure to Halogenated Anaesthetic Gases in Hospitals
Edit
This entry is adapted from the peer-reviewed paper 10.3390/ijerph20010514

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.

waste anaesthetic gases hospital staff inhaled anaesthetics monitoring techniques occupational risk assessment risk control

1. Introduction

The advent of modern general anaesthesia is undoubtedly one of the most important achievements of medicine because it allows safe performance of complex surgical and diagnostic procedures [1]. Nowadays, the most commonly used anaesthetic gases are halogenated gases, i.e., sevoflurane (C4H3F7O; CAS: 28523-86-6; 1 ppm = 8.17 mg/m3 at 1 atm and 25 °C), isoflurane (C3H2ClF5O; CAS: 26675-46-7; 1 ppm = 7.52 mg/m3 at 1 atm and 25 °C) and desflurane (C3H2F6O; CAS: 57041-67-5; 1 ppm = 6.87 mg/m3 at 1 atm and 25 °C) [2]. These chemicals appear initially in a liquid form and after being vaporized, volatile anaesthetics are administered via inhalation in a carrier gas (e.g., oxygen), alone or as a mixture (e.g., through mechanical ventilation, endotracheal tube, laryngeal mask airway, face mask, etc.). However, a certain amount of gases, known also as waste anaesthetic gases (WAGs), could be released or leak out and spread in the workplace (i.e., operating rooms, dental clinics and veterinary settings), thus giving rise to potential occupational exposure [3]. The emission of these gases in the atmospheres of operating rooms can be ascribed to various causes. The anaesthetic techniques used for the induction and/or maintenance of anaesthesia may play a fundamental role [4][5]. Exposure levels may depend on the type of mask worn by patients during anaesthesia [6]. In particular, face masks are frequently used in the treatment of paediatric patients and in this context a relevant release of anaesthetic gases from the face mask can be observed due to lack of cooperation of the patient [7][8][9][10][11][12]. However, even in the case of patient intubation, gas releases may occur during the medical procedures. In fact, the anaesthetic gases can be released from leaks in the anaesthesia system (e.g., from tubing, seals, gaskets, etc.) [13]. WAGs can also escape from around the patient’s endotracheal tube or laryngeal mask airway if the cuff is not properly inflated or the wrong size is used [14].
Other factors that could be related to exposure to WAGs are poor efficiency of the air removal/WAGs scavenging systems and of the room ventilation system [15][16][17][18]. Furthermore, improper anaesthetizing techniques and inappropriate behaviours can favour the release of WAGs. These include, for example, improperly connected tubes and fittings for the anaesthesia machine, turning on the anaesthetic gas before the scavenging system is active, not turning the gas off when the mask is removed from the patient’s face or removing the mask too quickly before the system has been flushed and the use of incorrect procedures for filling refillable vaporizers [11][13]. Finally, even during the patient’s extubating, there may be a release of anaesthetic gas from the patient respiratory system or from the apparatus [19].
Despite the constant search for safer anaesthetic methods, nowadays occupational exposure to anaesthetic gases still represents a significant risk within hospitals [20][21][22].
Anaesthetists, nurses, surgeons and other members of the medical personnel are professionally exposed to anaesthetic gases depending on work practices [23]: operating room personnel are generally more exposed than the personnel of other hospital wards. Further, a stratification of the occupational risk was hypothesized for healthcare professionals conventionally present in the operating room, according to the different level of exposure, with a higher risk for anaesthetists, a lower risk for surgeons and an intermediate risk level for the remaining nursing staff [12][21].
Many safety and health authorities and institutions, such as the U.K. Health and Safety Executive in the framework of the COSHH (Control of Substances Hazardous to Health) regulation, require the routine monitoring of WAGs concentrations in operating rooms to assess occupational exposure. This can be done by environmental and/or biological monitoring. Environmental monitoring is the most standardized way to assess exposures to WAGs and to determine the compliance with occupational limit values, while biological monitoring assumes importance because it provides additional information on the body burden of anaesthetic gases and early effects. However, the occupational exposure to WAGs can be measured through the use of different environmental monitoring techniques, following more or less complex monitoring protocols, during different types of operating sessions and with respect to various temporal resolutions [8][20][24][25][26].

2. Occupational Exposure to Halogenated Anaesthetic Gases in Hospitals

2.1. Halogenated WAGs and Concentrations Time Trends

 In addition to being well-known chemical risk factors, halogenated WAGs are key and current stressors of climate change. The fact that desflurane, which has the highest global warming potential among WAGs, is less used than isoflurane and sevoflurane is in line with climate-smart anaesthesia care procedures. The reason behind the increasing use of sevoflurane should be sought in the different pharmacokinetic and toxicodynamic properties of halogenated anaesthetic gases. While patients recovering from anaesthesia feel less confused when desflurane is used, sevoflurane is useful when rapid inhaled induction of anaesthesia is needed [27]. Sevoflurane is also characterized by a low solubility in blood, allowing more precision in the control of anaesthesia and a rapid induction to awakening, an advantage in paediatric anaesthesia and general recovery from anaesthesia [28][29].

The retrieved mean concentrations were segregated by decades and analysed. The median (max, min) of these values was calculated and depicted in Figure 1. This figure shows an increase of the sevoflurane concentrations in the 2000s and a raise in the median for isoflurane in the 2010s. Likewise, desflurane also shows an increase over the past decade.
/media/item_content/202303/640e71f62703aijerph-20-00514-g003.png
Figure 1. Median (circle, triangle and square), maximum and minimum (error bars) values of sevoflurane, isoflurane and desflurane concentrations in the 1990s, 2000s, 2010s, and number of studies considered per anaesthetic gas.

2.1.2. Air contamination by WAGs in Different Hospital Areas

Overall, in the operating rooms, higher mean values were measured (up to 19 ppm) with respect to the other investigated environments. In a few articles [30][31][32], the environmental monitoring was performed in anaesthesia rooms (excluded from Figure 2 due to the low number of available data). These are separate premises adjacent to operating theatres, used for the induction of anaesthesia in the UK. This is not the case in the other countries (i.e., US, Canada, Australia and most Scandinavian countries), where anaesthetic induction typically takes place in the operating room [33].
/media/item_content/202303/640e7207b3e67ijerph-20-00514-g004.png
Figure 2. Median (circle, triangle and square), maximum and minimum (error bars) values of all three gases concentrations (sevoflurane, isoflurane and desflurane) in the operating room, post-anesthesia and intensive care units, respectively. Divided in decades (1990s, 2000s, 2010s), number of studies considered per different hospital areas are shown.

2.1.2. Mitigation of WAGs emissions

WAGs emissions can be mitigated by means of scavenging systems, i.e. devices directly connected to the anaesthetic equipment or placed near the patient that take the gases released from the machine and direct them out of the operating room. A picture of the average efficacy of scavenging systems in reducing WAGs air concentrations is shown in Figure 3.
/media/item_content/202303/640e72261d35eijerph-20-00514-g005.png
Figure 3. Median (circle and triangle), maximum and minimum (error bars) values of halogenated gases (sevoflurane + isoflurane + desflurane) measured with and without scavenging systems. Results are presented  per decade (1990s, 2000s, 2010s). The number of studies considered is also shown.
As shown in the Figure 3, there was always an increase in median concentrations when the scavenging system was not used, especially during the 1990s and 2000s.
Furthermore, the maxima are also greater for the mean concentrations obtained without using a scavenging system. WAGs scavenging system is the primary line of defence against exposure; however, a properly designed heating, ventilation and air conditioning (HVAC) system can also help contribute to the dilution and removal of WAGs not collected by the scavenging system or escaping from leaks in the anaesthesia equipment or even resulting from poor work practices. Therefore, the efficiency of a scavenging system on the mitigation of exposures to anaesthetic gases appears to be appreciable.

2.2. Types and Evolution in Monitoring Techniques

Several techniques and approaches were used to investigate exposures or air contamination from halogenated gases. The monitoring techniques applied can be divided into real-time and time-integrated techniques (Figure 4). The first instruments allow a simultaneous sampling and an analysis at high temporal resolution while time-integrated techniques provide an average sampling time data.
/media/item_content/202303/640e723f5b6d4ijerph-20-00514-g006.png
Figure 4. Block Diagram of monitoring approaches for anaesthetic gases. PAS = photoacoustic spectroscopy; IR = infrared spectrophotometry; PTR-MS = proton-transfer-reaction mass spectrometry; IMS = ion mobility spectrometer.

2.2.1. Real-Time Monitoring

A detailed analysis of monitoring methods used for the sampling of WAGs in hospital settings revealed that the real–time approach is predominant (58% of the papers). Using these techniques, the identification of short-term transient peaks and an immediate exposure assessment became also possible. These instruments are essential to detect leak sources and control unacceptable exposures, and thus for a real-time management based on exposure data [34]. Since the NIOSH REL (2 ppm, 60 min) is currently in use although not specific and based according to the lowest level analytically detectable in the 1970s, it may be useful to adopt a real-time approach to assess short-term exposures. Furthermore, given the recent use of a combination of different gases to achieve optimal anaesthesia, the use of selective direct reading monitors can be crucial for a selective measurement of all the anaesthetic gases in the air mixture.
The most used real-time technique (Figure 4) is the photoacoustic spectroscopy (PAS) (51% of cases), mostly because of its solidness and user-friendliness [35]. The photoacoustic unit can be also connected to a multipoint sampler to obtain nearly simultaneous information from different areas of surgical units. As for other real-time approaches, a sample pre-treatment before measurement is not required. The resolution is in the order of 0.01 ppm, and the sampling interval is in the order of 60 s. However, PAS monitors are affected by some limitations. Among these, the sampling interval of PAS systems is usually quite large and dependent on the number of multi-point sampling locations and simultaneous monitoring of other gases [36]. So, it is possible that the staff is actually exposed to higher gas concentrations at some time-points not detected by the gas monitor (for details see [37]). Moreover, temperature, changes in ambient pressure, air humidity and the compresence of other gases and vapours such as N2O and alcohols may produce interference signal during monitoring [38]. The PAS is not suitable for personal sampling as it cannot be worn by the staff and placing tubing in the breathing zone of individuals would greatly affect their work activities, which can be particularly sensitive for healthcare workers. However, it appeared that PAS was used for personal sampling in most of the cases (90%), using tubes fixed on the health care personnel and connected to the photoacoustic monitor [4].
Single-beam infrared spectrophotometry (IR) is also widely used (40%) for the real-time monitoring of gases, probably for its rapidity to provide results: the estimated time resolution from a routine sample varies from seconds to a few minutes. As for PAS systems, the IR monitor mostly used (i.e., the MIRAN SapphIRe series (Thermo Electron Corporation, Waltham, MA)) weights about 10 kg, which is incompatible with personal monitoring. The measurement range is up to 30 ppm for halogenated agents and the detection limit varies according to the model, but in general it ranges between 0.01 and 0.2 ppm. Fourier transform infrared spectroscopy (FT-IR) devices (e.g., the GASMET DX-4030 (Gasmet Technologies (UK) Ltd.)) are more complex and powerful compared to the IR analysers discussed above because they can analyse all frequencies simultaneously and allow an analysis with a detection limit of 0.1 ppm [39].
Other real-time techniques can be used for real-time WAGs monitoring, such as the proton-transfer-reaction mass spectrometry (PTR-MS) and ion mobility spectrometry (IMS).

2.2.2. Time-Integrated Sampling

In a considerable part of the selected articles (39%), anaesthetic gas concentrations were collected through time-integrated approaches allowing the collection of information about the average concentration throughout an entire work shift (about 8 h), which is well-suited for long-term exposure assessment. In such a case, sampling methods can be classified as active (44%) or passive (56%).
In general, active sampling of anaesthetic gases is performed using sorbent tubes packed with a suitable material (e.g., Anasorb 747, XAD-2 or ORBO-33) and connected to a low-flow sampling pump. Direct air sampling using collection containers (e.g., the FKV Bottle-Vac) or Nalophan bags was also used in a few cases. Active sampling works by means of a pump which, connected to the sample collector, sucks the air that passes through the absorber for WAGs collection.
Passive or diffusive sampling requires a longer sampling time than the active sampling to collect the same amount of analyte, but is characterized by ease of use and cheapness [40][41]. Specifically, the SKC VOC-Check, 3M 3500, Draeger Orsa 5, Zambelli TK200 and ISC Maugeri Radiello® were used. Furthermore, diffusive sampling is particularly suitable for use in the operating room because of its very small size [21]. The sampling time varies upon the sampler type, the chemical of interest and the expected concentrations, for instance from less than 1 h to some weeks.
Either active or passive sampling implies sample collection onto collection media, which must be subsequently analysed in a laboratory, typically by gas chromatography after chemical or thermal desorption.
Chemical desorption is usually carried out with carbon disulfide. Instead, thermal desorption is a two-stage process occurring at high temperatures (100–300 °C) and using cold traps as refocusing devices. Desorption is followed by capillary gas chromatography, with mass spectrometric of flame ionization detection [42][43][44][45]. These approaches allow us to obtain the most reliable long-term exposure data for testing compliance with 8 h time-weighted average occupational exposure limit values (e.g., TLV–TWAs). Available studies outlined that gas chromatography is generally used for sample analysis (95%). However, in a few cases, samples collected in reservoir bags were analysed by infrared spectrometry [31][46].

2.2.3. Real-Time vs. Time-Integrated Monitoring

In recent years, there has been an increasing use of real-time analysers (PAS and IR monitors) compared to time-integrated approaches (active and passive sampling), probably because these techniques allow immediate feedback of exposure levels as well as the identification of the work phases and practices most at risk, also making possible an immediate adjustment of incorrect risk management practices [47].
In fact, more and more portable real-time instruments have been developed and are now available on the market, which allows the acquisition of the best dataset for short-term exposure assessment (peak exposures). As an example, portable gas chromatographs can be regarded as promising techniques for real-time monitoring of gas at fixed positions in the environment [48]. This method can quantify the air concentrations of anaesthetic agents offering a simultaneous, selective and continuous monitoring of several different halogenated gases in a single analytical run. These instruments also offer modular arrangements so that various detectors can be used. The most sensitive monitor is based on mass spectrometry (GC-MS), which delivers lab-quality results in minutes.
It is worth noting that, in some cases, time-integrated and real-time approaches were combined [31][49][50], using a diffusive or active sampling for personal monitoring and a real-time monitor placed in a fixed position to measure air contamination in different operating rooms or also in different areas of the same one. In particular, real-time approaches (e.g., photoacoustic spectroscopy, ion mobility spectroscopy, infrared spectroscopy, portable gas chromatography (GC)) can be useful to investigate exposure profiles and to identify exposure peaks, which is crucial to assess short-term exposures by comparison with short-term exposure limits [51]. However, the real-time methods are generally less reliable (in terms of accuracy, sensitivity, precision and specificity to the chemical/variable of interest) if compared to reference-grade methods [52]. Overall, real-time methods are being successfully used complementary to reference monitoring, but they are not yet validated as alternative techniques for reference instruments. On the other hand, time-integrated measurements, typically based on diffusive or active sampling and following GC analysis, are recommended for a robust determination of 8 h averaged exposures and can be very useful for the a posteriori correction of real-time data to achieve better accuracy.

3. Conclusions

In conclusion, despite the observation that environmental monitoring is dominant, it may be useful to combine it with biomonitoring to get a complete picture for risk assessment purposes, including biomarkers of early effects. For this reason, it would be very important to identify valid biomarkers of exposure to complement environmental monitoring information to be used in the practice of occupational hygiene. Furthermore, since sevoflurane is increasingly used in anaesthetic practice, it is important to derive health-based limit values for sevoflurane capable of protecting workers from acute and chronic effects. Real-time techniques are mostly used with sampling intervals consistent with the considered limit value (e.g., the NIOSH REL, 60 min). However, it can be also useful to measure the WAGs by a real-time analysis combined with a contextual time-integrated monitoring to improve accuracy and obtain the most reliable data for testing the compliance with 8 h occupational exposure limit values (e.g., TLV–TWAs) as well as for risk management purposes. As a general rule, it is very important to know in detail the uncertainty of exposure measurements and/or some analytical figures of merit such as the analytical specificity, precision and accuracy for a reliable identification of exposure events/patterns and for a sound quantification of health risks [53].

References

  1. Vutskits, L.; Xie, Z. Lasting impact of general anaesthesia on the brain: Mechanisms and relevance. Nat. Rev. Neurosci. 2016, 32, 667–675.
  2. Herzog-Niescery, J.; Seipp, H.M.; Weber, T.P.; Bellgardt, M. Inhaled anesthetic agent sedation in the ICU and trace gas concentrations: A review. J. Clin. Monit. Comput. 2018, 32, 667–675.
  3. Özelsel, T.J.P.; Kim, S.; Buro, K.; Tsui, B. Elevated waste anaesthetic gas concentration in the paediatric postanaesthesia care unit. Turk Anesteziyoloji ve Reanimasyon Dern. Derg. 2018, 46, 362–366.
  4. Gustorff, B.; Lorenzl, N.; Aram, L.; Krenn, C.G.; Jobst, B.P.; Hoerauf, K.H. Environmental monitoring of sevoflurane and nitrous oxide using the cuffed oropharyngeal airway. Anesth. Analg. 2002, 94, 1244–1248.
  5. Li, S.-H.; Li, S.-N.; Shih, H.-Y.; Yi, H.-D.; Chiang, C.-Y. Personnel Exposure to Waste Sevoflurane and Nitrous Oxide during General Anesthesia with Cuffed Endotracheal Tube. Acta Anaesthesiol. Sin. 2002, 40, 185–190.
  6. Saber, A.T.; Hougaard, K.S. Isoflurane, Sevoflurane and Desflurane: The Nordic Expert Group for Criteria Documentation of Health Risks from Chemicals; University of Gothenburg: Gothenburg, Sweden, 2009; Volume 43, ISBN 9789185971169.
  7. Byhahn, C.; Heller, K.; Lischke, V.; Westphal, K. Surgeon’s Occupational Exposure to Nitrous Oxide and Sevoflurane during Pediatric Surgery. World J. Surg 2001, 25, 1109–1112.
  8. Herzog-Niescery, J.; Vogelsang, H.; Bellgardt, M.; Botteck, N.M.; Seipp, H.-M.M.; Bartz, H.; Weber, T.P.; Gude, P. The child’s behavior during inhalational induction and its impact on the anesthesiologist’s sevoflurane exposure. Paediatr. Anaesth. 2017, 27, 1247–1252.
  9. Hoerauf, K.H.; Wallner, T.; Akça, O.; Taslimi, R.; Sessler, D.I. Exposure to sevoflurane and nitrous oxide during four different methods of anesthetic induction. Anesth. Analg. 1999, 88, 925–929.
  10. Hoerauf, K.H.; Funk, W.; Harth, M.; Hobbhahn, J. Occupational exposure to sevoflurane, halothane and nitrous oxide during paediatric anaesthesia. Waste gas exposure during paediatric anaesthesia. Anaesthesia 1997, 52, 215–219.
  11. Lucio, L.M.C.; Braz, M.G.; Nascimento Junior, P.D.; Braz, J.R.C.; Braz, L.G. Occupational hazards, DNA damage, and oxidative stress on exposure to waste anesthetic gases. Braz. J. Anesthesiol. 2018, 68, 33–41.
  12. Zaffina, S.; Camisa, V.; Poscia, A.; Tucci, M.G.; Montaldi, V.; Cerabona, V.; Wahocka, M.; Moscato, U. Esposizione professionale al Sevoflurano nelle sale operatorie di pertinenza pediatrica: Il contributo del monitoraggio ambientale con tecnica multi-punto nella valutazione del rischio. G. Ital. Med. Lav. 2012, 24, 266–268.
  13. Oliveira, C.R.D. Occupational exposure to anesthetic gases residue. Rev. Bras. Anestesiol. 2009, 59, 110–124.
  14. CCOHS Waste Anesthetic Gases, Hazards of. Ccohs.Ca. 2007. Available online: http://www.ccohs.ca/oshanswers/chemicals/waste_anesthetic.html (accessed on 25 November 2022).
  15. Borm, P.J.A.; Kant, I.; Houben, G.; van Rijssen-Moll, M.; Henderson, P.T. Monitoring of Nitrous Oxide in Operating Rooms:Identification of Sources and Estimation of Occupational Exposure. J. Occup. Environ. Med. 1990, 32, 1112–1116.
  16. Da Costa, M.G.; Kalmar, A.F.; Struys, M.M.R.F. Inhaled Anesthetics: Environmental Role, Occupational Risk, and Clinical Use. J. Clin. Med. 2021, 10, 1306.
  17. Kanmura, Y. Causes of nitrous oxide contamination in operating rooms. Anesthesiology 1999, 90, 693–696.
  18. Krajewski, W.; Kucharska, M.; Wesolowski, W.; Stetkiewicz, J.; Wronska-Nofer, T. Occupational exposure to nitrous oxide—The role of scavenging and ventilation systems in reducing the exposure level in operating rooms. Int. J. Hyg. Environ. Health 2007, 210, 133–138.
  19. Cheung, S.K.; Özelsel, T.; Rashiq, S.; Tsui, B.C. Postoperative environmental anesthetic vapour concentrations following removal of the airway device in the operating room versus the posthanesthesia care unit. Can. J. Anesth. 2016, 63, 1016–1021.
  20. 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.
  21. Scapellato, M.L.; Carrieri, M.; Maccà, I.; Salamon, F.; Trevisan, A.; Manno, M.; Bartolucci, G.B. Biomonitoring occupational sevoflurane exposure at low levels by urinary sevoflurane and hexafluoroisopropanol. Toxicol. Lett. 2014, 231, 154–160.
  22. Yılmaz, S.; Çalbayram, N.Ç. Exposure to anesthetic gases among operating room personnel and risk of genotoxicity: A systematic review of the human biomonitoring studies. J. Clin. Anesth. 2016, 35, 326–331.
  23. Deng, H.-B.; Li, F.-X.; Cai, Y.-H.; Xu, S.-Y. Waste anesthetic gas exposure and strategies for solution. J. Anesth. 2018, 32, 269–282.
  24. Blokker-Veldhuis, M.J.; Rutten, P.M.M.J.; De Hert, S.G. Occupational exposure to sevoflurane during cardiopulmonary bypass. Perfusion 2011, 26, 383–389.
  25. Casale, T.; Caciari, T.; Rosati, M.V.; Gioffrè, P.A.; Schifano, M.P.; Capozzella, A.; Pimpinella, B.; Tomei, G.; Tomei, F. Anesthetic gases and occupationally exposed workers. Environ. Toxicol. Pharmacol. 2014, 37, 267–274.
  26. Herzog-Niescery, J.; Botteck, N.M.; Vogelsang, H.; Gude, P.; Bartz, H.; Weber, T.P.; Seipp, H.M. Occupational chronic sevoflurane exposure in the everyday reality of the anesthesia workplace. Anesth. Analg. 2015, 121, 1519–1528.
  27. Sloan, M.H.; Conard, P.F.; Karsunky, P.K.; Gross, J.B. Sevoflurane Versus Isoflurane: Induction and Recovery Characeristics with Single-Breath Inhaled Inductions of Anesthesia. Anesth. Analg. 1996, 82, 528–532.
  28. Behne, M.; Wilke, H.-J.; Harder, S. Clinical Pharmacokinetics of Sevoflurane; Adis International: Auckland, New Zealand, 1999.
  29. Patel, S.S.; Goa, K.L. Desflurane: A review of its pharmacodynamic and pharmacokinetic properties and its efficacy in general anaesthesia. Drugs 1995, 50, 742–767.
  30. Hall, J.E.; Henderson, K.A.; Oldham, T.A.; Pugh, S.; Harmer, M. Environmental Monitoring during Gaseous Induction with Sevoflurane. Br. J. Anaesth. 1997, 79, 342–345.
  31. Henderson, K.A.; Matthews, I.P. An environmental survey of compliance with occupational exposure standards (OES) for anaesthetic gases. Anaesthesia 1999, 54, 941–947.
  32. Tanser, S.J.; Johnson, A. Evaluation of a new paediatric scavenging valve. Paediatr. Anaesth. 2002, 12, 448–450.
  33. Velzen, J.; Atkinson, S.; Rowley, E.; Martin, J.L. The Tradition of Anaesthetic Rooms: Best Practice or Patient Risk? Procedia Manuf. 2015, 3, 59–66.
  34. Elmer, J. An Analytical Comparison of Isoflurane Levels in Veterinary Operating Theaters. 2010. Available online: http://idea.library.drexel.edu/handle/1860/3581 (accessed on 25 November 2022).
  35. Haisch, C. Photoacoustic spectroscopy for analytical measurements. Meas. Sci. Technol. 2011, 23, 12001.
  36. Christensen, J. Technical Review—Optical filters and their Use with the Type 1302 & Type 1306 Photoacoustic Gas Monitors. Tech. Rev. 1990, 2, 1–20.
  37. Herzog-Niescery, J.; Gude, P.; Gahlen, F.; Seipp, H.-M.; Bartz, H.; Botteck, N.M.; Bellgardt, M.; Dazert, S.; Weber, T.P.; Vogelsang, H. Surgeons’ exposure to sevoflurane during paediatric adenoidectomy: A comparison of three airway devices. Anaesthesia 2016, 71, 915–920.
  38. Palzer, S. Photoacoustic-Based Gas Sensing: A Review. Sensors 2020, 20, 2745.
  39. Hsu, C.-P.S. Infrared Spectroscopy. Handb. Instrum. Tech. Anal. Chem. 1997, 50, 466–476.
  40. Hansen, J.; Schaal, N.; Juarez, T.; Woodlee, C. Nitrous Oxide Exposure Among Dental Personnel and Comparison of Active and Passive Sampling Techniques. Ann. Work Expo. Health 2019, 63, 337–348.
  41. Zabiegała, B.; Kot-Wasik, A.; Urbanowicz, M.; Namieśnik, J. Passive sampling as a tool for obtaining reliable analytical information in environmental quality monitoring. Anal. Bioanal. Chem. 2010, 396, 273–296.
  42. Jafari, A.; Bargeshadi, R.; Jafari, F.; Mohebbi, I.; Hajaghazadeh, M. Environmental and biological measurements of isoflurane and sevoflurane in operating room personnel. Int. Arch. Occup. Environ. Health 2018, 91, 349–359.
  43. Imbriani, M.; Ghittori, S.; Pezzagno, G. The Biological Monitoring of Inhalation Anaesthetics. G. Ital. Med. Lav. Ergon. 1998, 20, 44–49.
  44. Cope, K.A.; Merritt, W.T.; Krenzischek, D.A.; Schaefer, J.; Bukowski, J.; Foster, W.M.; Bernacki, E.; Dorman, T.; Risby, T.H. Phase II collaborative pilot study: Preliminary analysis of central neural effects from exposure to volatile anesthetics in the PACU. J. Perianesthesia Nurs. 2002, 17, 240–250.
  45. Prado, C.; Periago, F.; Ibarra, I.; Tortosa, J. Evaluation of isoflurane in air by thermal desorption-gas chromatography. J. Chromatogr. A 1993, 657, 131–137.
  46. Sessler, D.I.; Badgwell, J.M. Exposure of postoperative nurses to exhaled anesthetic gases. Anesth. Analg. 1998, 87, 1083–1088.
  47. Herzog-Niescery, J.; Steffens, T.; Bellgardt, M.; Breuer-Kaiser, A.; Gude, P.; Vogelsang, H.; Weber, T.P.; Seipp, H.M. Photoacoustic gas monitoring for anesthetic gas pollution measurements and its cross-sensitivity to alcoholic disinfectants. BMC Anesthesiol. 2019, 19, 148.
  48. Kaljurand, M.; Gorbatšova, J.; Mazina-Šinkar, J. A gas chromatograph for citizen science. Microchem. J. 2021, 165, 106195.
  49. Ritzu, S.; Boccalon, P.; Sanchez, M.A.; Arcangeli, G.; Capelli, V. Esposizione a gas anestetici: Risultati di 13 anni di monitoraggio ambientale e biologico in un’ azienda ospedaliera. G. Ital. Med. Lav. 2007, 29, 411.
  50. Virgili, A.; Scapellato, M.L.; Maccà, I.; Perini, M.; Carrieri, M.; Gori, G.; Saia, B.; Bartolucci, G.B. Esposizione professionale a gas anestetici in alcuni ospedali del Veneto. G. Ital. Med. Lav. 2002, 24, 447–450.
  51. Sackey, P.V.; Martling, C.R.; Nise, G.; Radell, P.J. Ambient isoflurane pollution and isoflurane consumption during intensive care unit sedation with the Anesthetic Conserving Device. Crit. Care Med. 2005, 33, 585–590.
  52. Fanti, G.; Borghi, F.; Spinazzè, A.; Rovelli, S.; Campagnolo, D.; Keller, M.; Cattaneo, A.; Cauda, E.; Cavallo, D.M. Features and practicability of the next-generation sensors and monitors for exposure assessment to airborne pollutants: A systematic review. Sensors 2021, 21, 4513.
  53. EN 482:2021; Workplace Exposure—Procedures for the Determination of the Concentration of Chemical Agents—Basic Performance Requirements. CEN-European Committee for Standardization: Brussels, Belgium, 2021; pp. 20–21.
More
© Text is available under the terms and conditions of the Creative Commons Attribution (CC BY) license; additional terms may apply. By using this site, you agree to the Terms and Conditions and Privacy Policy.
Upload a video for this entry
Information
Subjects: Public, Environmental & Occupational Health
Contributors MDPI registered users' name will be linked to their SciProfiles pages. To register with us, please refer to https://encyclopedia.pub/register :
Marta Keller
,
Andrea Cattaneo
,
Andrea Spinazzè
,
Letizia Carrozzo
,
Davide Campagnolo
,
Sabrina Rovelli
,
Francesca Borghi
,
Giacomo Fanti
,
Silvia Fustinoni
,
Mariella Carrieri
,
Angelo Moretto
,
Domenico Maria Cavallo
View Times: 309
Revisions: 2 times (View History)
Update Date: 13 Mar 2023
Table of Contents
    1000/1000
    Hot Most Recent
    Feedback