Health risks and occupational exposure to volatile anaesthetics--a review with a systematic approach.

AIMS AND OBJECTIVES To provide practicing nurse anaesthetists with evidence based knowledge as to whether they are at risk handling volatile anaesthetics by answering the question: What are the health risks threatening health care personnel occupationally exposed to volatile anaesthetics? BACKGROUND The interpretations of results from specific scientific studies vary and preliminary research results indicate that occupational exposure to volatile anaesthetics affects the health of operating room personnel. DESIGN Review of scientific literature with a systematic approach. METHOD The review included a systematic search in three major databases, a screening process of abstracts/articles followed by a quality assessment of the included studies. The screening process and the quality assessment were done independently by the six reviewers and followed specific protocols. RESULTS A systematic search of The Cochrane Library, MedLine and CINAHL resulted in a screening of 413 abstracts of which 31 articles were assessed for quality, all done independently by the reviewers. Finally, the reviewers agreed upon how to interpret the results of the assessed articles. CONCLUSIONS The 31 articles assessed covered areas such as genotoxic effects, neurobehavioural effects, immunology, and general health effects. In the scientific literature reviewed there is no evidence of occupational exposure to volatile anaesthetics either being associated with health risks or being harmless. Studies indicating a potential health risk are all investigating circumstances ignorant of modern environmental regulations and/or with no scavenging equipment. RELEVANCE TO CLINICAL PRACTICE Although no answer has been given, this review illuminates the methodological difficulties encountered in designing studies. The result of this review further stresses the need for scientific knowledge in this area and enhances the extensive use of scavenging equipment.

[1]  M. Estryn-behar,et al.  Work in operating rooms and pregnancy outcome among nurses , 1995, International archives of occupational and environmental health.

[2]  M. Estryn-behar,et al.  Neuropsychological symptoms and occupational exposure to anaesthetics. , 1992, British journal of industrial medicine.

[3]  H. W. Ruediger,et al.  High-Level, but Not Low-Level, Occupational Exposure to Inhaled Anesthetics Is Associated with Genotoxicity in the Micronucleus Assay , 2001, Anesthesia and analgesia.

[4]  V. Somenzi,et al.  Neurobehavioral functions in operating theatre personnel: a multicenter study. , 1997, La Medicina del lavoro.

[5]  D. Placidi,et al.  Neurotoxicity in operating room personnel working with gaseous and nongaseous anesthesia , 1996, International archives of occupational and environmental health.

[6]  D. Camerino,et al.  Neurobehavioral functions in operating theatre personnel exposed to anesthetic gases. , 1995, La Medicina del lavoro.

[7]  P Borella,et al.  Effects of chronic exposure to anaesthetic gases on some immune parameters. , 2001, The Science of the total environment.

[8]  V. Kašuba,et al.  Chromosome aberrations and micronucleus frequency in anaesthesiology personnel. , 2000, Arhiv za higijenu rada i toksikologiju.

[9]  P. Pelmear,et al.  Health effects associated with exposure to anaesthetic gases in Ontario hospital personnel. , 1990, British journal of industrial medicine.

[10]  S. T. Santhiya,et al.  Cytogenetic damage in operation theatre personnel , 1990, Anaesthesia.

[11]  D. Wylie,et al.  Evaluation of waste anesthetic gases, monitoring strategies, and correlations between nitrous oxide levels and health symptoms. , 1994, American Industrial Hygiene Association journal.

[12]  E. Lanz,et al.  DNA single-strand breaks in peripheral lymphocytes of clinical personnel with occupational exposure to volatile inhalational anesthetics. , 1994, Environmental research.

[13]  S. Monarca,et al.  Sister chromatid exchanges and micronuclei in lymphocytes of operating room personnel occupationally exposed to enfluorane and nitrous oxide. , 2001, Journal of environmental pathology, toxicology and oncology : official organ of the International Society for Environmental Toxicology and Cancer.

[14]  T. Finch,et al.  Occupational airborne allergic contact dermatitis from isoflurane vapour. , 2000, Contact dermatitis.

[15]  G. Shorten,et al.  Does chronic occupational exposure to volatile anesthetic agents influence the rate of neutrophil apoptosis? , 2000, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[16]  F. Violante,et al.  Short-term neurobehavioural effects in anaesthetists with low exposure to nitrous oxide. , 1999, Arhiv za higijenu rada i toksikologiju.

[17]  H. Rüdiger,et al.  Waste anaesthetic gases induce sister chromatid exchanges in lymphocytes of operating room personnel. , 1999, British journal of anaesthesia.

[18]  V. Kašuba,et al.  Chromosome aberrations in operating room personnel. , 1999, American journal of industrial medicine.

[19]  M. Marusic,et al.  Immunological disturbances in anaesthetic personnel chronically exposed to high occupational concentrations of nitrous oxide and halothane , 1991, Anaesthesia.

[20]  M. Beksac,et al.  The effects of volatile anaesthetic agents on human immune system function via occupational exposure. , 1992, Immunopharmacology and immunotoxicology.

[21]  W. Chang,et al.  Increased micronucleus formation in nurses with occupational nitrous oxide exposure in operating theaters , 1996, Environmental and molecular mutagenesis.

[22]  P. Rae,et al.  Nitrous oxide and formiminoglutamic acid: excretion in surgical patients and anaesthetists. , 1991, British journal of anaesthesia.

[23]  V. Kašuba,et al.  Preliminary study of cytogenetic damage in personnel exposed to anesthetic gases. , 2001, Mutagenesis.

[24]  Kate Flemming.  Asking answerable questions , 1998 .

[25]  Ş. Şardaş,et al.  Use of alkaline comet assay (single cell gel electrophoresis technique) to detect DNA damages in lymphocytes of operating room personnel occupationally exposed to anaesthetic gases. , 1998, Mutation research.

[26]  P. Lisi,et al.  Isoflurane: an uncommon cause of occupational airborne contact dermatitis , 1998, Contact dermatitis.

[27]  M. Petrovecki,et al.  Age‐dependent haematological disturbances in anaesthetic personnel chronically exposed to high occupational concentrations of halothane and nitrous oxide , 1994, Anaesthesia.

[28]  J. Gavora,et al.  Chromosome and sister-chromatid exchange analysis in peripheral lymphocytes, and mutagenicity of urine in anesthesiology personnel , 1992, International archives of occupational and environmental health.

[29]  Ş. Şardaş,et al.  Sister-chromatid exchanges in operating room personnel. , 1992, Mutation research.