Occupational exposure to trace concentrations of waste anesthetic gases.

The relationship between exposure to trace concentrations of waste anesthetic gases in the operating room and the possible development of adverse health effects has concerned health care professionals for numerous years. Results of studies have been conflicting. In the late 1960s and early 1970s, some US and European epidemiological studies of operating room personnel showed an increase in the incidence of adverse health effects, including spontaneous abortion and development of congenital abnormalities in offspring. However, subsequent analysis of these studies by 2 independent groups showed that the apparent increase in adverse health effects was most likely due to flaws in these studies' methods and data collection. A later prospective study showed no causal relationship between exposure to trace concentrations of waste anesthetic gases and adverse health effects. Each institution should have a waste anesthetic gas management program that includes scavenging of waste anesthetic gases, work practices to reduce contamination, documented maintenance and regular checking of all equipment, and education of all personnel on this subject. A mechanism for reporting work-related health problems should be in place in each institution.

[1]  C. Doré,et al.  MATERNAL AND PATERNAL CHRONIC EXPOSURE TO ENFLURANE AND HALOTHANE: FETAL AND HISTOLOGICAL CHANGES IN THE RAT , 1981 .

[2]  J. Kosek,et al.  Carcinogenicity of halothane in Swiss/ICR mice. , 1979 .

[3]  R. Mazze,et al.  Reproductive and Teratogenic Effects of Nitrous Oxide, Halothane, Isoflurane, and Enflurane in Sprague‐Dawley Rats , 1986, Anesthesiology.

[4]  J. Kosek,et al.  Carcinogen Bioassay of Isoflurane in Mice , 1988, Anesthesiology.

[5]  R. Mazze,et al.  Health Experiences of Operating Room Personnel , 1985 .

[6]  R. Dyke.  Hepatic centrilobular necrosis in rats after exposure to halothane, enflurane, or isoflurane. , 1982 .

[7]  B. Brown,et al.  Anesthesia, pregnancy, and miscarriage: a study of operating room nurses and anesthetists. , 1972, Anesthesiology.

[8]  R. Blandau,et al.  Teratogenic Activity of Nitrous Oxide , 1967, Nature.

[9]  V. Simmon,et al.  Mutagenic effects of inhalational anesthetics. , 1980, Mutation research.

[10]  L. Bodin,et al.  Shift work, nitrous oxide exposure, and spontaneous abortion among Swedish midwives. , 1996, Occupational and environmental medicine.

[11]  C. Weinberg,et al.  Nitrous oxide and spontaneous abortion in female dental assistants. , 1995, American journal of epidemiology.

[12]  R. Knill-Jones,et al.  ANÆSTHETIC PRACTICE AND PREGNANCY: Controlled Survey of Women Anæsthetists in the United Kingdom , 1972 .

[13]  Reduced fertility among women employed as dental assistants exposed to high levels of nitrous oxide. , 1992 .

[14]  R. V. Van dyke,et al.  Halothane Hepatitis: A Critical Review , 1972, Anesthesia and analgesia.

[15]  R. Gibbons,et al.  Comparative Toxicities of Halothane, Isoflurane, and Diethyl Ether at Subanesthetic Concentrations in Laboratory Animals , 1975, Anesthesiology.

[16]  K. Mortelmans,et al.  Lack of mutagens in urines of operating room personnel. , 1980, Anesthesiology.

[17]  D. Moyes,et al.  Effects of Low Concentrations of Nitrous Oxide on Rat Fetuses , 1980, Anesthesia and analgesia.

[18]  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.

[19]  E. Niebuhr,et al.  Sister Chromatid Exchanges and Structural Chromosome Aberrations in Lymphocytes in Operating Room Personnel , 1983, Acta anaesthesiologica Scandinavica.

[20]  J. M. Baden,et al.  Mutagenicity of the combination of a volatile anaesthetic and nitrous oxide. , 1987, British journal of anaesthesia.

[21]  B. Harvald,et al.  [Teratogenic effects of inhalation anesthetics]. , 1970, Nordisk medicin.

[22]  Vaĭsman Ai.  Working conditions in the operating room and their effect on the health of anesthetists , 1967 .

[23]  R. Goldberg,et al.  Exposure to anesthetic gases and reproductive outcome. A review of the epidemiologic literature. , 1985, Journal of occupational medicine. : official publication of the Industrial Medical Association.

[24]  R. Knill-Jones,et al.  Anaesthetic practice and pregnancy. Controlled survey of women anaesthetists in the United Kingdom. , 1972, Lancet.

[25]  H. F. Cascorbi.  Toxicity of Anesthetics , 1975 .

[26]  B. Brown,et al.  A Study of Operating Room Nurses and Anesthetists Ellis , 1971 .

[27]  R. V. Van dyke,et al.  Hepatic Centrilobular Necrosis in Rats after Exposure to Halothane, Enflurane, or Isoflurane , 1982, Anesthesia and analgesia.

[28]  Ronald M. Jones,et al.  The organ toxicity of inhaled anesthetics. , 1995, Anesthesia and analgesia.

[29]  P. Bigatti,et al.  Chromosome analysis in operating room personnel. , 1989, Mutagenesis.

[30]  H. Rüdiger,et al.  Sister chromatid exchange in human lymphocytes exposed to isoflurane and nitrous oxide in vitro. , 1999, British journal of anaesthesia.

[31]  E. Eger,et al.  Hepatic Injury Induced by Anesthetic Agents in Rats , 1983, Anesthesia and analgesia.

[32]  R. Mazze,et al.  Trace nitrous oxide levels in the postanesthesia care unit. , 1999, Anesthesia and analgesia.

[33]  E. Eger,et al.  A Test of the Carcinogenicity of Enflurane, Isoflurane, Halothane, Methoxyflurane, and Nitrous Oxide in Mice , 1978, Anesthesia and analgesia.

[34]  J. M. Baden,et al.  Mutagenicity of Inhaled Anesthetics in Drosophila melanogaster , 1985, Anesthesiology.

[35]  T. Lewis,et al.  Chronic Exposure to Low Concentrations of Halothane‐Nitrous Oxide: Lack of Carcinogenic Effect in the Rat , 1979, Anesthesiology.

[36]  J. Kosek,et al.  Carcinogenicity of Halothane in Swiss/ICR Mice , 1979, Anesthesiology.

[37]  E. D. Barnhart.  Physicians Desk Reference , 1990 .

[38]  Richard E. Morrissey,et al.  Reproductive and developmental toxicity in animals , 1989 .

[39]  A. Spence.  Environmental pollution by inhalation anaesthetics. , 1987, British journal of anaesthesia.

[40]  R. Rylander,et al.  Exposure to Anaesthetic Gases and Spontaneous Abortion: Response Bias in a Postal Questionnaire Study , 1982 .

[41]  Van Dyke Ra,et al.  Halothane Hepatitis: A Critical Review , 1972, Anesthesia and analgesia.

[42]  E. Kharasch,et al.  Absence of Biochemical Evidence for Renal and Hepatic Dysfunction after 8 Hours of 1.25 Minimum Alveolar Concentration Sevoflurane Anesthesia in Volunteers , 1998, Anesthesiology.

[43]  R. Piziali,et al.  Monitoring Occupational Exposure to Inhalation Anesthetics , 1977, Anesthesia and analgesia.