13. Workplace Safety


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  • Fatigue, headache, drowsiness, nausea, depression, and irritability are the short-term effects that resolve spontaneously when the person leaves the room where the waste gas is accumulating. If these symptoms recur frequently after each anesthetic period, the short-term effects may become more serious long-term effects.
  • Toxic metabolites include inorganic fluoride or bromide ions, oxalic acid, and free radicals. Isoflurane followed by sevoflurane are the least toxic inhalant anesthetics because of their primary elimination through the lungs. Methoxyflurane and halothane are the most toxic because of the large amount of waste gas retained by the anesthetist in body fat before they are metabolized by the liver and excreted by the kidneys.
  • These effects are most pronounced in areas in which the waste gas is not scavenged. It is difficult to interpret or compare results of waste anesthetic gas because there is a wide variation in agents used and conditions under which they are used. Also, personnel may be exposed to more than one agent at a time.
  • There have been many studies to determine the effects of long-term exposure to waste anesthetic gas, but there are still many questions about the results of the studies. The best way to minimize the long-term effects is to minimize the amount of unscavenged waste anesthetic gas to which operating room personnel are exposed.
  • Anesthetic gases that leak out of machines are not reduced by the scavenging system. Whereas large leaks may be obvious by their hissing sound, the odor of anesthetic gas, or a jet of air coming out of the reservoir bag or a hose, small leaks are often not detected until a specific test for leaks is conducted.
  • Because the potent opioids are so potent it may take more than normal amounts of reversal agent to antagonize them. Measures must be in place to provide respiratory and cardiovascular support in case of accidental exposure.
  • 13. Workplace Safety

    1. 1. Veterinary technicians must be familiar with the human safety considerations involved in veterinary anesthesia Workplace Safety Chapter 13
    2. 2. Hazards of Waste Anesthetic Gas <ul><li>Sources of waste inhalant anesthetic gas </li></ul><ul><ul><li>Exhaled by patient or escaped from anesthetic machine during anesthetic period </li></ul></ul><ul><ul><li>Inhaled when emptying or filling anesthetic vaporizers </li></ul></ul><ul><ul><li>Inhaled after an accidental anesthetic liquid spill </li></ul></ul><ul><li>Measurement of waste anesthetic gas in parts per million (ppm) </li></ul>
    3. 3. Hazards of Waste Anesthetic Gas (Cont’d) <ul><li>Short-term effects of exposure to high levels of waste anesthetic gas </li></ul><ul><ul><li>Direct effect of anesthetic agent on brain neurons </li></ul></ul><ul><ul><li>Resolve spontaneously when area is left </li></ul></ul><ul><ul><li>Frequent occurrence indicates excessive waste gas levels </li></ul></ul>
    4. 4. <ul><li>Long-term effects of exposure to high levels of waste anesthetic gas </li></ul><ul><ul><li>Serious health problems </li></ul></ul><ul><ul><ul><li>Reproductive Oncogenic </li></ul></ul></ul><ul><ul><ul><li>Hepatic Renal </li></ul></ul></ul><ul><ul><ul><li>Hematologic Neurologic </li></ul></ul></ul><ul><ul><li>May be the result of toxic metabolites produced by the liver </li></ul></ul><ul><ul><li>Anesthetics eliminated through the lungs are less likely to produce long-term effects </li></ul></ul>Hazards of Waste Anesthetic Gas (Cont’d)
    5. 5. Long-Term Effects of High Level Exposure to Waste Anesthetic Gas <ul><li>Reproductive effects </li></ul><ul><ul><li>Risk of spontaneous abortion </li></ul></ul><ul><ul><li>Infertility </li></ul></ul><ul><ul><li>Congenital anomalies in children </li></ul></ul><ul><li>Oncogenic effects </li></ul><ul><ul><li>None of the commonly used agents are associated with an increased risk of developing cancer </li></ul></ul><ul><li>Hepatic effects </li></ul><ul><ul><li>Hepatotoxicity </li></ul></ul><ul><ul><ul><li>Rare, most common with halothane exposure </li></ul></ul></ul>
    6. 6. Long-Term Effects of High Level Exposure to Waste Anesthetic Gas (Cont’d) <ul><li>Renal effects </li></ul><ul><ul><li>Possible renal toxicity with methoxyflurane exposure </li></ul></ul><ul><li>Neurologic effects </li></ul><ul><ul><li>Possible loss of motor skills and short-term memory </li></ul></ul><ul><ul><li>Possible increased incidence of neurological disease </li></ul></ul><ul><li>Hematologic effects </li></ul><ul><ul><li>Possible bone marrow abnormalities </li></ul></ul>
    7. 7. Measuring Waste Gas Levels <ul><li>Highest levels are in surgery suites, surgical prep rooms, and anesthesia recovery rooms </li></ul><ul><li>Highest levels during the anesthetic period are nearest the anesthetic machine </li></ul><ul><li>Factors that determine levels </li></ul><ul><ul><li>Duration of anesthesia </li></ul></ul><ul><ul><li>Flow rate of carrier gas </li></ul></ul><ul><ul><li>Anesthetic machine maintenance </li></ul></ul><ul><ul><li>Effective scavenging system </li></ul></ul><ul><ul><li>Anesthetic techniques used </li></ul></ul><ul><ul><li>Room ventilation (15-20 air changes per hour is ideal) </li></ul></ul><ul><ul><li>Anesthetic spills </li></ul></ul>
    8. 8. Reducing Exposure to Waste Anesthetic Gas <ul><li>Use a scavenging system </li></ul><ul><ul><li>Collects waste gas from the anesthetic machine and conducts it to a disposal site outside the building </li></ul></ul><ul><ul><li>Installation and consistent use are most important factors </li></ul></ul><ul><ul><li>Include exhaust from anesthetic machine, nonrebreathing systems, ventilators, anesthetic chambers, and capnometers </li></ul></ul><ul><ul><li>Active (high vacuum, low vacuum) or passive </li></ul></ul><ul><ul><li>Active system with dedicated vacuum pump is most efficient </li></ul></ul><ul><ul><li>Passive system is least expensive and is best used in rooms with exterior walls </li></ul></ul>
    9. 9. Active and Passive Scavenging Systems
    10. 10. Potential Difficulties with a Scavenging System <ul><li>Prevent the negative (vacuum) pressure on the breathing circuit </li></ul><ul><ul><li>Reservoir bag will collapse </li></ul></ul><ul><ul><li>Negative pressure relief valve will open </li></ul></ul><ul><li>Obstructions may block waste gas from entering the scavenging system </li></ul><ul><ul><li>Anesthetic gas will accumulate in the anesthetic circuit </li></ul></ul><ul><ul><li>Excess pressure develops in circuit and patient’s lungs </li></ul></ul><ul><ul><li>Positive-pressure relief valve will open </li></ul></ul>
    11. 11. Alternative to Scavenging System <ul><li>Activated charcoal cartridges </li></ul><ul><ul><li>Used in rooms not set up for scavenging </li></ul></ul><ul><ul><li>Charcoal absorbs anesthetic vapors </li></ul></ul><ul><ul><li>Replace cartridge every 12 hours or when weight increases 50 g </li></ul></ul><ul><ul><li>Don’t absorb nitrous oxide vapors </li></ul></ul><ul><ul><li>Inefficient at flow rates >2 L/min </li></ul></ul><ul><li>Masks with charcoal filters </li></ul><ul><ul><li>Worn by personnel at special risk </li></ul></ul><ul><ul><li>Not effective for nitrous oxide </li></ul></ul><ul><ul><li>Don’t use masks designed for particulate matter </li></ul></ul>
    12. 12. Reducing Exposure to Waste Anesthetic Gas <ul><li>Check equipment for leaks </li></ul><ul><li>Common sites for leaking equipment </li></ul><ul><ul><li>Nitrous oxide connections not tightly secured </li></ul></ul><ul><ul><li>Rings, washers, other seals joining tanks to machine hanger yokes are missing, worn, or out of position </li></ul></ul><ul><ul><li>Covering of unidirectional valve is not tightly closed </li></ul></ul><ul><ul><li>Carbon dioxide absorber canister is not securely sealed </li></ul></ul><ul><ul><li>Pop-off valve/scavenger connection is not airtight </li></ul></ul><ul><ul><li>Holes in or loose connections for breathing hoses, reservoir bag, or ET tubes </li></ul></ul><ul><ul><li>Vaporizer cap missing </li></ul></ul>
    13. 13. Types of Leak Tests for Anesthetic Equipment <ul><li>High-pressure tests </li></ul><ul><ul><li>Check for leaks between the gas tanks and the flow meter </li></ul></ul><ul><ul><li>Gas pressure ≥50 psi </li></ul></ul><ul><ul><li>Only oxygen or nitrous oxide (the carrier gasses) is released through any leaks </li></ul></ul>
    14. 14. Types of Leak Tests for Anesthetic Equipment (Cont’d) <ul><li>Low-pressure tests </li></ul><ul><ul><li>Check for leaks in the anesthetic machine and breathing circuit </li></ul></ul><ul><ul><li>Gas pressure ≤15 psi </li></ul></ul><ul><ul><li>Oxygen, nitrous oxide, and anesthetic gas released through any leaks </li></ul></ul>
    15. 15. Reducing Exposure to Waste Anesthetic Gas <ul><li>What type of leak test to perform </li></ul><ul><ul><li>High-pressure and low-pressure: both nitrous oxide and oxygen carrier gasses </li></ul></ul><ul><ul><li>Low-pressure test alone: oxygen carrier gas alone </li></ul></ul><ul><ul><li>Low-pressure test: prior to machine use each day </li></ul></ul><ul><ul><li>High-pressure test: nitrous oxide tank weekly or when tank is changed </li></ul></ul><ul><li>Leaks may be found by locating a hiss of escaping air or by using a detergent solution </li></ul><ul><li>Don’t use machine with a leak until the source of the leak has been identified and repaired </li></ul>
    16. 16. Monitoring Waste Gas Levels <ul><li>Important considerations </li></ul><ul><ul><li>Hospital employee becomes pregnant </li></ul></ul><ul><ul><li>Odor of anesthetic gas is frequently detected </li></ul></ul><ul><ul><li>Special concerns about waste gas levels </li></ul></ul><ul><li>Professional monitoring </li></ul><ul><ul><li>Accredited industrial hygiene laboratory </li></ul></ul><ul><li>In-house monitoring </li></ul><ul><ul><li>Detector tubes or badge dosimeters </li></ul></ul>
    17. 17. Safely Handling Compressed Gases <ul><li>Fire safety </li></ul><ul><ul><li>Oxygen and nitrous oxide support combustion </li></ul></ul><ul><ul><li>Static electricity can cause fire when oxygen and combustibles are present </li></ul></ul><ul><ul><li>Eliminate all sources of ignition or flames from any room where cylinders are stored or used </li></ul></ul>
    18. 18. Safely Handling Compressed Gases (Cont’d) <ul><li>Use and storage </li></ul><ul><ul><li>Cylinders are storehouses of large amounts of energy </li></ul></ul><ul><ul><li>Wear impact-resistant goggles when connecting cylinders to anesthetic machine </li></ul></ul><ul><ul><li>Turn valve slowly and with proper wrench when turning on the cylinder </li></ul></ul><ul><ul><li>Chain or belt cylinders to wall </li></ul></ul><ul><ul><li>Store in an upright position to prevent damage </li></ul></ul><ul><ul><li>Store cylinders away from high traffic areas </li></ul></ul><ul><ul><li>Don’t drag or roll a cylinder </li></ul></ul><ul><ul><li>Keep full and empty cylinders separate </li></ul></ul><ul><ul><li>Label with tear-off labels </li></ul></ul><ul><ul><li>Use cylinders in the order they are received </li></ul></ul>
    19. 19. Labeling Compressed Air Cylinders
    20. 20. Accidental Exposure to Injectable Agents <ul><li>Opioids used for restraint and capture of wild animals </li></ul><ul><ul><li>Etorphine (Immobilon, M99) and carfentanil (Wildnil) </li></ul></ul><ul><ul><li>More potent than morphine </li></ul></ul><ul><ul><li>Absorbed through mucous membranes or broken skin </li></ul></ul><ul><ul><li>Accidental exposure through accidental injection, eye splash, or oral ingestion </li></ul></ul>
    21. 21. Accidental Exposure to Injectable Agents (Cont’d) <ul><li>Precautions </li></ul><ul><ul><li>Become educated on potent opioids before using them </li></ul></ul><ul><ul><li>Don’t work alone and wear gloves when using potent opioids </li></ul></ul><ul><ul><li>Have reversal agents drawn up and ready for use </li></ul></ul><ul><ul><li>Have a treatment plan in place </li></ul></ul><ul><ul><li>Dispose of needles and syringes in a closed container immediately </li></ul></ul>
    22. 22. Accidental Exposure to Injectable Agents (Cont’d) <ul><li>Cyclohexamines (ketamine, tiletamine) </li></ul><ul><ul><li>Accidental eye splash may cause disorientation, excitement, dizziness, or unconsciousness </li></ul></ul><ul><li>Alpha 2 -agonists </li></ul><ul><ul><li>Xylazine, detomidine, medetomidine, dexmedetomidine </li></ul></ul><ul><ul><li>Accidental injection or skin contact may cause sedation, hypotension, bradycardia, respiratory depression, coma </li></ul></ul>
    23. 23. Accidental Exposure to Injectable Agents (Cont’d) <ul><li>Precautions </li></ul><ul><ul><li>Personal protective equipment </li></ul></ul><ul><ul><li>Carefully load syringes </li></ul></ul><ul><ul><li>Properly dispose of needles and syringes </li></ul></ul><ul><ul><li>First aid, including eye wash, readily available </li></ul></ul>