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Health Effects Of Anesthetic Agents On Operating Room Personnel
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Health Effects Of Anesthetic Agents On Operating Room Personnel

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Docotral course final project presentation.

Docotral course final project presentation.

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    Health Effects Of Anesthetic Agents On Operating Room Personnel Health Effects Of Anesthetic Agents On Operating Room Personnel Presentation Transcript

    • Health Effects of Anesthetic Agents on Operating Room Personnel with Special Emphasis on Sevoflurane and Nitrous Oxide By Margaret Czart, MPH
    • Introduction
      • Anesthesia is commonly used in medical care for patient’s undergoing surgery.
      • Inhalation anesthetics are just one of the most common occupational health hazards for operating room personnel.
      • Inhalation anesthetics fall into two main categories:
        • Halogenated
        • Gaseous
    • Inhalation Anesthetic Agents C2HBrClF3 C3H2ClF5O C3H2ClF5O (Fluothane) a,b (Ethrane) a,b (Forane) a,b C3H2F6O C4H3OF7 N2O (Suprane) a,b (Ultane) a,b (Nitrous Oxide) a,b Source: a)OSHA 2000 , b) Evers et. al. 2006
    • Metabolism – Halogenated Agents Source: Reichle et.al, 2003
    • Metabolism - Sevoflurane Source: Abbott Laboratories, 2006
    • Metabolism - Sevoflurane Source: Abbott Laboratories, 2006
    • Metabolism – Nitrous Oxide
      • Nitrous Oxide is believed not to be metabolized in the body.
        • Oxidizes Cobalt from Vitamin B12 (Cobalamin).
          • Results with an inactivation of B12.
    • Animal Studies
      • Most common health effects from halogenated anesthetic agents are:
        • Reproductive
        • Behavioral
        • Fetotoxicity
        • Abnormal development
        • Spontaneous abortions
        • Changes to DNA
    • Animal Studies
      • Sevoflurane:
        • Reproductive & behavioral effects on mice and rats.
          • Exploratory skills, locomotors skill, anxiety, learning and memory functions
        • Sperm production and sperm morphology among rabbits
          • Abnormal movement and shape
    • Animal Studies
      • Nitrous Oxide:
        • Among rats there are signs of bone marrow toxicity & effect on embryo development.
        • Among other animals there is evidence of damage to the nervous system and liver.
    • Clinical Studies
      • Historical studies on inhalation anesthetic agents focused on:
        • Reproduction effects.
        • Hepatic disease among exposed males.
        • Cervical cancer, liver disease and kidney disease among exposed women.
      • Later studies
        • Hepatic effects.
        • Genotoxicity (contradictory).
        • Increased abortion rate, stillbirths, premature deliveries, low birth weight babies and fertility (contradictory).
        • Renal Effects.
    • Clinical Studies- Halogenated
      • Halothane, Enflurane & Isoflurane:
        • Reduce the functionality of the liver
        • Renal effects
        • DNA effects (Halothane only)
        • Birth defects and miscarriage (Halothane only)
      • Desflurane:
        • No reduced functionality of the liver
        • Contradictory results of DNA effects, birth defects and miscarriage.
    • Clinical Studies - Sevoflurane
      • Observed Effects:
        • DNA effects (Compound A)
        • Birth defects and miscarriage (contradictory).
        • Spontaneous abortion rate (contradictory).
        • Stillbirths (contradictory).
        • Premature deliveries & low birth weight babies and fertility (contradictory).
      • No Known:
        • Renal effects
        • Hepatic disease
        • Cancer
    • Clinical Studies – Nitrous Oxide
      • Observed Effects:
        • Neurological deterioration (inactivate vitamin B12)
        • Spontaneous abortions (surgical nurses & wives of male workers)
        • Premature delivery
        • Low birth weight babies (female workers)
        • Birth defects (female workers)
        • Female & Male infertility (inactivate vitamin B12)
        • Leukemia (contradictory)
      • No Known:
        • Renal effects
        • Hepatic effects
    • Diagnosis
      • Common diagnosed symptoms of inhalation anesthetic agents include:
        • Dizziness
        • Headaches
        • Weakness
        • Nausea
        • Dry skin
        • Redness in eyes
        • Slurred speech (Halothane)
    • Diagnosis - Sevoflurane
      • Diagnosed symptoms of Sevoflurane exposure:
        • Decrease in:
          • blood pressure
          • urinary output
          • renal blood flow
          • respiratory rate
        • Slight increase in heart rate
        • Increase in blood flow
        • Muscle relaxation
    • Diagnosis – Nitrous Oxide
      • Acute exposure may show signs of:
        • Dizziness
        • Difficulty breathing
        • Headache
        • Nausea
        • Fatigue
        • Reduction in white & red blood cell count
        • Agitation
        • Shivering
      • Chronic exposure may show signs of:
        • Numbness
        • Difficulty in concentrating
        • Reproductive effect
    • Regulations N/A 50 ppm (8hr day) (40 hr week) 2ppm (1 hr) 0.5 ppm (w halogenated) Nitrous Oxide N/A N/A 2ppm (1 hr) 0.5 ppm (w N2O) Sevoflurane N/A 75 ppm 2ppm (1 hr) 0.5 ppm (w N2O) Desflurane N/A 75 ppm 2ppm (1 hr) 0.5 ppm (w N2O) Isoflurane N/A 75 ppm 2ppm (1 hr) 0.5 ppm (w N2O) Enflurane N/A 50 ppm (8hr day) (40 hr week) 2ppm (1 hr) 0.5 ppm (w N2O) Halothane PEL TLV REL Agent
    • Public Health Prevention
      • Exposure Prevention:
        • Establish occupational exposure regulations (PEL)
        • Medical surveillance
        • Scavenging system
        • Protection for respiration, skin and eyes
    • Conclusion
      • Waste anesthetic gases during surgical procedures have put the operating room personnel health at risk.
      • Need for more clinical studies.
      • Healthcare institutions and operating room personnel must take the appropriate prevention measures to decrease their risk of exposure during surgical procedures.
    • Thank You!