Health Effects Of Anesthetic Agents On Operating Room Personnel


Published on

Docotral course final project presentation.

Published in: Education, Health & Medicine
  • Be the first to comment

  • Be the first to like this

No Downloads
Total views
On SlideShare
From Embeds
Number of Embeds
Embeds 0
No embeds

No notes for slide

Health Effects Of Anesthetic Agents On Operating Room Personnel

  1. 1. Health Effects of Anesthetic Agents on Operating Room Personnel with Special Emphasis on Sevoflurane and Nitrous Oxide By Margaret Czart, MPH
  2. 2. Introduction <ul><li>Anesthesia is commonly used in medical care for patient’s undergoing surgery. </li></ul><ul><li>Inhalation anesthetics are just one of the most common occupational health hazards for operating room personnel. </li></ul><ul><li>Inhalation anesthetics fall into two main categories: </li></ul><ul><ul><li>Halogenated </li></ul></ul><ul><ul><li>Gaseous </li></ul></ul>
  3. 3. 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
  4. 4. Metabolism – Halogenated Agents Source: Reichle, 2003
  5. 5. Metabolism - Sevoflurane Source: Abbott Laboratories, 2006
  6. 6. Metabolism - Sevoflurane Source: Abbott Laboratories, 2006
  7. 7. Metabolism – Nitrous Oxide <ul><li>Nitrous Oxide is believed not to be metabolized in the body. </li></ul><ul><ul><li>Oxidizes Cobalt from Vitamin B12 (Cobalamin). </li></ul></ul><ul><ul><ul><li>Results with an inactivation of B12. </li></ul></ul></ul>
  8. 8. Animal Studies <ul><li>Most common health effects from halogenated anesthetic agents are: </li></ul><ul><ul><li>Reproductive </li></ul></ul><ul><ul><li>Behavioral </li></ul></ul><ul><ul><li>Fetotoxicity </li></ul></ul><ul><ul><li>Abnormal development </li></ul></ul><ul><ul><li>Spontaneous abortions </li></ul></ul><ul><ul><li>Changes to DNA </li></ul></ul>
  9. 9. Animal Studies <ul><li>Sevoflurane: </li></ul><ul><ul><li>Reproductive & behavioral effects on mice and rats. </li></ul></ul><ul><ul><ul><li>Exploratory skills, locomotors skill, anxiety, learning and memory functions </li></ul></ul></ul><ul><ul><li>Sperm production and sperm morphology among rabbits </li></ul></ul><ul><ul><ul><li>Abnormal movement and shape </li></ul></ul></ul>
  10. 10. Animal Studies <ul><li>Nitrous Oxide: </li></ul><ul><ul><li>Among rats there are signs of bone marrow toxicity & effect on embryo development. </li></ul></ul><ul><ul><li>Among other animals there is evidence of damage to the nervous system and liver. </li></ul></ul>
  11. 11. Clinical Studies <ul><li>Historical studies on inhalation anesthetic agents focused on: </li></ul><ul><ul><li>Reproduction effects. </li></ul></ul><ul><ul><li>Hepatic disease among exposed males. </li></ul></ul><ul><ul><li>Cervical cancer, liver disease and kidney disease among exposed women. </li></ul></ul><ul><li>Later studies </li></ul><ul><ul><li>Hepatic effects. </li></ul></ul><ul><ul><li>Genotoxicity (contradictory). </li></ul></ul><ul><ul><li>Increased abortion rate, stillbirths, premature deliveries, low birth weight babies and fertility (contradictory). </li></ul></ul><ul><ul><li>Renal Effects. </li></ul></ul>
  12. 12. Clinical Studies- Halogenated <ul><li>Halothane, Enflurane & Isoflurane: </li></ul><ul><ul><li>Reduce the functionality of the liver </li></ul></ul><ul><ul><li>Renal effects </li></ul></ul><ul><ul><li>DNA effects (Halothane only) </li></ul></ul><ul><ul><li>Birth defects and miscarriage (Halothane only) </li></ul></ul><ul><li>Desflurane: </li></ul><ul><ul><li>No reduced functionality of the liver </li></ul></ul><ul><ul><li>Contradictory results of DNA effects, birth defects and miscarriage. </li></ul></ul>
  13. 13. Clinical Studies - Sevoflurane <ul><li>Observed Effects: </li></ul><ul><ul><li>DNA effects (Compound A) </li></ul></ul><ul><ul><li>Birth defects and miscarriage (contradictory). </li></ul></ul><ul><ul><li>Spontaneous abortion rate (contradictory). </li></ul></ul><ul><ul><li>Stillbirths (contradictory). </li></ul></ul><ul><ul><li>Premature deliveries & low birth weight babies and fertility (contradictory). </li></ul></ul><ul><li>No Known: </li></ul><ul><ul><li>Renal effects </li></ul></ul><ul><ul><li>Hepatic disease </li></ul></ul><ul><ul><li>Cancer </li></ul></ul>
  14. 14. Clinical Studies – Nitrous Oxide <ul><li>Observed Effects: </li></ul><ul><ul><li>Neurological deterioration (inactivate vitamin B12) </li></ul></ul><ul><ul><li>Spontaneous abortions (surgical nurses & wives of male workers) </li></ul></ul><ul><ul><li>Premature delivery </li></ul></ul><ul><ul><li>Low birth weight babies (female workers) </li></ul></ul><ul><ul><li>Birth defects (female workers) </li></ul></ul><ul><ul><li>Female & Male infertility (inactivate vitamin B12) </li></ul></ul><ul><ul><li>Leukemia (contradictory) </li></ul></ul><ul><li>No Known: </li></ul><ul><ul><li>Renal effects </li></ul></ul><ul><ul><li>Hepatic effects </li></ul></ul>
  15. 15. Diagnosis <ul><li>Common diagnosed symptoms of inhalation anesthetic agents include: </li></ul><ul><ul><li>Dizziness </li></ul></ul><ul><ul><li>Headaches </li></ul></ul><ul><ul><li>Weakness </li></ul></ul><ul><ul><li>Nausea </li></ul></ul><ul><ul><li>Dry skin </li></ul></ul><ul><ul><li>Redness in eyes </li></ul></ul><ul><ul><li>Slurred speech (Halothane) </li></ul></ul>
  16. 16. Diagnosis - Sevoflurane <ul><li>Diagnosed symptoms of Sevoflurane exposure: </li></ul><ul><ul><li>Decrease in: </li></ul></ul><ul><ul><ul><li>blood pressure </li></ul></ul></ul><ul><ul><ul><li>urinary output </li></ul></ul></ul><ul><ul><ul><li>renal blood flow </li></ul></ul></ul><ul><ul><ul><li>respiratory rate </li></ul></ul></ul><ul><ul><li>Slight increase in heart rate </li></ul></ul><ul><ul><li>Increase in blood flow </li></ul></ul><ul><ul><li>Muscle relaxation </li></ul></ul>
  17. 17. Diagnosis – Nitrous Oxide <ul><li>Acute exposure may show signs of: </li></ul><ul><ul><li>Dizziness </li></ul></ul><ul><ul><li>Difficulty breathing </li></ul></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Nausea </li></ul></ul><ul><ul><li>Fatigue </li></ul></ul><ul><ul><li>Reduction in white & red blood cell count </li></ul></ul><ul><ul><li>Agitation </li></ul></ul><ul><ul><li>Shivering </li></ul></ul><ul><li>Chronic exposure may show signs of: </li></ul><ul><ul><li>Numbness </li></ul></ul><ul><ul><li>Difficulty in concentrating </li></ul></ul><ul><ul><li>Reproductive effect </li></ul></ul>
  18. 18. 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
  19. 19. Public Health Prevention <ul><li>Exposure Prevention: </li></ul><ul><ul><li>Establish occupational exposure regulations (PEL) </li></ul></ul><ul><ul><li>Medical surveillance </li></ul></ul><ul><ul><li>Scavenging system </li></ul></ul><ul><ul><li>Protection for respiration, skin and eyes </li></ul></ul>
  20. 20. Conclusion <ul><li>Waste anesthetic gases during surgical procedures have put the operating room personnel health at risk. </li></ul><ul><li>Need for more clinical studies. </li></ul><ul><li>Healthcare institutions and operating room personnel must take the appropriate prevention measures to decrease their risk of exposure during surgical procedures. </li></ul>
  21. 21. Thank You!