Employee Exposures to Waste Anesthetic Gases in Hospital Operating Rooms

Transcription

1 ( 9 ) J Korean Soc Occup nviron Hyg ;():9- mployee xposures to Waste nesthetic Gases in Hospital Operating Rooms Jung Young ha o Myung Paek Nam Won Paik Graduate School of Public Health, Seoul National University This study was performed to investigate employee exposures to waste anesthetic gases, such as enflurane and sevoflurane in operating rooms of general surgical, children s and dental clinics of a large hospital located in Seoul and to analyze factors affecting the concentrations of waste anesthetic gases. The results of the study are summarized below.. ased on results of personal and area samples for airborne enflurane, all of the employees investigated in this study were exposed to airborne enflurane concentrations below the GIH-threshold limit value (TLV) of ppm.. However, based on results of personal samples for sevoflurane, employees of two () out of eleven () operating rooms were exposed to sevoflurane concentrations in excess of the NIOSH recommended exposure limit (RL) of ppm. similar trend was found in the area samples.. To investigate the source of sevoflurane emissions, airborne sevoflurane concentrations were measured on an anesthesia machine, a drug cabinet and a desk. It was indicated that the geometric means were.9 ppm,.8 ppm and. ppm, respectively.. Factors affecting waste anesthetic gas concentrations were the age of anesthesia machine, the volume of operating room and the extent of ventilation (p<.).. It is recommended that the use of anesthesia equipments be properly controlled, the operating room be well ventilated, and the airborne concentrations of anesthetic gases be continuously monitored. nflurane, Sevoflurane, Waste anesthetic gases, TW concentration, Scavenging system 8 8 Tel : --888, Fax: --9, -mail: nwpaik@snu.ac.kr)

2 9 emergence induction recovery maintenance Johnson, et al., 98 ndrea et al., ; diethylether, cyclopropane, fluroxene chloroform trichloroethylene methoxyflurane nitrous oxide NO desflurane, sevoflurane halothane, enflurane, isoflurane, Tran, et al., 99; Johnson, et al., 98 scavenging system Waste nesthetic Gases, WGs Hobbhahn, et al., 998 nitrous oxide endotracheal intubation fitting mask reserve mask 8 air changes per hour, H hour yhahn, et al., National Institute for Occupational Safety and Health, NIOSH Sevoflurane RL TW ppm merican onference of Governmental Industrial Hygienists, GIH nflurane 8 TLV TW ppm GIH, Krenzischek, et al., ; Occupational Safety and Health dministration, OSH OSH, 99; OSH, nasorb tube 9 mg, SK, US Low flow pump, Gilian, US. Lpm 8

3 99 S Toluene chromatography, HP 89, Hewlett Packard, US Flame ionization detector, FI Hoerauf, n decane Gas 9 scavenging system, air conditioner nitrous oxide NO halogenated agents nflurane, Sevofluran IQ L 8 M U, TSI, US rug cabinet esk nesthesia machine nesthetist ir ventilation Measurement points oors Type of linic Operating Room No. of Workers Room Size, ( ) nesthetic Gas oncentration (vol%) isturbance at exhaust General Pediatric ental F G H

4 9. ppm GIH ppm system scavenging system. rouch, et al,. NO O : scavenging. ppm 8. ppm, H NIOSH ppm. ppm,. ppm 8. ppm.8 ppm.8 ppm.9 ppm. ppm. ppm H NIOSH TW.9 ppm.8 ppm. ppm. ppm. ppm.9 ppm.8 ppm. ppm Type of linic Operating Room Personal Sample oncentration by Type of Sampling, ppm rea* Sample General (.-.). (.9-.).8 (.9-.9).9 (.-9.9) 9. ental..8.. (.-.). (.-.) 8.8

5 9 Type of linic General Pediatric ental Operating Room F G H Personal Sample <..9 oncentration by Type of Sampling, ppm rea Sample. (.-.9). (.-.8). (.-.88). (.-.).8. (.8-.9). (.-.).8 (.89-.). (.-.). (.-.8).88. (.-.8) <..

6 98 99 umulative Percentage (%) 9. Personal Sample rea Sample nflurane oncentration (ppm) 99 umulative Percentage (%) 9 Personal Sample rea Sample... Sevoflurane oncentration (ppm) F General G H Pediatric ental p-value Result of Personal Sample (ppm) Result of rea Sample (ppm) ge of nesthesia Machine (year) 8. Volume of Room ( ) 9 9. isturbance at exhaust.

7 99 8 NIOSH p. p value.8,. scavenging system TW p. p. p value NIOSH, 998 TW oncentration, ppm nesthesia Machine rug abinet esk NIOSH RL ( ppm) F G H General Pediatric ental

8 p. TW regression model value.8,. GLM general linear p halogenated agents NO O : p.. vol%. vol% 8 over years less than years TW oncentration, ppm personal rea Sampling Types 8 Smaller than m Larger than m TW oncentration, ppm personal rea Sampling Types

9 8 Hour Time Weighted verage, TW Hour Time Weighted verage, TW GIH ppm. ppm 8. ppm NIOSH ppm.8 ppm. ppm. ppm NIOSH NIOSH NIOSH, 998 hour.9 ppm,.8 ppm. ppm ppm NIOSH p. RFRNS 998 merican onference of Governmental Industrial Hygienists (GIH). TLVs and Is ased on the ocumentation of the Threshold Limit Values for hemical Substances and iological xposure Indices. GIH, incinnati, Ohio,. ndrea M. Sass-Kortsak, Purdham JT, ozek PR, Murphy JH : xposure of hospital operating room personnel potentially harmful environmental agents. m Ind Hyg ssoc J 99;:-9. yhahn, Heller K, Lischke V, Westphal K. Surgeon s occupational exposure to nitrous oxide and sevoflurane during pediatric surgery. World J Surg ;: 9-. rouch KG, McGlothlin J, Johnston O [999]. Long-Term study of the development of NO controls at a pediatric dental facility. m Ind Hyg ssoc J ;:-. Hobbhahn J, Hoerauf K, Wiesner G, Schroegendorfer K, Taeger K.Waste Gas xposure during esflurane and Isoflurane anaesthesia. cta-naesthesiol-scand. 998; : 8-8. Hoerauf K, Koller, Jakob W, Taeger K, Hobbhahn J. Isoflurane waste gas exposure during general anaesthesia: the laryngeal mask compared with tracheal intubation. ritish Journal of naesth 99;:89-9. Johnson J, uchan RM, Reif JS. ffect of waste anesthetic gas and vapor exposure on reproductive outcome in veterinary personnel. m Ind Hyg ssoc J 98;8:-. Krenzischek,, Schaefer J, Nolan M, ukowski J, Twilley M, ernacki, orman T (). Phase I ollaborative Pilot Study: Waste nesthetic Gas Levels in the PU. J Perinesth Nurs ; :-9. National Institute for Occupational Safety and Health (NIOSH). Health are Workers Guidelines. NIOSH, incinnati, Ohio, 998. Occupational Safety and Health dministration (OSH). Sampling and nalytical Method, OSH, incinnati, Ohio, 99. Occupational Safety and Health dministration (OSH). nesthetic gases guidelines for workplace exposures. 999 July[Revised May] vailable from: URL: anesthet icgases/index.html Occupational Safety and Health dministration (OSH). hemical Sampling Information Sevoflurane, OSH, incinnati, Ohio,. Tran N, lias J, Rosenberg T, Wylie, Gaborieau, Yassi. valuation of waste anesthetic gases, monitoring strategies, and correlations between nitrous oxide levels and health symptoms. m Ind Hyg ssoc J 99;():-