Anestetyki wziewne w atmosferze sal operacyjnych. Badania w dwóch makroregionach Polski

Roman Szulc¹, Andrzej Nestorowicz², Paweł Sobczyński¹, Anna Fijałkowska², Ireneusz Stachecki¹

Summary
Background. Interest in environmental safety of operating theatres arose in the late 1960´s and led to the introduction of the term "professional risk” regarding employed staff. Chronic exposure to trace concentrations of inhalational anaesthetics in the operating room atmosphere is among the documented hazards concerning anaesthetists, surgeons and OR personnel. We estimate that several thousand health care providers may be affected in Poland alone. So far, there have been no Polish studies concerning environmental pollution of operating rooms with inhalational agents. Methods. This study is the first part of a larger project, titled "Evaluation of pollution with inhalational anaesthetics of operating theatres and its potential genotoxic effects on humans” sponsored by the State Committee for Scientific Research. We have assessed contamination of OR air with traces of inhalational anaesthetics, in different reference level hospitals in the Lublin and Wielkopolska regions. Results obtained should give an indication to the situation throughout the country. Measurements were taken of ambient concentrations of inhalational agents in operating rooms in 79 hospitals (28 in the Lublin region and 51 in the Wielkopolska region), using an infrared spectrometer. We noted the number of incidents when threshold values (N₂O – 100 ppm, halothane – 5 ppm, isoflurane and sevoflurane – 10 ppm) were exceeded, the use of scavenging devices, the total air space of operating rooms, the age of anaesthetic apparatus; and fresh gas flow used during anaesthesia. Results. The most common overexposure incidents were noted with the use of nitrous oxide, mainly between operating sessions. Significant increases in ambient concentrations of sevoflurane were noted in operating theatres with a total air space less than 100 m³. Leakage from anaesthetic machines more than 10 years old (approx. 20% of all tested) was more frequent. There was a 50% reduction in the number of overexposures when scavenging systems were used (38% of operating theatres lacked any exhaust systems). Conclusion. The results obtained may indicate the need to introduce mandatory procedures which could lead to a decrease in operating theatre air pollution. We believe that the use of nitrous oxide should be limited and/or replaced by total intravenous anaesthesia.

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