Anaesthesia

13. Environmental Hazards in Operating Rooms

13. Environmental Hazards in Operating Rooms There are a number of ways that people in the operating theatres (both patients an d working personnel ) ma y b e adversel y affected . Amongs t thes e ar e pollutio n o f th e operating theatre' s atmospher e b y gase s an d vapour s use d i n anaesthesia , hazard s due t o malfunctionin g o f electrical an d othe r equipmen t an d th e risk o f explosion s and fires. Pollution (i) Toxicity. Althoug h inhalationa l anaesthetic s hav e bee n i n us e sinc e th e 1840 s or even earlier, it was not until the report b y Vaisman (1967) that attentio n wa s focused o n thi s problem. Thi s repor t note d a n unusuall y hig h incidenc e o f fa tigue , headache an d irritabilit y i n all those investigate d a s wel l as a n increase d incidence of spontaneous abortions and abnormal pregnancies in exposed females. One of the most comprehensiv e studie s began i n 197 2 in the U.S.A . (Cohen , et al., 1974) . Data from 40,04 4 respondents exposed to the operating theatres were compared wit h data fro m contro l groups . Those participatin g include d th e en tire membershi p o f th e America n Societ y o f Anesthesiologist s (ASA ) an d th e American Association of Nurse Anesthetists (AANA). In addition, the American Academy of Paediatrics (AAP), the Association of Operating Room Nurses, the American Nursin g Association (ANA ) and th e Association o f Operating Roo m Technicians also took part . I t was found tha t spontaneou s abortion rat e for th e occupationally expose d personne l (define d a s thos e wh o regularl y administe r anaesthetics or work in the operating rooms) was about twice that of the control group. Birt h defect s (excludin g th e skin ) i n th e sam e group s appeare d t o b e different b y a facto r o f tw o (howeve r statistica l differenc e wa s no t achieved , probably due to the small number of births). In comparing birth defects in larger groups (AN A an d AANA) , where the numbe r o f birth s i s greater, ther e was a significant increas e i n defects i n offsprings o f those exposed. Comparin g cance r data o f th e femal e membershi p o f th e AS A an d AA P grou p showe d a nearl y twofold differenc e betwee n the exposed and the not exposed groups. The rate of liver disease (excluding serum hepatitis) was 2.9 in pediatricians compared to 4.9 in anaesthesiologists (per 100) . In addition the health of 2415 general dentists and oral surgeons who adminis- Environmental Hazards in Operating Rooms 239 ter inhalatio n anaesthesi a mor e than thre e hours/week wa s compared wit h tha t of 179 0 dentists employing inhalation anaesthesi a les s than thre e hours/week. I t was found that the spouses of exposed dentists showed spontaneous abortion 1. 8 above controls (Cohen, et al, 1975) . Liver disease (excluding serum hepatitis) was 2.6 above control groups. These survey studies indicated a n increase d incidenc e of spontaneou s abortion , birt h defects , cance r an d live r diseas e i n associatio n with working in the operating rooms. A cause-effec t relationshi p betwee n th e healt h hazard s o f th e operatin g theatres and chronic exposure to trace gases is suggested by animal experiments . Various species, chronically exposed to any of the inhalation agents tested (ether, cyclopropane, nitrous oxide, halothane, etc.) have shown to be subject to adverse effects, suc h as congenital malformations includin g skeleta l defects, interferenc e with growth, anaemia and malignancy. Fetal lethality was found i n rats exposed to N 2 0 a t a concentratio n o f 100 0 part s pe r million . Variou s anima l specie s showed decrease d surviva l rat e afte r chroni c exposur e t o halothan e a t 0.03% . Rats (and thei r offspring) develope d change s...