Compound A does not accumulate during closed circuit sevoflurane anaesthesia with the Physioflex.
(1/21)
We have investigated inspiratory and end-tidal gas composition during sevoflurane anaesthesia in a closed circle system with continuous gas flow (70 litre min-1, Physioflex) to determine possible accumulation of sevoflurane degradation products. During five abdominal operations in adults lasting more than 2 h, anaesthesia was maintained with an end-tidal concentration of 2% sevoflurane in 40% oxygen-air. The circle included an absorbing canister filled with 1 litre of fresh soda lime. Samples were obtained at the end of an expiration from the tracheal tube and from the inspiratory limb before, and at selected times after, addition of sevoflurane. The temperature of soda lime was 24.7 +/- 0.7 degrees C at the beginning and reached a maximum of 31.2 +/- 1.0 degrees C after 20-30 min, followed by a plateau. Inspiratory compound A (CH2F-O-C(= CF2)(CF3)) 3-8 ppm was detected after 10 min, but did not accumulate in the circle over 2 h without flushing. Expired concentrations were consistently lower with 1.5-3 ppm signalling absorption by patients. Calculated total amounts absorbed over 2 h varied between 2.0 and 7.2 ppm h. Other degradation products such as compound B or methanol were not detected. In summary, we did not detect sevoflurane metabolites with soda lime in significant amounts during closed circle anaesthesia with the Physioflex. The observed concentrations of compound A were below the threshold of nephrotoxicity in rats by a factor of more than 20. (+info)
Occupational exposure to inhaled anesthetic. Is it a concern for pregnant women?
(2/21)
QUESTION: Two of my pregnant patients are exposed to inhaled anesthetic on the job. One is an anesthetist, and the other is a veterinarian. They have both expressed concern about this exposure. How should I advise them? ANSWER: Occupational exposure to waste anesthetic gas is not associated with increased risk of major malformations. Risk of spontaneous abortion might be slightly increased, however. This risk can be reduced, if not eliminated, by good gas scavenging systems. (+info)
Waste gas exposure to sevoflurane and nitrous oxide during anaesthesia using the oesophageal-tracheal Combitube small adult.
(3/21)
Exposure to sevoflurane (SEV) and nitrous oxide during ventilation using a Combitube (37Fr) small adult (SA) was compared with waste gas exposure using conventional endotracheal tubes. Trace concentrations of SEV and nitrous oxide were assessed using a direct reading spectrometer during 40 gynaecological laparoscopic procedures under general anaesthesia. Measurements were made at the patients' mouth and in the anaesthetists' breathing zone. Mean (SD) concentrations of SEV and nitrous oxide measured at the patients' mouth were comparable in the Combitube SA (SEV 0.6 (0.2) p.p.m.; nitrous oxide 9.7 (8.5) p.p.m.) and endotracheal tube group (SEV 1.2 (0.8) p.p.m.; nitrous oxide 17.2 (10.6) p.p.m.). These values caused comparable contamination of the anaesthetists' breathing zone (SEV 0.6 (0.2) p.p.m. and nitrous oxide 4.3 (3.7) p.p.m. for the Combitube SA group, compared with SEV 0.5 (0.2) p.p.m. and nitrous oxide 4.1 (1.8) p.p.m. for the endotracheal tube group). We conclude that the use of the Combitube SA during positive pressure ventilation is not necessarily associated with increased waste gas exposure, especially when air conditioning and scavenging devices are available. (+info)
Influence of push element geometry on the capture efficiency of push-pull ventilation systems in surface treatment tanks.
(4/21)
A full-scale installation which simulates a surface treatment tank provided with a push-pull ventilation system has been designed. This study examines the influence of the geometry of the push element on the capture efficiency of the system. It is observed that: (i) capture efficiency increases with the number of holes because of the continuous curtain formed, the size of the holes having no significant effect within the range studied (5-20 mm diameter); (ii) the push element is best supported on the tank wall so that no air from outside penetrates below the emitting jets because in this way the impact of the curtain on the tank occurs earlier and losses are less; (iii) the best results are obtained when the holes are directed downwards towards the tank surface at an angle of between 22 and 45 degrees. (+info)
Determination and interpretation of total and transversal linear efficiencies in push-pull ventilation systems for open surface tanks.
(5/21)
A real-scale pilot installation simulating an open surface treatment tank with a push-pull ventilation system has been designed. From experiments carried out, typical representations of the total and transversal linear efficiencies show that when total efficiency is related to push flow rate, taking as a parameter the pull flow rate, a parabolic profile is obtained with a maximum point or plateau that increases as the pull flow increases. When the transversal linear efficiency is analysed, three general zones where losses occur to the exterior can be detected: (i) when the push flow rate is low, any distortion in the wall jet, whether external (e.g. in the air flow inside the workshop) or internal (e.g. thermal effects), provokes an escape from contaminant; (ii) in the impact zone, where the push flow impacts on the tank surface, distortion increases as the push flow rate increases; (iii) when the push/pull flow rate ratio increases and preferential currents are produced inside the exhaust hood, these escape and cause substantial losses in efficiency. (+info)
Neuropsychological symptoms and occupational exposure to anaesthetics.
(6/21)
OBJECTIVE: To analyse the relation between symptoms regularly reported by hospital personnel and exposure to anaesthetics. SETTING: Personnel of 18 hospitals in Paris from 1987 to 1989. DESIGN: An exposed group that included all operating theatre members except for doctors, and which was divided into three subgroups depending on the degree of exposure--exposure was measured by the frequency of the use of the scavenging system--and a control group that included other hospital personnel matched by hospital, sex, occupation, age, and duration of service. SUBJECTS: 557 exposed workers and 566 unexposed workers. MAIN OUTCOME MEASURES: The groups were compared according to the crude rates of regular symptoms. Adjusted odds ratios were calculated to estimate the risks associated with exposure to anaesthetic gas. Liver transaminase activities (alanine aminotransferase, aspartate aminotransferase (s-ASAT, and gamma-glutamyl transpeptidase) were measured and compared between groups of exposure. RESULTS: After controlling for working conditions and matching factors, neuropsychological symptoms and tiredness were reported more by workers in less often scavenged theatres than by controls. No difference was found between workers of the well scavenged theatres and controls. Among the exposed workers, the members of paediatric surgical staffs reported a higher rate of neurological complaints (tingling, numbness, cramps) and tiredness than the members of the other surgical staffs. They had a high value of s-ASAT more frequently than the other exposed workers. CONCLUSION: These results strengthen the hypothesis of a causal relation between exposure to anaesthetics and neuropsychological symptoms, and show a dose-response effect. They suggest that the use of ventilating systems in operating rooms is an effective means of prevention. (+info)
Effects of temperature gradient correction of carbon dioxide absorbent on carbon dioxide absorption.
(7/21)
BACKGROUND: The effects of temperature gradients in CO(2) absorbents on water content and CO(2) absorption are not clear. We constructed a novel temperature gradient correction (TGC) canister, and investigated the effects of temperature gradient correction on the water content and longevity (time to exhaustion) of CO(2) absorbent using a simulated anaesthesia circuit. METHODS: Experiments were divided into two groups according to the type of canister used: the TGC canister (n=6) or the conventional canister (n=6). One kilogram of fresh CO(2) absorbent was placed into the canister. The anaesthetic ventilator was connected to a 3 litre bag and 300 ml min(-1) of CO(2) was introduced. Oxygen (500 ml min(-1)) was used as fresh gas. The anaesthetic ventilator was set at a ventilatory frequency of 12 bpm, and tidal volume was adjusted to 700 ml. RESULTS: Before the experiment, the water content of the fresh CO(2) absorbent in the conventional canister and TGC canister was 16.1 (0.9)% and 15.7 (1.1)%, respectively. After the experiment, the water content of CO(2) absorbent near the upper outer rim of the canister increased to 32.4 (0.7)% in the conventional canister, but increased to only 20.6 (1.3)% in the TGC canister (P<0.01). The longevity of CO(2) absorbent in the conventional canister and TGC canister was 434 (9) min and 563 (13) min (P<0.01). CONCLUSIONS: Temperature gradient correction prevented a local excessive increase in water content and improved the longevity of CO(2) absorbent. (+info)
Effectiveness of 2 scavenger mask systems for reducing exposure to nitrous oxide in a hospital-based pediatric dental clinic: a pilot study.
(8/21)
Chronic exposure to elevated ambient air levels of nitrous oxide during nitrous oxide/ oxygen (N2O/2) sedation can result in deleterious side effects to dentists and auxiliary staff. A sampling survey was done in the outpatient dental clinic at the Hospital for Sick Children to determine whether airborne nitrous oxide (N2O) gas concentrations were within established regulatory limits. The effectiveness of 2 scavenger mask systems, the Matrix Medical single-mask system and the Porter/Brown double-mask system, for reducing airborne contamination in a clinical environment during the treatment of pediatric dental patients was compared in a pilot study. The results indicated that the double-mask system more effectively minimized N2O exposure during N2O/O2 sedation of outpatients for a variety of clinical pediatric dental procedures. (+info)