Exposição ocupacional a resÃduos de gases anestésicos
Occupational exposure to anesthetic gases residue
Carlos Rogério Degrandi Oliveira
Resumo
Palavras-chave
Abstract
BACKGROUND AND OBJECTIVES: Although the absence of negative effects of prolonged exposure to anesthetic gases residue has been reported, controversies on the subject still linger. Contradictory data on the variability in individual response to different agents can be found in the literature. The objective of this report was to present a review of occupational exposure to anesthetic gases residue. CONTENTS: The results of the main articles on the subject, as well as the causes of contamination of the surgical environment, ventilation, exhaust system, monitoring, and dosage of anesthetic gases residues are discussed. Recommendations to minimize the supposed effects of inhalational agents are emphasized. CONCLUSIONS: Even in task-forces studies of renowned international regulating institutions, there are some controversies on the risks of occupational exposure to anesthetic gases residue. Minimal values for occupational exposure are stipulated, but acknowledging the lack of epidemiological evidence of any type of damage caused by said exposure in places where standard measures of ventilation and exhaust systems and the use of anesthetic equipment are observed. In our country, most of the time those measures are not implemented and, when they are, they are not supervised properly. Besides, differences in techniques and working conditions have to be considered. Taking into consideration the multifactorial nature of the exposure of health care professionals, measures should be undertaken to minimize occupational exposure to agents with known or probable toxic potential. The demand for better equipped operating rooms, with adequate ventilation and exhaust systems as well as their maintenance should be stimulated.
Referências
Vaisman AI. Working conditions in the operating room and their effect on the health of anesthetists. Eksperiment Khirurg Anesteziol. 1967;12:44-49.
Fink BR, Shepard TH, Blandau RJ. Teratogenic activity of nitrous oxide. Nature. 1967;214:146-148.
Waste Anesthetic Gases in Operating Room Air: a Suggested Program to Reduce Personnel Exposure. 1981.
Baden JM, Simmon VF. Mutagenic effects of inhalational anesthetics. Mutat Res. 1980;74:169-189.
Eger EI II, White AE, Brown CL. Anesth AnalgA test of the carcinogenicity of enflurane, isoflurane, halothane, methoxyflurane, and nitrous oxide in mice. 1978;57:678-694.
Chloroform as an ingredient of human drug and cosmetic products. Federal Register. 1976;14:15026.
Carcinogenisis bioassay of trichloroethlene. Carcinogenesis technical report series. 1976.
Baden JM, Kundomal YR, Mazze RI. Carcinogen bioassay of isoflurane in mice. Anesthesiology. 1988;69:750-753.
Baden JM, Kundomal YR, Luttropp ME Jr. Carcinogen bioassay of nitrous oxide in mice. Anesthesiology. 1986;64:747-750.
Baden JM, Egbert B, Mazze RI. Carcinogen bioassay of enflurane in mice. Anesthesiology. 1982;56:9-13.
Baden JM, Mazze RI, Wharton RS. Carcinogenicity of halothane in Swiss/ICR mice. Anesthesiology. 1979;51:20-26.
Coate WB, Ulland BM, Lewis TR. Chronic exposure to low concentrations of halothane-nitrous oxide: Lack of carcinogenic effect in the rat. Anesthesiology. 1979;50:306-309.
Rice SA, Fish KJ. Reproductive and Developmental Toxicity of Anesthetics in Animals. Anesthetic Toxicity. 1994:157-174.
Shepard TH, Fink BR. Teratogenic activity of nitrous oxide in rats. Toxicity of Anesthetics. 1968:308-323.
Vieira E, Cleaton-Jones P, Austin JC. Effects of low concentrations of nitrous oxide on rat fetuses. Anesth Analg. 1980;59:175-177.
Occupational disease among operating room personnel: A national study. Anesthesiology. 1974;41:321-340.
Buring JE, Hennekens CH, Mayrent SL. Health experiences of operating room personnel. Anesthesiology. 1985;62:325-330.
Knill-Jones RP, Rodrigues LV, Moir DD. Anaesthetic practice and pregnancy: Controlled survey of women anaesthetists in the United Kingdom. Lancet. 1972;1:1326-1328.
Rosenberg P, Kirves A. Miscarriages among operating theatre staff. Acta Anaesthesiol Scand. 1973;53:37-42.
Axelsson G, Rylander R. Exposure to anaesthetic gases and spontaneous abortion: Response bias in a postal questionnaire. Int J Epidemiol. 1982;11:250-256.
Spence AA, Knill-Jones RP. Is there a health hazard in anaesthetic practice?. Br J Anaesth. 1978;50:713-719.
Cohen EN, Bellville JW, Brown BW Jr. Anesthesia, pregnancy, and miscarriage: A study of operating room nurses and anesthetists. Anesthesiology. 1971;34:343-347.
Tannenbaum TN, Goldberg RJ. Exposure to anesthetic gases and reproductive outcome: A review of the epidemiologic literature. J Occup Med. 1985;27:659-668.
Spence AA. Environmental pollution by inhalation anaesthetics. Br J Anaesth. 1987;59:96-103.
Friedman JM. Teratogen update: Anesthetic agents. Teratology. 1988;37:69-77.
Ebi KL, Rice SA, Fish KJ. Reproductive and developmental toxicity of anesthetics in humans. Anesthetic Toxicity. 1994:175-198.
Guidelines for the Use of Conscious Sedation, Deep Sedation and General Anesthesia for Dentists. 1996.
Sweeney B, Bingham RM, Amos RJ. Toxicity of bone marrow in dentists exposed to nitrous oxide. Br Med J. 1985;291:567-569.
Helfenstein E. Farmacodinâmica dos Anestésicos Inalatórios. Tratado de Anestesiologia. 2006:791-802.
Rowland AS, Baird DD, Weinberg CR. Reduced fertility among women employed as dental assistants exposed to high levels of nitrous oxide. N Engl J Med. 1992;327:993-997.
Rowland AS, Baird DD, Shore DL. Nitrous oxide and spontaneous abortion in female dental assistants. Am J Epidemiol. 1995;141:531-538.
Maran NJ, Knill-Jones RP, Spence AA. Infertility among female hospital doctors in the UK. Br J Anaesth. 1996;76:581.
Information for Management in Anesthetizing Areas and the Postanesthesia Care Unit. 2004.
Torres MLA, Carlos RV. Aparelhos de Anestesia: Componentes e Normas Técnicas. Tratado de Anestesiologia. 2006:163-175.
Guidelines for Construction and Equipment of Hospitals and Medical Facilities. 1992.
Almeida FV, Alberici RM, Braga FS. Contaminação atmosférica num centro cirúrgico por compostos orgânicos voláteis e dióxido de carbono. Rev Bras Anestesiol. 1999;49:190-195.
Marshall JW. Health care ventilation standard: Air change per hour or CFM/patient?. ASHRAE J. 1996;38:27-30.
Turiel I, Rudy JV. Occupant-generated CO2 as an indicator of ventilation rate. ASHRAE Transactions. 1982;88:197-210.
Criteria for a Recommended Standard: Occupational Exposure to Waste Anesthetic Gases and Vapors. 1977.
Hazard Communication Standard. 1985.
Anaesthetic agents: Controlling exposure under COSHH. 1995.
Gardner RJ. Inhalation anaesthetics exposure and control: A statistical comparison of personal exposures in operating theatres with and without anaesthetic gas scavenging. Ann Occup Hyg. 1989;33:159-173.
Portaria MTE n.° 485 - NR 32 - Segurança e Saúde no Trabalho em Serviços de Saúde, de 11 de novembro de 2005. .
Chinelato AR, Froes NDTC. Efeitos genotóxicos em profissionais expostos aos anestésicos inalatórios. Rev Bras Anestesiol. 2002;52:79-85.