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Potential problems associated with occupational exposure to nitrous oxide
... One patient developed symmetrical sensory distal axonal polyneuropathy after several years of exposure to an industrial solvent (flugene; 1,1,2-trichloro-1,2,2-trifluoroethane) [23]. The second patient worked as an anesthesiologist and developed sensory-motor axonal polyneuropathy years after professional exposure to volatile anesthesia (trichloroethylene, nitrous oxide, halogenated hydrocarbons) [24], no other possible explanation for peripheral neuropathy was discovered, and Neurol Sci a presumptive diagnosis of occupational-related neuropathy was made [25]. ...
Objectives
Chronic neuropathies are a common cause of neurological disability worldwide. However, few reports have evaluated, in real life, the prevalence of the several conditions which can cause it.
Patients and methods
The authors reviewed informatic database for outpatient office to confirm identification of chronic neuropathy in a 3-year interval period.
Results
Among the 100 selected patients with chronic neuropathies, almost one fifth (19%) remained idiopathic. The most common etiologies were diabetes (17%), dysimmune neuropathies (38%), and vitamin B12 deficiency (9%). In the “dysimmune neuropathies” group, we distinguished various etiologies, including dysimmune neuropathies associated or not with systemic autoimmune diseases (7 and 3%, respectively), chronic inflammatory polyneuropathy (CIDP) (8%), multifocal motor neuropathy (MMN) (3%), paraproteinemic (8%), celiac disease-related (6%), and paraneoplastic (3%) neuropathies.
Conclusions
In this report from a single neurological center, treatable causes of chronic neuropathies, such as dysimmune neuropathies, including CIDP, and celiac disease-associated neuropathy, were common. These findings suggest the utility of routine screening with blood testing for dysimmune neuropathy and celiac disease for all patients presenting with idiopathic chronic polyneuropathy in whom primary diagnostic testings had failed to identify an etiology for the disease.
Significance
Our results indicate that patients with peripheral neuropathy could receive a benefit from being evaluated routinely in a specialized neurological center, as many of the conditions that were discovered represented potentially treatable causes of neuropathy.
This chapter discusses the risk factors in using general anesthetics and therapeutic gases. It discusses the general risk factors in patients having familial dysautonomia, and duchenne muscular dystrophy. It also explains the drug interactions, withdrawal syndrome, and malignant hyperthermia. The effects of anesthesia in elders, cardiovascular complications, effects of general anesthesia during pregnancy and its effects on immune system have also been discussed in the chapter. There is also some discussion about hypersensitivity reactions and toxicity of inhalation anesthetics. This chapter also discusses the gases such as Enflurane and its interactions, Halothane and its side effects on organs and interactions, lsoflurane and its interactions, Methoxyflurane, Sevoflurane, and Nitrous oxide. Intravenous agents such as Barbiturates, Thiopental sodium, Etomidate, Ketamine, Midazolam and injectable benzodiazepines and its interactions, and Propofol have been discussed.
The purpose of this study was to record room air concentrations of nitrous oxide during sessions of cryotherapy and to compare them with available norms. Complementary objectives were to determine the knowledge of Canadian colposcopists and to evaluate the need for education regarding nitrous oxide toxicities.
Air concentrations of nitrous oxide during cryotherapy sessions were measured with an infrared gas analyzer. A survey was sent to colposcopists throughout Canada to evaluate their knowledge of toxicities of nitrous oxide.
The mean air concentrations of nitrous oxide measured were 169, 91, 99, and 103 ppm, respectively. Adding a tube to the cryotherapy scavenging outlet to dispose of the gas diminished the concentration to 17 ppm. The survey showed that 74% of the gynecologists surveyed use nitrous oxide as a refrigerant and only 18% know about the toxicities of nitrous oxide.
Without a device to dispose of nitrous oxide securely during cryotherapy, the air concentration exceeds safe levels. Education of clinicians on the toxicities of nitrous oxide should be a goal in the future.
Numerous potential problems have been associated with long term or occupational exposure to both nitrous oxide and halothane. Despite the lack of firmly established cause-and-effect relationships, particularly in humans, it would seem prudent to use techniques that minimize operator exposure. With this in mind, a scavenging system for use in both conscious sedation and general anesthetic techniques was developed which fulfills the requirements of both general dentists as well as those administering general anesthesia. This paper describes this system and its adaptation to the commonly used Magill circuit. It also briefly reviews the factors involved in potential toxicity caused by long term exposure to nitrous oxide and halothane.
This article identifies the potential sources of nitrous oxide in the dental environment and reviews the harmful effects of chronic exposure to nitrous oxide. The author suggests methods of controlling nitrous oxide concentrations to approximate the recommended levels in the dental care environment.
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.
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