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Effect Of Inhaled Anesthetics Gases On Health Staff Health Status In Al-Najaf City

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Exposure of workers to waste anaesthetic gases in the operating and recovery rooms of hospitals is of concern because of the reported adverse effects of such gases on the health of personnel in this occupational group. Objectives To determine the effect of inhaled anesthetics gases on health staff health status (headache and dizziness). And to find out the association between the effects of inhaled anesthetics gases on health staff health status and their demographic data and job related data. Methodology, A Case-Control study is carried out in Al-Najaf Health Directorate / Al-Sadder medical city, from June 1st, 2013 to September 1st, 2013. A probability stratified sample of (29) from health staff personnel working in the operative rooms selected as a study group, and (13) from health staff personnel working in the other hospital wards selected as a control group, were included in the study. The data are collected through the use of semi-structured questionnaire, which consists of three parts including, demographic and job related data, data about headache characteristics, and data about the dizziness characteristics. Results and Conclusions The study results indicate that the health staff in operative rooms are more prone to have a headache and dizziness than those who working in other wards. And that there is a significant effect of the work place and the job title on the suffering of headache and dizziness among operative room health staff. Recommendations, The researchers recommend a further studies should be employed to involve a large number of health staff with a national level. An education programs should be focusing on how to manage these gases to reduce its effects on health staff health status.
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Effect Of Inhaled Anesthetics Gases On Health
Staff Health Status In Al-Najaf City
Ibrahim A. Kadhim Al-Ashour, Diaa K. Abd-Ali, Mansour A. Fallah, Iman Q. Kteo
Abstract: Exposure of workers to waste anaesthetic gases in the operating and recovery rooms of hospitals is of concern because of the reported
adverse effects of such gases on the health of personnel in this occupational group. Objectives To determine the effect of inhaled anesthetics gases on
health staff health status (headache and dizziness). And to find out the association between the effects of inhaled anesthetics gases on health staff
health status and their demographic data and job related data. Methodology, A Case-Control study is carried out in Al-Najaf Health Directorate / Al-
Sadder medical city, from June 1st, 2013 to September 1st, 2013. A probability stratified sample of (29) from health staff personnel working in the
operative rooms selected as a study group, and (13) from health staff personnel working in the other hospital wards selected as a control group, were
included in the study. The data are collected through the use of semi-structured questionnaire, which consists of three parts including, demographic and
job related data, data about headache characteristics, and data about the dizziness characteristics. Results and Conclusions The study results indicate
that the health staff in operative rooms are more prone to have a headache and dizziness than those who working in other wards. And that there is a
significant effect of the work place and the job title on the suffering of headache and dizziness among operative room health staff. Recommendations,
The researchers recommend a further studies should be employed to involve a large number of health staff with a national level. An education programs
should be focusing on how to manage these gases to reduce its effects on health staff health status.
Key wards: effect, anesthesia gases, health status ————————————————————
Introduction
Inhalation anesthetics are substances that are brought into
the body via the lungs and are distributed with the blood
into the different tissues. The main target of inhalation
anesthetics (or so-called volatile anesthetics) is the brain.
Inhalation anesthetics act either by amplifying inhibitory
function or decreasing excitatory transmission at the nerve
endings in the brain. The role of inhalation agents in
general anesthesia is changing. Volatile anesthetics are
seldom used alone in our days. A combination of inhalation
anesthetics and intravenous drugs is called balanced
anesthesia. Currently used inhalation anesthetics include
enflurane, halothane, isoflurane, sevoflurane, desflurane,
and nitrous oxide. Older volatile anesthetics include ether,
chloroform, and methoxyflurane (Wenker, 1999). Exposure
to high concentrations of anesthetics has been reported to
affect health.
Nitrous oxide concentrations as low as 50 ppm caused
measurable performance decrements in psychological tests
taken by healthy male graduate students. Nitrous oxide
may result in hematological change and abuse of nitrous
oxide causes peripheral neuropathy. Anesthetic
concentrations of halothane may result in acute hepatitis
with liver necrosis. Possible chronic effects studied in
exposed populations include cancer, and liver and kidney
disease, but the findings are inconsistent (Guirguis, et. al.,
1990). Exposure to anesthetic gases in the health sector,
whether in the operating room, recovery room, or in the
context of outpatient clinics, may entail a health risk for the
personnel exposed. Although health care workers are
exposed to much lower anesthetic concentrations than the
patients, this exposure often extends over many years.
Personnel often indicate fatigue and headaches, especially
when occupational hygiene conditions are inadequate.
More serious disorders such as reduced fertility and
problems during pregnancy are mentioned. The decisive
factors as concerns the adverse health effects of exposure
to anesthetic gases are mainly the type of gases used, the
length of exposure, and the gas concentrations
(International Section on the Prevention of Occupational
Risks in Health Services, 2001). Occupational exposure to
volatile anesthetic agents may result in various adverse
health effects. Anesthetic agents eliminated rapidly from the
body due to low solubility in blood and tissues. Genetic
material has been shown to be a sensitive target of
numerous harmful agents including anesthetic gases.
Investigate the genotoxic effect of exposure to volatile
anesthetics on leukocytes of exposed operating room
personnel [anesthetists, surgeons and nurses], determine
the effect of exposure to volatile anesthetics on oxidative
stress [super oxide dismutase [SOD] and determine work-
related subjective symptoms. Statistically significantly
higher frequency of work-related symptoms included
dizziness, headache, irritability, decreased concentration,
anxiety and easy fatigability were reported among ORP
compared to controls (Aal, et. al., 2008).
______________________________
Ibrahim A. Kadhim Al-Ashour, Diaa K. Abd-Ali,
Mansour A. Fallah, Iman Q. Kteo
M.Sc. Nursing, Head of fundamental of Nursing
Branch, faculty of Nursing, University of Kufa
M.Sc. Nursing, Head of Adult Health Nursing Branch,
faculty of Nursing, University of Kufa
M.Sc. Nursing, Head of maternity Nursing Branch,
faculty of Nursing, University of Kufa
B.Sc. Nursing, Adult Health Nursing, College of
Nursing, University of Kufa
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Methodology
Study Design
A Case Control study is carried out in Al-Najaf Health
Directorate / Al-Sadder Medical City, from June 1st, 2013 to
September 1st, 2013.
Study Sample
A probability stratified sample of (29) from health staff
personnel working in the operative rooms selected as a
study group, and (13) from health staff personnel working in
the other hospital wards selected as a control group, were
included in the study.
Instrument
The data are collected through the use of semi-structured
questionnaire, which consists of three parts including,
demographic and job related data, data about headache
characteristics, and data about the dizziness
characteristics.
Data collection
The data are collected through the use of semi-structured
questionnaire and by means of interview with the study
subjects.
Data Analyses
In order to achieve the early stated objectives, the data of
the study were analyzed through the use of statistical
package of social sciences (SPSS) version 16 through
descriptive and inferential statistical analyses
Results
Table (1) Observed Frequencies and Percentages for
the Study Groups Demographic Data
Freq. (frequency), % (percentage), n (29 study group,
and 13 control group)
This table shows that the majority of the study sample were
male in both groups (study group and control group), with
an estimation of 86% and 76% respectively. Also in
regarding to the age groups, the study results indicate that
the 34.5% and 38.5% were for the third age group (29-37
years) among study and control groups respectively. In
addition to that and in regarding to the years of experience,
the study results indicate that the highest percentages 48.3
% and 38.5 were for 2-9 years among the study and control
groups respectively. While for the job prescription, the study
results indicate that the highest percentage (72.4%), were
for the anesthesiologist assistant among study group, while
for the control group, the higher percentage were for nurses
(61.5%). Another results indicate that the 5 days is the
dominant days that the health staff spent in work in a week,
while the 6 days is the dominant number of days that the
health staff spent in work in a week among the control
group, with an estimation of (75.9% and 100%)
respectively. Finally in this table, the study results indicate
that the health staff spent about 5-9 hours in work daily in
both study and control groups and estimated about 89.7%
and 84.6% respectively.
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Figure 1.A Observed Frequencies and Percentages for the
Study Groups Demographic Data
Figure 1.B Observed Frequencies and Percentages for the
Study Groups Demographic Data
Table (2) Observed Frequencies and Percentages for
the Study Groups Responses in regarding to Headache
and its Characteristics
This table shows that (55.2%) are suffering from headache
among the study group. While (100%) aren't have
headache among the control group. In addition, that
(34.5%) from those who are suffering from headache stated
that their headache started at the end of their work, periodic
headache (51.7%), severity between the 3 and 4 based on
visual analogue scale (17.2%), aggravating with a (8)
(27.6%), (44.8%) from them are feeling better during the
rest, and (24.1%) from them are suffering from (1) as an
associated symptoms.
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Figure 2. Observed Frequencies and Percentages for the
Study Groups Responses in regarding to Headache and its
Characteristics
Table (3) Observed Frequencies and Percentages for
the Study Groups Responses in regarding to Dizziness
and its Characteristics
Freq. (frequency), % (percentage), n (29 study group, and
13 control group)
This table shows that (69%) are suffering from dizziness
among the study group, while (84.6%) aren't have dizziness
among the control group. In addition, that (37.9% ) from
those who are suffering from dizziness are stated that their
dizziness started at the end of their work, periodic dizziness
(58.6%), aggravating with a (5) (55.2%), (62.1%) from them
are feeling better during the rest, and (41.4%) from them
are suffering from (1) as an associated symptoms.
Figure 3. Observed Frequencies and Percentages for the
Study Groups Responses in regarding to Dizziness and its
Characteristics
Table (4) Observed Mean Differences between the
Study and Control Group in Regarding to the suffering
of Headache and Dizziness with Comparison t-value
and the Level of Significance
This table shows that there is a significant differences
between the study group and the control group in regarding
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to the suffering from headache and dizziness, with a
significant differences less than 0.05.
Table (5) association between the suffering of
Headache and different demographic data
This table shows that there is a significant association
between the age groups and the job prescription and the
suffering of headache, at p-value less than 0.05. while there
is a non significant association between the health staff
gender and their years of experience and the suffering from
headache at p-value more than 0.05.
Table (6) association between the suffering of dizziness
and different demographic data
This table shows that there is a non-significant association
between the suffering of dizziness and all the demographic
data, at p-value more than 0.05, except with the job
prescription, the study results indicate that there is a
significant association, at p-value less than 0.05.
Table (7) association between the suffering of dizziness
and suffering of headache
This table shows that there is a highly significant
association between the suffering of dizziness and the
headache, at p-value less than 0.05.
Discussion
The study results indicate that more of the operative room
health staff personnel are suffering from headache and
dizziness more than those staff who are working in another
hospital units. That mean that the operative room health
staff are more prone to exposure anesthesia gases, as well
as they more attend to having a headache or dizziness.
This results is supported with Vohra,1994. Munday et al
,1995 . Dashfield et al ,1997 . berg et al, 1998 . Apfel et al
,2002. Reichle and Conzen ,2003; Johnson et. al., 2008.
They mentioned that the operative room health staff
anesthetics it causes early but not delayed post-operative
vomiting, airways irritation during induction of anesthesia,
retching, headache and restlessness, and dizziness. In
addition the study results indicate that a significant effect of
the operative rooms health staff age groups and the job
prescription on their perception of pain and dizziness. This
result is supported with Gao, 2011, their results indicate
that there is a significant effect of the operative rooms
workers and their degree of headache. Also a highly
significant effect of the suffering of dizziness on the
headache perception. This result is supported with
Brantberg, et. al. (2005), they mentioned that there is an
association between the dizziness and headache
perception.
Conclusions and Recommendations:
The researcher concluded that the health staff in operative
rooms is more prone to have a headache and dizziness
than those who working in other wards. And that there is a
significant effect of the age, and the job title on the
suffering of headache and dizziness among operative
rooms health staff. Recommendations, The researchers
recommend further studies should be employed to involve a
large number of health staff with a national level. An
education programs should be focusing on how to manage
these gases to reduce its effects on health staff health
status.
References:
[1] Aal, B.; Galal A.; Manal A.: GENOTOXIC AND
OXIDATIVE STRESS EFFECTS DUE TO
OCCUPATIONAL EXPOSURE TO ANESTHETIC
GASES AMONG OPERATING ROOM
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No.1 Jan 2008.
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[2] Apfel, K.; Papenfuss, R.; and Heineck, G.: Volatile
anaesthetics may be the main cause of early but
not delayed postoperative vomiting: a randomized
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journal-of-anesthesiology/volume-3-number-
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part-i.html#sthash.VhIWfOXd.dpuf
... While one of the principal goals of anesthesia is to prevent patients from feeling pain and stress during surgery, the exposure of workers to waste anesthetic gases is a concern, because of the reported adverse effects on the health care personnel working in the potential area of inhalation anesthetic exposure. [1][2][3] This exposure occurs when inhalational anesthetics gas is released or leaks during medical procedures in the work areas like the operating room, recovery room, delivery room, ICU, or other areas where workers may be subject to job-related exposure. 4,5 Globally, it is estimated that more than 200,000 healthcare personnel may be exposed to waste anesthetics gases annually, 6 and mostly health care personnel like anesthesiologists, nurse anesthetists, specialists (surgical, obstetric, and orthopedic), OR nurses, operating room technicians, post-anesthesia care nurses, dentists, veterinarians are potentially exposed to waste anesthetics gases (WAGs) and are at risk of much occupational illness including adverse reproductive effects like spontaneous abortion, preterm delivery, infertility, stillbirth, congenital anomaly, premature rupture of membrane, and delay in conception to health care personnel are the main concern. ...
... but the severity of these anesthetics exposure hazards of adverse health effects varies according to the type of gases used, the length of exposure, and the gas concentrations. 3,[14][15][16] These potential adverse effects due to occupational chronic exposure to these compounds have led public health authorities to publish standards (guidelines and protocols) like the use of the latest inhalational agents with minimum effects, adequate ventilation of OR, use of personal protective equipment (PPE) and properly disposing of the pollutes/ WAGs by scavenging system to the outside of the facilities and also develop technical procedure like sampling methods, active air treatment systems, maintenance procedures and leak test of the machinery used for anesthesia, air suctioning and air conditioning systems and medical surveillance of exposed workers to regulate the possible health effects. [17][18][19] But these protocols are not implemented in our setup and we expect many associated health problems and high concentration of WAGs or/and their metabolites in the OR air, in the blood and urine of exposed HCPs beyond the recommended level of WHO and still, the status of adverse health effects was undefined in the setting indeed which needs to be explored and adoption of formal practices and regulations to reduce ambient air pollution in the working area to safe or minimum levels of exposure. ...
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Background: Emerging of anesthetics opens a new era to medical discipline in relieving patients' pain and stress when undergoing surgery but simultaneously exposes the healthcare personnel working in areas of anesthetics exposure to many adverse health effects including reproductive outcomes effects. Thus, this study aimed to assess the effect of inhalational anesthetics exposure on reproductive outcomes and its predictors among health care personnel in hospitals of Jimma zone public hospitals. Methods: A comparative cross-sectional study was conducted from May 01 to 30, 2021. We approached 483 healthcare personnel in Jimma zone public hospitals to partake in this study. Of this number, we recruited 292 healthcare personnel, comprising 146 exposed healthcare personnel and 146 unexposed healthcare personnel. Structured questionnaires were used to assess the reproductive outcomes. Data were entered into EPI-data version 4.6.1 and exported to SPSS version 24 for analysis. Binary logistic regressions were carried out to identify associated factors with reproductive outcomes. Statistical significance was declared using a p value <0.05. Results: The overall prevalence of bad reproductive outcome status was high (30.8%) and the prevalence was much higher among exposed HCPs (20.9%) when compared to unexposed HCPs (9.9%). Among a total of 292 HCPs the likelihood of occurred bad reproductive outcomes was higher among an exposed group (AOR=3.17, 95% CI: 1.40-7.16) and those who smoke cigarettes (AOR=8.44, 95% CI: 1.93-36.91). The occurrence rate of bad reproductive outcome was higher among 30-45h/week exposure (AOR=11.94, 95% CI: 1.25-24.95) if separately analyzed among exposed and age of couple above 41 years among unexposed (AOR=5.87, 95% CI: 1.56-22.06) were significantly associated with bad reproductive outcomes. Conclusion: Prevalence of bad reproductive outcomes was higher among exposed HCPs. Hence, it requires attention to create awareness about the danger of anesthetics exposure in the study setting, suggesting the need to further minimize the exposure.
... While one of the principal goals of anesthesia is to prevent patients from feeling pain and stress during surgery, the exposure of workers to waste anesthetic gases is a concern, because of the reported adverse effects on the health care personnel working in the potential area of inhalation anesthetic exposure (1)(2)(3). This exposure occurs when inhalational anesthetics gas is released or leaks during medical procedures in the work areas like operating room, recovery room, delivery room, ICU, or other areas where workers may be subject to job-related exposure (4,5). ...
... Similarly, the study conducted at Sudan Khartoum indicates that there was a high incidence of infertility in operating room personnel 7.35% compared to 1.47% in non-exposed health workers. Higher incidence of abortion in operation room nurses (43.3%) while 14.29% in non-exposed health workers (13) The potential victims of this occupational hazard are health care personnel working in operating facilities with no automatic ventilation or scavenging systems or poor condition, recovery rooms/ ICU where gases exhaled by recovering patients not properly vented or scavenged, leakage in the anesthetics breathing circuit but the severity of these anesthetics exposure hazards of adverse health effects vary according to the type of gases used, the length of exposure, and the gas concentrations (3,(14)(15)(16). ...
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Background Emerging of anesthetic opens a new era to medical discipline in relieving patient’s pain and stress who undergoing surgery but simultaneously exposes the health care personnel working in areas of anesthetic exposure to many adverse health effects including reproductive outcomes effects. Therefore this study aimed to assess the effect of inhalational anesthetics exposure on reproductive outcomes and its predictors among Health care personnel in hospitals of Jimma zone public hospitals. Methods Comparative cross-sectional study was conducted from May 01 to 30, 2021. We approached 483 health care personnel in Jimma zone public hospitals to partake in this study. Of this number, we recruited 292 Health care personnel, comprising 146 exposed health care personnel and 146 unexposed Health care personnel. Structured questionnaires were used to assess the reproductive outcomes. Data were entered into EPI-data version 4.6.1 and exported to SPSS version 24 for analysis. Binary logistic regressions were carried out to identify associated factors with reproductive outcomes. Statistical significance was declared using a p value< 0.05. Results The overall prevalence of bad reproductive outcome status was high (30.8%) and the prevalence was much higher among exposed HCPs, (20.9%) when compared to unexposed HCPs (9.9%)). Among a total of 292 HCPs, the likelihood of occurred bad reproductive outcomes was higher among an exposed group (AOR=3.17, 95%CI: 1.40-7.16); smoke cigarettes (AOR=8.44, 95%CI: 1.93-36.91). The occurrence rate of bad reproductive outcome was higher among 30-45h/week exposure (AOR=11.94; 95%CI: 1.25-24.95) if separately analyzed among exposed and age of couple above41years among unexposed (AOR=5.87, 95%CI: 1.56-22.06) were significantly associated with bad reproductive outcomes. Conclusion Prevalence of bad reproductive outcomes was higher among exposed HCPs. Hence, it requires attention through creating awareness about the danger of anesthetics exposure in the study setting suggesting the need to further minimize the exposure.
... Personnel who are working in operating rooms are more likely to be exposed to waste anesthetic gases with no automatic ventilation or scavenging systems, and the latter if present are in poor condition. Also recovery rooms where gases exhaled by recovering patients are not properly vented or scavenged ( Al-Ashour et al., 2014). Volatile anesthetics are the major pollutants in operating rooms, where personnel are exposed to low doses of them, for long periods of time. ...
... But there was highly statistical significant difference between them in occurrence of threatened and spontaneous abortion, abortion>2 times, congenital anomalies and symptoms during work as headache and drowsiness with marked increase among Group I ( Table 2). The present study showed that 92% of exposed nurses were suffering from headache during work in contrast to 33.3 % among the non exposed group, and 88% of operating room nurses (ORP) were complaining of dizziness ( Table 2).This is consistent with a study carried out by Al-Ashour et al. (2014) who detected that (55.2%) of his studied group were suffering from headache and (69%) were suffering from dizziness. ...
... he inhalation agents used in operations include the fluorinated ethers; isoflurane, sevoflurane, and desflurane and the gas nitrous oxide (N2O). Waste anesthetic gases are small amounts of volatile anesthetic gases that leak from the patient's anesthetic breathing circuit into the air of operating rooms during delivery of anesthesia (Al- Ashour et al., 2014). ...
... They found a statistically significant increase in headache and drowsiness among exposed compared to control group, and this can be explained that both studies were done in the same hospital with the same conditions. Also our work were similar to the results obtained by Al-Ashour et al., (2014), in their study done on 29 operating room personnel exposed to anesthetic gases in Al-Sadder medical city in Iraq and 13 unexposed control, they found that staff in ORs were more prone to headache and dizziness than non exposed staff. ...
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Introduction: Anesthetics are essential materials used in hospitals to induce unconsciousness in patients prior to surgical procedures. The most commonly used agents are isoflurane , sevoflurane and halothane. Aim of work: To assess the health effects of exposure to anesthetic gazes focusing on hepatic and renal manifestations among operating room (OR) personnel. Materials and methods: Operating room (OR) personnel (184: 68 males and 116 females) were included in the study and compared with 192 (63 males and 129 females) from other departments staff of the same hospital mainly from internal medicine hospital and outpatient clinics. The studied groups filled a questionnaire including personnel, family, past and present histories. Liver and kidney function tests were examined. Plain urine samples were collected at the end of shift to test for β2 microglobulin. Operating theaters were evaluated regarding the type of breathing circuits used whether open or closed, the type of anesthetic gases used, presence of air conditioning, and scavenging system. Isoflurane air level was measured using the organic method 103 by OSHA. Results: OR personnel experienced symptoms namely headache, tiredness, drowsiness, and decreased memory compared with their controls, without having statistical significance except for headache. There was a statistically significant increase in the level of ALP (Alkaline phosphatase), total bilirubin, urea, creatinine and B2 microglobulin among exposed when compared to the control group. Also AST (Aspartate transaminase), ALP, direct bilirubin, B2 microglobulin, urea and creatinine were higher among personnel using both open and closed circuits than in those using closed circuits only. The mean values of AST, ALP, total bilirubin, B2 microglibulin urea and creatinine were higher among personnel using isoflurane, sevoflurane and halothane (3 types of anesthetic gazes) more than those using isoflurane and sevoflurane or those using isoflurane only. The mean levelsof urea and creatinine were statistically higher among surgeons when compared to other groups. Conclusion: Personnel working in operating theaters are more at risk to develop disturbances in liver and kidney functions compared to the controls especially surgeons. Recommendations: Implementation of adequate and working scavenging system, air conditioning, use of closed circuits whenever possible, periodic checking of anesthetic air levels, periodic biochemical analysis for OR personnel, and replacement of any malfunctioning parts of anesthesia machine.
... Many anesthesiologists prefer to perform orthopedic surgery under spinal anesthesia or regional nerve blocks. [18][19][20] It is a good strategy to reduce exposure to anesthetic chemicals. ...
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Despite intensive research, the main causes of postoperative nausea and vomiting (PONV) remain unclear. We sought to quantify the relative importance of operative, anaesthetic and patient-specific risk factors to the development of PONV. We conducted a randomized controlled trial of 1180 children and adults at high risk for PONV scheduled for elective surgery. Using a five-way factorial design, we randomly assigned subjects by gender who were undergoing specific operative procedures, to receive various combinations of anaesthetics, opioids, and prophylactic antiemetics. Of the 1180 patients, 355 (30.1% 95% CI (27.5-32.7%)) had at least one episode of postoperative vomiting (PV) within 24 h post-anaesthesia. In the early postoperative period (0-2 h), the leading risk factor for vomiting was the use of volatile anaesthetics, with similar odds ratios (OR (95% CI)) being found for isoflurane (19.8 (7.7-51.2)), enflurane (16.1 (6.2-41.8)) and sevoflurane (14.5 (5.6-37.4)). A dose-response relationship was present for the use of volatile anaesthetics. In contrast, no dose response existed for propofol anaesthesia. In the delayed postoperative period (2-24 h), the main predictors were being a child (5.7 (3.0-10.9)), PONV in the early period (3.4 (2.4-4.7)) and the use of postoperative opioids (2.5 (1.7-3.7)). The influence of the antiemetics was considerably smaller and did not interact with anaesthetic or surgical variables. Volatile anaesthetics were the leading cause of early postoperative vomiting. The pro-emetic effect was larger than other risk factors. In patients at high risk for PONV, it would therefore make better sense to avoid inhalational anaesthesia rather than simply to add an antiemetic, which may still be needed to prevent or treat delayed vomiting.
Article
In a retrospective study (by questionnaire) of 8032 personnel exposed to anaesthetic gases in operating and recovery rooms in Ontario hospitals, and 2525 non-exposed hospital staff, the response was 78.8% for the exposed and 87.2% for the unexposed personnel during the period 1981-5. Logistic regression analysis, with age and smoking standardised, showed that women in the exposed group had significantly increased frequencies of spontaneous abortion and their children had significantly more congenital abnormalities (p less than 0.05). No chronic disease was significantly associated with the exposed group. These findings, together with similar ones from other studies, suggest that it is prudent to minimise exposure to waste anaesthetic gases.
Article
The purpose of this study was to measure the serum fluoride concentration after enflurane or sevoflurane anesthesia and to compare the effects of prolonged anesthesia with these drugs on renal concentrating function in male volunteers. The study was subdivided into three stages; an ascending dose study of 3.0 and 6.0 minimum alveolar anesthetic concentration (MAC) hours of sevoflurane alone, a 6.0-MAC-hour comparison of enflurane and sevoflurane, and a 9.0-MAC-hour comparison of enflurane and sevoflurane. Renal concentrating function was assessed by an 18-h period of fluid deprivation and the serum fluoride concentration was measured at intervals until 60 h postanesthesia. The maximum serum fluoride concentration was greater in the volunteers exposed to sevoflurane and reached a peak in the 9-MAC-hour sevoflurane group of 36.6 microM (SD 4.3) compared with 27.5 microM (SD 2.6) in the 9-MAC-hour enflurane group. However, the rapid decrease in the serum fluoride concentration after sevoflurane was such that there was no difference between the areas under the fluoride concentration-time curves. There were no significant differences between the median maximum urine osmolalities after enflurane or sevoflurane anesthesia. Prolonged anesthesia with enflurane or sevoflurane is not associated with impaired renal concentrating function despite an increase in the serum fluoride concentration.
Article
The aim of this investigation was to study the role of the nasal airway in mediating upper airway reflexes during induction of anaesthesia when the commonly used irritant inhalational anaesthetic agent enflurane is used. In a prospective randomised study, 40 ASA 1 & 2 day-case patients undergoing body surface surgery were recruited. Following intravenous induction using propofol, 20 patients received enflurane administered via a laryngeal mask airway (LMA), the anaesthetic vapour therefore bypassing the nasal airway. In the other group, 20 patients received enflurane anaesthesia administered using a face mask, the nasal airway therefore being exposed to inhalation anaesthetic. We were unable to demonstrate any significant (p < 0.05) differences between the two groups in relation to upper airway complications (cough, breath holding, laryngeal spasm, bronchospasm and excitement). Previous work has identified the nose as a possible important reflexogenic site for upper airway reflexes in humans during anaesthesia. We have been unable to demonstrate any difference in upper airway complications when the nasal airway was included or excluded from exposure to irritant anaesthetic vapours, when administered in a clinical setting.
Article
Isoflurane has exceeded halothane and enflurane in usage. A literature search, however, revealed no data comparing the effects on emesis, headache and restlessness of these three agents. With hospital ethics committee approval and patient consent, a prospective, randomised, double-blind study of 556 patients undergoing ENT and eye surgery was undertaken to evaluate the effects of halothane, isoflurane and enflurane on vomiting, retching, headache and restlessness until 24 h after anaesthesia. Balanced general anaesthesia was administered comprising benzodiazepine premedication, induction with thiopentone-atracurium-morphine (ENT patients) or fentanyl (eye patients), controlled ventilation and maintenance with either halothane 0.4-0.6 vol% (n = 186), isoflurane 0.6-0.8 vol% (n = 184) or enflurane 0.8-1 vol% (n = 186) in nitrous oxide 67% and oxygen. The three study groups were comparable, and comprised comparable subgroups having ear, nose, throat, intraocular and non-intraocular surgery. During early recovery from anaesthesia, the respective requirements for halothane, isoflurane and enflurane for analgesia (7%, 9% and 10%), frequency of emesis (6%, 8% and 8%), antiemetic requirements (1%, 1% and 2%), restlessness-pain scores and time spent in the recovery ward (27 SD 10, 31 SD 12 and 26 SD 9 min) were similar. During the ensuing 24-h postoperative period, patients who had isoflurane experienced emesis less often than those who had halothane (36% vs 46%, P < 0.025) but did so with similar frequency to those who had enflurane (46% vs 41%). Antiemetic requirements were least in those given isoflurane (isoflurane 12%, halothane and enflurane 23% each, P < 0.005), but headache and analgesic requirements were similar. Isoflurane induces less postoperative emesis than halothane, but headache is similarly frequent after anaesthesia with any of these agents.
Migraineassociated vertigo, ActaOto-Laryngologica
  • K Brantberg
  • T Natalie
  • W Robert
Brantberg, K: Natalie T.; & Robert W.: Migraineassociated vertigo, ActaOto-Laryngologica, 2005; 125: 276_/279
  • A Johnson
  • Job
  • In
  • Operating
Johnson, A.: JOB SATISFACTION IN THE OPERATING ROOM: AN ANALYSIS OF THE CULTURAL COMPETENCE OF NURSES, Dissertation, Capella University, 2008, (1-109)
Halogenated inhalational anaesthetics. Best practice and Research Clinical Anaesthesiology
  • F Reichle
  • P Conzen
Reichle, F.; Conzen P.: Halogenated inhalational anaesthetics. Best practice and Research Clinical Anaesthesiology.17,29_49. 2003