29841
document
[ Occupational exposure to nitrous oxide and sevoflurane during pediatric anesthesia : evaluation of an anesthetic gas extractor ] . OBJECTIVES To determine the level of occupational exposure to anesthetic gases in the absence of an extractor during pediatric anesthesia and to assess the efficacy of a purpose-built extraction system . METHODS The patients were 24 children undergoing tonsillectomy and adenoidectomy . Gases were extracted from the room for 1 group and were not extracted for the other group ( n=12 in each group ) . Induction was with 8 % sevoflurane , 60 % nitrous oxide ( N2O ) , 40 % oxygen at a flow rate of 8 L x min ( -1 ) through a Mapleson C circuit . Maintenance was with 2 % sevoflurane at the same flow rate and gas mixture under spontaneous ventilation with an endotracheal tube and a Mapleson D circuit . The circuits were equipped with an airway pressure-limiting valve to allow connection to an anesthetic gas extractor . Ambient levels of sevoflurane and N2O were measured in the breathing area around the anesthesiologist . The surgeon and the nurse were asked about symptoms related to occupational exposure . RESULTS The mean ( SD ) exposure to N2O and sevoflurane in the group without an extractor was 423 ( 290 ) and 12 ( 10.9 ) parts per million ( ppm ) , respectively . In the group working with the extractor , exposure was 94 % and 91 % lower : 24.7 ( 26 ) and 1.1 ( 1 ) ppm ( P < .001 ) . A higher incidence of noticing a " smell of gas " was registered for the group without an extractor ( 87 % vs 11 % in the extractor group , P=.003 ) . Higher rates were also found for general discomfort ( 62 % vs 11 % , P=.05 ) , nausea ( 62 % vs 0 % , P=.009 ) , and headache ( 62 % vs 0 % , P=.009 ) in the absence of the extractor . CONCLUSIONS Gas extraction decreased the level of exposure by up to 94 % , achieving levels that were below the recommended limits and greatly reducing occupational risk .
29842
Intervention_Pharmacological
nitrous oxide and sevoflurane
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Intervention_Pharmacological
pediatric anesthesia
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Intervention_Pharmacological
pediatric anesthesia
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Intervention_Pharmacological
sevoflurane
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Intervention_Pharmacological
nitrous oxide
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Intervention_Pharmacological
oxygen
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Intervention_Pharmacological
sevoflurane
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Intervention_Physical
spontaneous ventilation
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Intervention_Surgical
endotracheal tube
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Intervention_Pharmacological
sevoflurane
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Outcome_Physical
evaluation of an anesthetic gas extractor ]
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Outcome_Other
Ambient levels
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Outcome_Physical
of sevoflurane and N2O
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Outcome_Physical
The
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Outcome_Other
mean ( SD ) exposure to N2O
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Outcome_Physical
and sevoflurane
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Outcome_Physical
exposure
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Outcome_Physical
" smell of gas "
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Outcome_Adverse-effects
general discomfort
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Outcome_Adverse-effects
nausea
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Outcome_Adverse-effects
headache
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Outcome_Other
level of exposure
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Outcome_Physical
occupational risk .