Exposure of personnel to sevoflurane during paediatric anaesthesia: influence of professional role and anaesthetic procedure.
OBJECTIVE
This study was performed to determine the individual exposure of paediatric operating theatre personnel to sevoflurane and to evaluate the impact of inhalation induction and various airway approaches on exposure to airborne sevoflurane.


METHODS
Mean individual environmental (workplace air) exposure to sevoflurane and a biomarker of exposure (urinary sevoflurane) were monitored in 36 subjects (10 anaesthetists, 10 surgeons, 12 nurses and 4 auxiliary personnel) working in two paediatric operating rooms.


RESULTS
Environmental and urinary values were significantly greater in anaesthetists compared with other groups, with median values of 0.65ppm (interquartile range 1.36; 95th percentile 4.36) for breathing zone sevoflurane and 2.1 microgL(-1) urine (interquartile range 2.6; 95th percentile 7.6) for urinary sevoflurane. Anaesthetists exceeded the 2ppm maximum allowed environmental concentration recommended by the National Institute for Occupational Safety and Health in 4 of 22 cases (18.1%). A positive correlation was found between the number of patients undergoing inhalational induction each day and mean values of breathing zone and urinary sevoflurane. An increase in the number of daily laryngeal mask insertions, or the use of rigid bronchoscopy, are statistically related to higher environmental and urinary values (P < 0.01 and <0.00001 for breathing zone sevoflurane, P < 0.05 and <0.01 for urinary sevoflurane, respectively).


CONCLUSIONS
Anaesthesia with sevoflurane can pose a hazard of chronic exposure with anaesthetists having the highest risk. Endotracheal intubation offers considerable protection against exposure. Routine anaesthesia using a standard facemask, a laryngeal mask or rigid bronchoscopy are risk factors for increased anaesthetic exposure.
S Orsola-Malpighi Hospital, Department of Paediatric Anaesthesia and Intensive Care, Bologna, Italy. andrea_gentili@libero.it
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Gentili
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Accorsi
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Pigna
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Bachiocco
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Domenichini
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Baroncini
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Violante
D000328:Adult; D000769:Anesthesia, Inhalation; D018685:Anesthetics, Inhalation / Q000009:adverse effects* / Q000032:analysis / Q000652:urine; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D004784:Environmental Monitoring; D005260:Female; D008401:Gas Chromatography-Mass Spectrometry; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D017214:Laryngeal Masks; D008297:Male; D008738:Methyl Ethers / Q000009:adverse effects* / Q000032:analysis / Q000652:urine; D008875:Middle Aged; D009726:Nurses; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D009873:Operating Rooms; D010820:Physicians; D000077149:Sevoflurane; D000078329:Workforce
D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane