Health risks and occupational exposure to volatile anaesthetics--a review with a systematic approach.
OBJECTIVE
To provide practicing nurse anaesthetists with evidence based knowledge as to whether they are at risk handling volatile anaesthetics by answering the question: What are the health risks threatening health care personnel occupationally exposed to volatile anaesthetics?


BACKGROUND
The interpretations of results from specific scientific studies vary and preliminary research results indicate that occupational exposure to volatile anaesthetics affects the health of operating room personnel.


METHODS
Review of scientific literature with a systematic approach.


METHODS
The review included a systematic search in three major databases, a screening process of abstracts/articles followed by a quality assessment of the included studies. The screening process and the quality assessment were done independently by the six reviewers and followed specific protocols.


RESULTS
A systematic search of The Cochrane Library, MedLine and CINAHL resulted in a screening of 413 abstracts of which 31 articles were assessed for quality, all done independently by the reviewers. Finally, the reviewers agreed upon how to interpret the results of the assessed articles.


CONCLUSIONS
The 31 articles assessed covered areas such as genotoxic effects, neurobehavioural effects, immunology, and general health effects. In the scientific literature reviewed there is no evidence of occupational exposure to volatile anaesthetics either being associated with health risks or being harmless. Studies indicating a potential health risk are all investigating circumstances ignorant of modern environmental regulations and/or with no scavenging equipment.


CONCLUSIONS
Although no answer has been given, this review illuminates the methodological difficulties encountered in designing studies. The result of this review further stresses the need for scientific knowledge in this area and enhances the extensive use of scavenging equipment.
Nilsson
Roland
R
Department of Anaesthesia, Malmö University Hospital, SE-205 02 Malmö, Sweden. roland.p.nilsson@skane.se
Björdal
Chatarina
C
Andersson
Matts
M
Björdal
Jörn
J
Nyberg
Anna
A
Welin
Bengt
B
Willman
Ania
A
D018685:Anesthetics, Inhalation / Q000032:analysis / Q000506:poisoning; D002869:Chromosome Aberrations / Q000139:chemically induced; D003072:Cognition Disorders / Q000139:chemically induced; D004780:Environment, Controlled; D006801:Humans; D007154:Immune System Diseases / Q000139:chemically induced; D048629:Micronuclei, Chromosome-Defective / Q000139:chemically induced; D020380:Needs Assessment; D009422:Nervous System Diseases / Q000139:chemically induced; D009719:Nurse Anesthetists / Q000706:statistics & numerical data*; D009784:Occupational Diseases / Q000139:chemically induced* / Q000453:epidemiology; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis; D016272:Occupational Health / Q000706:statistics & numerical data*; D009873:Operating Rooms; D018570:Risk Assessment; D012307:Risk Factors; D012854:Sister Chromatid Exchange / Q000187:drug effects
D018685:Anesthetics, Inhalation