title: Second-hand exposure to aerosolized intravenous anesthetics propofol and fentanyl may cause sensitization and subsequent opiate addiction among anesthesiologists and surgeons.
abstract: We hypothesize that aerosolization of anesthetics administered intravenously to patients in the operating room may be an unintended source of exposure to physicians. This may lead to inadvertent sensitization, which is associated with an increased risk for developing addiction. This may contribute to the over-representation of certain specialties among physicians with addiction. We retrospectively reviewed the de-identified demographic information of all licensed physicians treated for substance abuse in the State of Florida since 1980, to determine if medical specialty was associated with addiction in this group of individuals. Then, to identify the potential for exposure, two mass spectrometry assays were developed to detect two intravenously administered drugs, fentanyl and propofol, in air. Since 1980, 7.6% of licensed Florida physicians underwent treatment for addiction. Addiction in anesthesiologists was higher than expected. Opiate abuse was greater in anesthesiologists and surgeons compared to other specialties. Aerosolized fentanyl was detected in the air of the cardiothoracic operating room, in patients' expiratory circuits, and in the headspace above sharps boxes, but not in adjoining hallways. Aerosolized propofol was detected in the expirations of a patient undergoing transurethral prostatectomy. While access and stress may place anesthesiologists and surgeons at greater risk for substance abuse, an additional risk factor may be unintended occupational exposure to addictive drugs. This report provides preliminary evidence of detection of aerosolized intravenous anesthetics using two newly developed analytical methods. We conclude that the potential exists for chronic exposure to low levels of airborne intravenously administered drugs. Further studies are under way to determine the significance of this exposure.
authors.affiliation: Department of Surgery, University of Florida College of Medicine, Gainesville, 32610, USA. mcaulp@surgery.ufl.edu
authors.forename: Priscilla F
authors.initials: PF
authors.lastname: McAuliffe
authors.forename: Mark S
authors.initials: MS
authors.lastname: Gold
authors.forename: Lakshmikant
authors.initials: L
authors.lastname: Bajpai
authors.forename: Michele L
authors.initials: ML
authors.lastname: Merves
authors.forename: Kimberly
authors.initials: K
authors.lastname: Frost-Pineda
authors.forename: Raymond M
authors.initials: RM
authors.lastname: Pomm
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Goldberger
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Melker
authors.forename: Juan C
authors.initials: JC
authors.lastname: Cendán
mesh_terms: D000336:Aerosols / Q000032:analysis; D000393:Air Pollutants / Q000032:analysis; D000397:Air Pollution / Q000706:statistics & numerical data; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000032:analysis*; D000776:Anesthesiology; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000032:analysis; D005283:Fentanyl / Q000008:administration & dosage / Q000032:analysis; D005431:Florida / Q000453:epidemiology; D013502:General Surgery; D006801:Humans; D015994:Incidence; D007275:Injections, Intravenous / Q000706:statistics & numerical data; D009784:Occupational Diseases / Q000453:epidemiology*; D016273:Occupational Exposure / Q000706:statistics & numerical data; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D010815:Physician Impairment / Q000706:statistics & numerical data*; D015742:Propofol / Q000008:administration & dosage / Q000032:analysis; D012042:Registries; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors
chemical_list: D000336:Aerosols; D000393:Air Pollutants; D000701:Analgesics, Opioid; D018686:Anesthetics, Intravenous; D005283:Fentanyl; D015742:Propofol