title: Pollution of ambient air by volatile anesthetics: a comparison of 4 anesthetic management techniques.
abstract: Long-term exposure to waste anesthetic gas (WAG) may lead to health problems. The purpose of this study was to compare WAG concentrations resulting from 4 combinations of fresh gas flow (FGF) and vaporizer settings during a simulated intravenous induction in which the anesthetic is deepened using a volatile anesthetic delivered via mask ventilation before intubation. By using a lung model, WAG was sampled 3 times each using 4 combinations and 3 volatile anesthetics: 3% sevoflurane, 2% isoflurane, and 6% desflurane. The combinations were FGF off/vaporizer on, FGF on/vaporizer off, both on, and both off. WAG was measured using a MIRAN Ambient Air Analyzer placed at a level approximating the anesthetist's head. One-way analysis of variance with a Student-Newman-Keuls post hoc test was used to compare the concentration of WAG among the combinations of FGF/vaporizer settings for each agent. Regardless of the agent, only the FGF on/vaporizer on combination at 60 seconds resulted in a statistically greater WAG level (P < .005). The results support using 3 of the 4 combinations examined when mask ventilation with a volatile agent accompanies intravenous induction. Future studies should examine other methods of controlling WAG levels and use time-weighted averages to help address clinical significance.
authors.affiliation: Uniformed Services University of the Health Sciences, Graduate School of Nursing, Nurse Anesthesia Program, Bethesda, MD, USA.
authors.forename: Joy C
authors.initials: JC
authors.lastname: Barberio
authors.forename: Jason D
authors.initials: JD
authors.lastname: Bolt
authors.forename: Paul N
authors.initials: PN
authors.lastname: Austin
authors.forename: William J
authors.initials: WJ
authors.lastname: Craig
mesh_terms: D000328:Adult; D016902:Air Pollution, Indoor / Q000009:adverse effects / Q000032:analysis* / Q000517:prevention & control; D000704:Analysis of Variance; D000769:Anesthesia, Inhalation / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D018685:Anesthetics, Inhalation / Q000009:adverse effects / Q000032:analysis*; D000077335:Desflurane; D004784:Environmental Monitoring; D006801:Humans; D007442:Intubation, Intratracheal; D007530:Isoflurane / Q000031:analogs & derivatives / Q000032:analysis; D007828:Laryngoscopy; D008168:Lung / Q000187:drug effects / Q000502:physiology; D008738:Methyl Ethers / Q000032:analysis; D008954:Models, Biological; D009330:Nebulizers and Vaporizers; D016273:Occupational Exposure / Q000009:adverse effects / Q000032:analysis* / Q000517:prevention & control; D016272:Occupational Health; D000077149:Sevoflurane; D015144:Southeastern United States; D013997:Time Factors
chemical_list: D018685:Anesthetics, Inhalation; D008738:Methyl Ethers; D000077149:Sevoflurane; D000077335:Desflurane; D007530:Isoflurane