title: Persistent cognitive functioning deficits in operating rooms: two cases.
abstract: BACKGROUND
  To date, chronic toxic encephalopathy (CTE) has never been described in operating room personnel.
  
  
  METHODS
  We report two cases of anaesthetists who developed this pathology. They have both used anaesthetic gases for many years in paediatric surgery. Air conditioning was deficient during three years in operating rooms and atmospheric anaesthetics concentration was high (N(2)O mean concentration: 311 ppm, peak levels 1,600 ppm; halogenated: 16 ppm, peak levels: 1,600 ppm).
  
  
  METHODS
  Mood troubles and non-specific neuropsychic deficits gradually evolved until they had to stop working. Neuropsychological assessment showed important deficits in attention, executive functioning, short-term memory and visuo-spatial organization. Blood tests, VEPs, MRI, neuroSPECT and cardiovascular exams were normal. Troubles had slowly improved after cessation of exposure and sequels still remain.
  
  
  CONCLUSIONS
  These CTE cases seem to be the consequence of a long-term exposure to important levels of anaesthetic gases, and particularly nitrous oxide. It points out the importance of preventive measures in operating rooms, where occupational hazards are varied.
authors.affiliation: Consultation de Pathologie Professionnelle, AP-HM Timone, Marseille, France.
authors.forename: Elsa
authors.initials: E
authors.lastname: Dreyfus
authors.forename: Eve
authors.initials: E
authors.lastname: Tramoni
authors.forename: Marie-Pascale
authors.initials: MP
authors.lastname: Lehucher-Michel
mesh_terms: D000776:Anesthesiology; D018685:Anesthetics, Inhalation / Q000009:adverse effects* / Q000032:analysis; D003072:Cognition Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D020258:Neurotoxicity Syndromes / Q000175:diagnosis / Q000628:therapy; D009609:Nitrous Oxide / Q000009:adverse effects* / Q000032:analysis; D009784:Occupational Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D016273:Occupational Exposure / Q000009:adverse effects* / Q000032:analysis; D009873:Operating Rooms; D010564:Personnel, Hospital; D016896:Treatment Outcome; D014691:Ventilation
chemical_list: D018685:Anesthetics, Inhalation; D009609:Nitrous Oxide