Health worker exposure risk during inhalation sedation with sevoflurane using the (AnaConDa®) anaesthetic conserving device.
OBJECTIVE
Occupational exposure to sevoflurane should not exceed 2 ppm. During inhalation sedation with sevoflurane using the anaesthetic conserving device (AnaConDa(®)) in the post-anaesthesia care unit, waste gases can be reduced by gas extraction systems or scavenging devices such as CONTRAfluran™. However, the efficacy of these methods has not been clearly established. To determine the safest scenario for healthcare workers during inhalation sedation with sevoflurane in the post-surgical intensive care unit.


METHODS
An experimental study on occupational exposure was conducted in a post-cardiothoracic care unit during March-August 2009. The measurements were performed in four post-cardiac surgery sedated adults in post-surgical intensive care unit and four nurses at the bedside, and at four points: scenario A, inhalation sedation without gas extraction system or contrafluran as a reference scenario; scenario B, applying a gas extraction system to the ventilator; scenario C, using contrafluran; and scenario 0, performing intravenous isolation sedation. Sevoflurane concentrations were measured in the nurses' breathing area during patient care, and at 1.5 and 8 m from the ventilator using diffusive passive monitor badges.


RESULTS
All badges corresponding to the nurses' breathing area were below 2 ppm. Levels of sevoflurane detected using prevention systems were lower than that in the control situation. Only one determination over 2 ppm was found, corresponding to the monitor placed nearest the gas outlet of the ventilator in scenario A. Trace concentrations of sevoflurane were found in scenario 0 during intravenous sedation.


CONCLUSIONS
Administration of sevoflurane through the AnaConDa(®) system during inhalation sedation in post-surgical intensive care units is safe for healthcare workers, but gas extraction systems or scavenging systems, such as CONTRAfluran™ should be used to reduce occupational exposure as much as possible.
Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain. Electronic address: rgonzalezr@santpau.cat.
R
R
González-Rodríguez
Servicio de Riesgos Laborales y Medicina Preventiva, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
A
A
Muñoz Martínez
Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
J
J
Galan Serrano
Servicio de Anestesiología y Reanimación, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
M V
MV
Moral García
D000395:Air Pollutants, Occupational / Q000009:adverse effects* / Q000032:analysis; D000769:Anesthesia, Inhalation / Q000295:instrumentation*; D018685:Anesthetics, Inhalation / Q000008:administration & dosage / Q000009:adverse effects*; D004867:Equipment Design; D015920:Gas Scavengers; D005740:Gases; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects* / Q000032:analysis; D019570:Inhalation Exposure / Q000009:adverse effects / Q000032:analysis; D007362:Intensive Care Units; D008738:Methyl Ethers / Q000009:adverse effects* / Q000032:analysis; D009726:Nurses; D016273:Occupational Exposure; D011997:Recovery Room; D000077149:Sevoflurane; D012122:Ventilators, Mechanical
D000395:Air Pollutants, Occupational; D018685:Anesthetics, Inhalation; D005740:Gases; D006993:Hypnotics and Sedatives; D008738:Methyl Ethers; D000077149:Sevoflurane
Cuidados intensivos postoperatorios; Exposición profesional; Inhalation sedation; Post-surgical intensive care unit; Professional exposure; Sedación inhalatoria; Sevoflurane; Sevoflurano