The document discusses hazards from exposure to waste anesthetic gases, including short and long-term health effects. It recommends using scavenging systems and active monitoring to reduce exposure. Proper handling and storage of compressed gas cylinders and safe disposal of injectable agents are also covered.
Fatigue, headache, drowsiness, nausea, depression, and irritability are the short-term effects that resolve spontaneously when the person leaves the room where the waste gas is accumulating. If these symptoms recur frequently after each anesthetic period, the short-term effects may become more serious long-term effects.
Toxic metabolites include inorganic fluoride or bromide ions, oxalic acid, and free radicals. Isoflurane followed by sevoflurane are the least toxic inhalant anesthetics because of their primary elimination through the lungs. Methoxyflurane and halothane are the most toxic because of the large amount of waste gas retained by the anesthetist in body fat before they are metabolized by the liver and excreted by the kidneys.
These effects are most pronounced in areas in which the waste gas is not scavenged. It is difficult to interpret or compare results of waste anesthetic gas because there is a wide variation in agents used and conditions under which they are used. Also, personnel may be exposed to more than one agent at a time.
There have been many studies to determine the effects of long-term exposure to waste anesthetic gas, but there are still many questions about the results of the studies. The best way to minimize the long-term effects is to minimize the amount of unscavenged waste anesthetic gas to which operating room personnel are exposed.
Anesthetic gases that leak out of machines are not reduced by the scavenging system. Whereas large leaks may be obvious by their hissing sound, the odor of anesthetic gas, or a jet of air coming out of the reservoir bag or a hose, small leaks are often not detected until a specific test for leaks is conducted.
Because the potent opioids are so potent it may take more than normal amounts of reversal agent to antagonize them. Measures must be in place to provide respiratory and cardiovascular support in case of accidental exposure.