[Exposure of anesthetists to sevoflurane and nitrous oxide during inhalation anesthesia induction in pediatric anesthesia].

Abstract

Inhalational mask induction with nitrous oxide and sevoflurane in young children is an appropriate alternative to intravenous induction and is considered safe and of rapid onset. Disadvantages of this technique are environmental pollution and occupational exposure to the inhalation agents used. Moreover, the potential health hazards are not yet completely clear. The purpose of the present study was to examine the anaesthesiologist's occupational exposure to nitrous oxide and sevoflurane in paediatric anaesthesia and mask induction. Twenty children underwent inhalational induction with nitrous oxide and sevoflurane in the operating theatre (air exchange rate 20.2/h, anaesthetic waste gas scavenger 40 l/min). Anaesthesia was maintained with the same agents. Air samples were taken from the edge of the anaesthesiologist's mouth continuously every 90 seconds, and trace concentrations of nitrous oxide and sevoflurane were analyzed with a direct reading infrared spectrometer (Brüel & Kjaer 1302, Denmark). Measurements taken during anaesthesia showed an increase in the concentrations of the anaesthetics used, but these were low. The highest mean concentrations occurred during induction (3.35 +/- 4.23 ppm for sevoflurane and 37.09 +/- 11.65 ppm for nitrous oxide). The overall peak levels measured were 6.31 +/- 4.23 ppm for sevoflurane and 68.78 +/- 40.79 ppm for nitrous oxide. Though the induction period was short compared to the whole length of anaesthesia, its impact on the overall waste gas exposure was 46.3% for sevoflurane (nitrous oxide 40.6%). Nonetheless, applicable German health law regulations were never infringed. The trace concentrations measured during inhalational mask induction and maintenance of anaesthesia were very low. With regard to modern workplace laws and health care regulations, gaseous induction in paediatric anaesthesia does not threaten the personnel's health.