ccupational Exposure to Anesthetic WasteGases in Operating Rooms: a Need to ReviseOccupational Exposure Limits in Iran

a Need to ReviseOccupational Exposure Limits in IranMohammad Hajaghazadehli, Abbas Jafariz1 Department of Occupational Health, Health Faculty, Urmia University of Medical Sciences, Urmia, |ran- 2Department of Occupational Health, School of Health, Urmia University of MedicalSciences, Urmia, |ran- Corresponding Author: Mohammad Hajaghazadeh, Email: hajaghazade@gmai|.com, Tel: [phone]nesthetic gases were developed in the17th century and nowadays are widely usedfor the general anesthesia in the operatingrooms (ORs).1 Anesthetic agents, especiallyhalogenated anesthetics and nitrous oxide (NZO),can contaminate the ambient air of the ORs andtherefore occupational exposure to these gases is acommon occupational hazard. The anesthesiamachine leakage, inadequate scavenging system andexhalation of the patient are the major causes ofexposure to anesthetic wastes in ORs.2The emissionof anesthetic gases into the atmosphere of ORs couldbe minimized by different approaches such asengineering and administrative controls.Different adverse health effects includingneurobehavioral changes, fatigue, headaches, dizziness,lethargy, memory problems have been reported as theresult of exposure to trace levels of waste anestheticgases. According to much of the supportive evidencederives from animal studies, the chronic exposure tothese agents have linked to liver and kidney damage,genotoxicity, spontaneous abortion, and congenitalmalformations. Personal exposure assessment of anestheticgases includes biological and breathing zone airmonitoring. ACGIH did not set any biologicalexposure index (BEI) for anesthetic gases. Someresearchers investigated the urinary concentration ofunmetabolised anesthetic agents or their metabolites.For example, the urinary concentrations of sevofluraneand hexafluoro-isopropanol (HFIP) have beeninvestigated in the occupationally exposedpersonnel.7’8 In the studies in which the concentrationof breathing zone and urinary concentration ofanesthetic agent has been correlated, a biologicalequivalent limit corresponding to the established OELhas been suggested. For example, Jafari et al. foundbiological equivalent limit of 3.61 pg/lurine for 2 ppmenvironmental exposure of isoflurane. Similar valueshave also reported as biological equivalent limit forisoflurane by other researchers Further studies areneeded to establish BEI for anesthetic agents.