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The child's behavior during inhalational induction and its impact on the anesthesiologist's sevoflurane exposure
Jennifer Herzog-Niescery1, Heike Vogelsang1, Martin Bellgardt1
1Department of Anesthesiology, Ruhr-University Bochum, St. Josef- and St. Elisabeth Hospital, Bochum, Germany.
Insights
Child behavior during anesthesia induction significantly impacts anesthesiologist exposure to sevoflurane gas. Negative behaviors in children led to higher sevoflurane concentrations, highlighting the need to consider behavioral factors in operating room safety.
Area of Science:
- Anesthesiology
- Occupational Health
- Pediatric Care
Background:
- Sevoflurane is a common inhalational anesthetic for pediatric induction.
- Personnel exposure to sevoflurane poses potential health risks.
- Child behavior's impact on operating room (OR) pollution is understudied.
Purpose of the Study:
- To investigate the relationship between child behavior during anesthesia induction and sevoflurane waste in anesthesiologists' breathing zones.
- To assess the influence of the Frankl Behavioral Scale on sevoflurane exposure levels.
Main Methods:
- Prospective observational study of 68 children (36-96 months) undergoing elective ENT surgery.
- Sevoflurane induction via facemask with standardized concentration and oxygen flow.
- Anesthesiologist behavior assessment using the Frankl Behavioral Scale (1-2 negative, 3-4 positive).
- Continuous photoacoustic gas monitoring of mean (c¯mean) and maximum (c¯max) sevoflurane concentrations in the anesthesiologist's breathing zone.
Main Results:
- Children exhibiting negative behaviors had significantly higher mean (12.63 ± 8.66 p.p.m) and maximum (242.86 ± 139.91 p.p.m) sevoflurane concentrations.
- Children with positive behaviors showed lower mean (4.38 ± 4.02 p.p.m) and maximum (70.06 ± 61.08 p.p.m) sevoflurane concentrations.
- Both mean and maximum concentrations were statistically significant (P < .001).
Conclusions:
- Negative child behavior during induction is associated with substantially increased sevoflurane exposure for anesthesiologists.
- Premedication status significantly influences the degree of sevoflurane pollution in the operating room environment.
- Behavioral management and premedication strategies may be crucial for reducing occupational exposure to anesthetic gases.
Background:
Sevoflurane is commonly used for inhalational inductions in children, but the personnel's exposure to it is potentially harmful. Guidance to reduce gas pollution refers mainly to technical aspects, but the impact of the child's behavior has not yet been studied.
Aims:
The purpose of this study was to determine how child behavior, according to the Frankl Behavioral Scale, affects the amount of waste sevoflurane in anesthesiologists' breathing zones.
Methods:
Sixty-eight children aged 36-96 months undergoing elective ENT surgery were recruited for this prospective, observational investigation. After oral midazolam premedication (0.5 mg/kg body weight), patients obtained sevoflurane using a facemask with an inspiratory concentration of 8 Vol.% in 100% oxygen (flow 10 L/min). Ventilation was manually supported and a venous catheter was placed. The inspiratory sevoflurane concentration was reduced, and remifentanil and propofol were administered before the facemask was removed and a cuffed tracheal tube inserted. The child's behavior toward the operating room personnel during induction was evaluated by the anesthesiologist (Frankl Behavioral Scale: 1-2 = negative behavior, 3-4 = positive behavior). During induction mean (c¯mean) and maximum (c¯max), sevoflurane concentrations were determined in the anesthesiologist's breathing zone by continuous photoacoustic gas monitoring.
Results:
Mean and maximum sevoflurane concentrations were c¯mean = 4.38 ± 4.02 p.p.m and c¯max = 70.06 ± 61.08 p.p.m in patients with positive behaviors and sufficient premedications and c¯mean = 12.63 ± 8.66 p.p.m and c¯max = 242.86 ± 139.91 p.p.m in children with negative behaviors and insufficient premedications (c¯mean: P < .001; c¯max: P < .001).
Conclusion:
Negative behavior was accompanied by significantly higher mean and maximum sevoflurane concentrations in the anesthesiologist's breathing zone compared with children with positive attitudes. Consequently, the status of premedication influences the amount of sevoflurane pollution in the air of operating rooms.
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