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[Exposure of the pediatric surgeon to inhalation-anesthetic during pediatric bronchoscopy procedures]
K Westphal1, V Lischke, T Aybeck
1Zentrum für Anästhesiologie und Wiederbelebung, J. W. Goethe-Universität Frankfurt.
Background:
General anaesthetic agents are frequently used for paediatric bronchoscopy. A disadvantage of this open system anaesthesia seems to be the contamination of the working environment. The aim of this study was to determine the exposure of the endoscopist during paediatric bronchoscopy under general anaesthesia in different working environments and to compare these measurements with the currently valid international threshold limit values.
Material And Methods:
25 children (ASA I-III) scheduled for diagnostic bronchoscopy were included in the study. After inhalational induction all children were intubated with a nonflexible bronchoscope and manually ventilated through a side arm of the bronchoscope. Maintenance of anaesthesia was achieved with sevoflurane (2-3 vol%) in 80% oxygen. Trace concentrations were measured every 90 seconds in the breathing zones of the paediatrician by means of a highly sensitive direct-reading instrument (Brüel & Kjaer 1302). The lower detection limit was 0.02 ppm. The investigation was done in an OT with and without air conditioning and scavening system.
Results:
The mean age of the children was 50.3 months (range: 3-109 months). Ventilation and oxygenation were stable throughout the bronchoscopic procedure. Mean exposure of the paediatrician without air-conditioning and scavening system to sevoflurane was over 50 ppm for the endoscopist. All international threshold limit values were exceeded. Peak concentrations higher than 100 ppm sevoflurane were detected repeatedly in 40% of anaesthesias. During bronchoscopy in the operating room equipped with laminar air flow (20.2 air exchanges per hour) and narcotic gas evacuation (30 l/min) the mean exposure of the paediatrician was 26.4 ppm sevoflurane.
Conclusions:
The main finding of the present study is that under inhalation anaesthesia with sevoflurane for paediatric bronchoscopy occupation exposure is higher than the limits stated in all known health regulation guidelines. Therefore, in case of such working conditions, the use of total intravenous anaesthesia is advocated also in very small infants.