Concerns about the possible toxic effects of occupational exposure to inhalational anesthetics have been expressed since their introduction into clinical practice.

Several studies testing for chromosomal aberrations, sister chromatid exchanges, or changes in peripheral lymphocytes have found no evidence of cellular damage among clinicians exposed to the levels of anesthetic gases that are encountered in an adequately ventilated operating room (OR).

Nitrous oxide exposure is a special situation as this gas can irreversibly oxidize the cobalt atom of vitamin B₁₂ to an inactive state. This inhibits methionine synthetase and prevents the conversion of methyltetrahydrofolate to tetrahydrofolate, which is required for DNA synthesis, assembly of the myelin sheath, and methyl substitutions in neurotransmitters. At adequate clinically used concentrations of nitrous oxide, this inhibition could result in anemia and polyneuropathy. As with the halogenated hydrocarbon anesthetics, these effects with nitrous oxide have not been demonstrated in adequately scavenged ORs with effective waste gas scavenging.

There is no increased risk of spontaneous abortion in studies of personnel who work in scavenged environments where waste gases were scavenged.

It is likely that other job-associated conditions (e.g., stress, infections, long work hours, shift work, radiation exposure)
besides exposure to trace anesthetic gases may account for many of the adverse reproductive outcomes reported among some health care workers (HCWs).

The evidence taken as a whole suggests that there is a slight increase in the relative risk of spontaneous abortion and congenital abnormalities in offspring of female health care professionals working in ORs. This risk is minimized when appropriate waste gas scavenging technology is applied.

One of the principal reasons identified by the National Institute of Occupational Safety and Health (NIOSH) for limiting occupational exposure to waste anesthetic gases is to prevent “decrements in performance, cognition, audiovisual ability, and dexterity.”

Most of the measurable psychomotor and cognitive impairments (lethargy, fatigue) produced by brief exposures are short lived and disappear within 5 minutes of cessation of exposure.

Appropriate scavenging equipment and with adequate air exchange in the OR, levels of waste anesthetic gases could be significantly reduced.

Minimal levels of anesthetic gases can be obtained in the postanesthesia care unit (PACU) by ensuring adequate room ventilation and fresh gas exchange and by discontinuing the anesthetic gases in sufficient time before leaving the OR.

In 1977, NIOSH issued a criteria document that included recommended exposure limits (RELs) for waste anesthetic gases of 2 parts-per-million (ppm) (1-hour ceiling) for halogenated anesthetic agents when used alone or 0.5 ppm for halogenated agent and 25 ppm of nitrous oxide when used together (time-weighted average during the period of anesthetic administration).

NIOSH has not yet developed RELs for the agents most commonly used in current practice (isoflurane, sevoflurane, and desflurane). These volatile agents have potencies, chemical characteristics, and rates and products of metabolism that differ significantly from older anesthetics.
However, most states have instituted regulations calling for routine measurement of ambient gases in ORs and have mandated that levels not exceed an arbitrary maximum.

It is prudent to institute measures that reduce waste anesthetic levels in the OR environment to as low as possible. To ensure reduced occupational exposure, departmental programs facilities where anesthetics are administered should have procedures to monitor for detection of leaks in the anesthesia machines and contamination as a result of faulty anesthetic techniques (e.g., poor mask fit, or leaks around the cuffs of endotracheal tubes cuffs and laryngeal mask airways, and scavenging system malfunctions; Table 3-1).

Known cardiovascular complications of methyl methacrylate in surgical patients include hypotension, bradycardia, and cardiac arrest.

Reported risks from repeated occupational exposure to methyl methacrylate include skin irritation and burns, allergic reactions and asthma, eye irritation including possible corneal ulceration, headache, and neurologic signs.

The Occupational Safety and Health Administration (OSHA) recommends use of scavenging devices in order to maintain an 8-hour, time-weighted average exposure to methyl methacrylate of 100 ppm.

Latex in surgical and examination gloves has become a common source of allergic reactions among OR personnel. In many cases, HCWs who are allergic to latex experience their first adverse reactions while they are patients undergoing surgery. The prevalence of latex sensitivity among anesthesiologists is approximately 12%.

The protein content is responsible for most of the generalized allergic reactions to latex-containing surgical gloves. These reactions are exacerbated by the presence of powder that enhances the potential of latex particles to aerosolize and to spread to the respiratory systems of personnel and to environmental surfaces during the donning or removal of gloves (Table 3-2).

Anesthesia personnel are at risk of exposure from both direct (primary x-ray beam, leakage for other sites with x-ray equipment) and indirect (scattered radiation from reflected surfaces) sources of ionizing radiation.

Effects of radiation that result in DNA injury may result in the development of cancer. There is no known threshold below which the risk of developing cancer completely disappears, and there can be a long latency period before the clinical presentation of an induced neoplasm.

Recent studies, conducted subsequent to the increased utilization of ionizing radiation in ORs, cardiac catheterization laboratories and other interventional radiology suites have revealed a worrisome trend towards increased exposure among anesthesia personnel (although still well below OSHA limits [5 Rems]).