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Zanin M, Varela Junior AS, Bonel Acosta I, Anastacio Da Silva E, Gehrcke MI, Corcini CD. Acute exposure to isoflurane impairs sperm parameters in mice. Drug Chem Toxicol 2024; 47:330-337. [PMID: 36756678 DOI: 10.1080/01480545.2023.2176513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/22/2023] [Accepted: 01/28/2023] [Indexed: 02/10/2023]
Abstract
Isoflurane, an inhalational anesthetic from the halogenated group, has been increasingly used in the medical and scientific fields. Due to its characteristics, it is capable of inducing anesthesia quickly and quietly; however, the adverse effects resulting from its use have not yet been fully elucidated, especially with regard to reproductive aspects. Considering its common use in research laboratories, whether for performing surgical procedures or for prior exposure to euthanasia, knowledge about its interference in sperm parameters of experimental models characterizes an important study goal. The aim of the present study was to determine the interference of acute exposure to isoflurane on the sperm quality of mice, both immediately previous to euthanasia and in later evaluation, twenty days after a single anesthetic exposure. Our results demonstrate that acute anesthetic exposure reduces sperm motility and is responsible for the formation of damaged sperm cells that are prone to apoptosis, which may affect the outcome of reproductive experiments even 20 days after exposure.
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Affiliation(s)
- Marina Zanin
- Program in Physiological Sciences, Institute of Biological Sciences, Federal University of Rio Grande, Rio Grande, Brazil
- Faculty of Veterinary Medicine, RAC-Center for Teaching and Research in Animal Reproduction, Federal University of Pelotas, Pelotas, Brazil
| | - Antonio Sergio Varela Junior
- Faculty of Veterinary Medicine, RAC-Center for Teaching and Research in Animal Reproduction, Federal University of Pelotas, Pelotas, Brazil
- Institute of Biological Sciences, Federal University of Rio Grande, Rio Grande, Brazil
| | - Izani Bonel Acosta
- Faculty of Veterinary Medicine, RAC-Center for Teaching and Research in Animal Reproduction, Federal University of Pelotas, Pelotas, Brazil
- Faculty of Veterinary Medicine, Federal University of Pelotas, University Campus, Pelotas, Brazil
| | - Edenara Anastacio Da Silva
- Faculty of Veterinary Medicine, RAC-Center for Teaching and Research in Animal Reproduction, Federal University of Pelotas, Pelotas, Brazil
- Faculty of Veterinary Medicine, Federal University of Pelotas, University Campus, Pelotas, Brazil
| | - Martielo Ivan Gehrcke
- Faculty of Veterinary Medicine, Federal University of Pelotas, University Campus, Pelotas, Brazil
| | - Carine Dahl Corcini
- Faculty of Veterinary Medicine, RAC-Center for Teaching and Research in Animal Reproduction, Federal University of Pelotas, Pelotas, Brazil
- Institute of Biological Sciences, Federal University of Rio Grande, Rio Grande, Brazil
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Ladeira C, Møller P, Giovannelli L, Gajski G, Haveric A, Bankoglu EE, Azqueta A, Gerić M, Stopper H, Cabêda J, Tonin FS, Collins A. The Comet Assay as a Tool in Human Biomonitoring Studies of Environmental and Occupational Exposure to Chemicals-A Systematic Scoping Review. TOXICS 2024; 12:270. [PMID: 38668493 PMCID: PMC11054096 DOI: 10.3390/toxics12040270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 03/31/2024] [Accepted: 04/02/2024] [Indexed: 04/29/2024]
Abstract
Biomonitoring of human populations exposed to chemical substances that can act as potential mutagens or carcinogens, may enable the detection of damage and early disease prevention. In recent years, the comet assay has become an important tool for assessing DNA damage, both in environmental and occupational exposure contexts. To evidence the role of the comet assay in human biomonitoring, we have analysed original research studies of environmental or occupational exposure that used the comet assay in their assessments, following the PRISMA-ScR method (preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews). Groups of chemicals were designated according to a broad classification, and the results obtained from over 300 original studies (n = 123 on air pollutants, n = 14 on anaesthetics, n = 18 on antineoplastic drugs, n = 57 on heavy metals, n = 59 on pesticides, and n = 49 on solvents) showed overall higher values of DNA strand breaks in the exposed subjects in comparison with the unexposed. In summary, our systematic scoping review strengthens the relevance of the use of the comet assay in assessing DNA damage in human biomonitoring studies.
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Affiliation(s)
- Carina Ladeira
- H&TRC-Health & Technology Research Center, ESTeSL-Escola Superior de Tecnologia da Saúde, Instituto Politécnico de Lisboa, 1990-096 Lisbon, Portugal
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, 1600-560 Lisbon, Portugal
| | - Peter Møller
- Department of Public Health, Section of Environmental Health, University of Copenhagen, 1172 Copenhagen, Denmark;
| | - Lisa Giovannelli
- Department NEUROFARBA, Section Pharmacology and Toxicology, University of Florence, 50121 Florence, Italy;
| | - Goran Gajski
- Division of Toxicology, Institute for Medical Research and Occupational Health, 10000 Zagreb, Croatia; (G.G.); (M.G.)
| | - Anja Haveric
- Institute for Genetic Engineering and Biotechnology, University of Sarajevo, 71000 Sarajevo, Bosnia and Herzegovina;
| | - Ezgi Eyluel Bankoglu
- Institute of Pharmacology and Toxicology, University of Würzburg, 97078 Würzburg, Germany; (E.E.B.); (H.S.)
| | - Amaya Azqueta
- Department of Pharmaceutical Sciences, School of Pharmacy and Nutrition, University of Navarra, 31009 Pamplona, Spain;
| | - Marko Gerić
- Division of Toxicology, Institute for Medical Research and Occupational Health, 10000 Zagreb, Croatia; (G.G.); (M.G.)
| | - Helga Stopper
- Institute of Pharmacology and Toxicology, University of Würzburg, 97078 Würzburg, Germany; (E.E.B.); (H.S.)
| | - José Cabêda
- Guarda Nacional Republicana, Destacamento Territorial de Vila Franca de Xira, Núcleo de Proteção Ambiental, 1500-124 Lisbon, Portugal;
| | - Fernanda S. Tonin
- Pharmaceutical Care Research Group, Universidad de Granada, 18012 Granada, Spain;
| | - Andrew Collins
- Department of Nutrition, University of Oslo, 0316 Oslo, Norway;
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Silva MAP, Figueiredo DBS, de Carvalho LR, Braz LG, Braz MG. Modulation of gene expression and influence of gene polymorphisms related to genotoxicity and redox status on occupational exposure to inhaled anesthetics. Int J Hyg Environ Health 2024; 256:114307. [PMID: 38065035 DOI: 10.1016/j.ijheh.2023.114307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/29/2023] [Accepted: 11/30/2023] [Indexed: 12/19/2023]
Abstract
The extensive use of inhalational anesthetics contributes to both indoor and outdoor (environmental) pollution. The influence of genetic susceptibility on DNA damage and oxidative stress and the possible modulation of gene expression have not yet been investigated upon occupational exposure to waste anesthetic gases (WAGs). This study assessed 8-oxoguanine DNA glycosylase 1 (OGG1) and superoxide dismutase 2 (SOD2) gene expression, which are related to oxidized DNA repair and antioxidant capacity, respectively, and the influence of their polymorphisms (OGG1 rs1052133 and SOD2 rs4880) in 100 professionals highly exposed to WAGs and 93 unexposed volunteers (control group). Additionally, X-ray repair cross complementing 1 (XRCC1 rs25487 and rs1799782) and ataxia telangiectasia mutated (ATM rs600931) gene polymorphisms as well as genetic instability (micronucleus-MN and nuclear bud-NBUD) and oxidative stress (malondialdehyde-MDA and ferric reducing antioxidant power-FRAP) biomarkers were assessed in the groups (control and exposed) and in the subgroups of the exposed group according to job occupation (anesthesiologists versus surgeons/technicians). Except for the ATM TT controls (associated with increased FRAP), there were no influences of OGG1, XRCC1, ATM, and SOD2 polymorphisms on MN, NBUD, MDA, and FRAP values in exposed or control subjects. No significant difference in the expression of either gene evaluated (OGG1 and SOD2) was found between the exposed and control groups. Increased OGG1 expression was observed among OGG1 -/Cys individuals only in the control group. Among the exposed group, anesthesiologists had a greater duration of WAG exposure (both h/week and years) than surgeons/technicians, which was associated with increased MDA and decreased antioxidant capacity (FRAP) and SOD2 expression (redox status). Higher expression of OGG1 was found in -/Cys surgeons/technicians than in anesthesiologists with the same genotype. Increased antioxidant capacity was noted in the surgeons/technicians carrying the ATM T allele and in those carrying XRCC1 -/Gln. Increased MN was influenced by OGG1 -/Cys in surgeons/technicians. Anesthesiologists with ATM CC exhibited increased MN, and those carrying the C allele (CC/CT genotype) exhibited increased NBUD. SOD2 polymorphism did not seem to be relevant for WAG exposure. These findings contribute to advancing the knowledge on genetic susceptibility/gene expression/genetic instability/oxidative stress, including differences in job occupation considering the workload, in response to occupational exposure to WAGs.
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Affiliation(s)
- Mariane A P Silva
- GENOTOX Laboratory, Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - Drielle B S Figueiredo
- GENOTOX Laboratory, Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - Lídia R de Carvalho
- Institute of Biosciences, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - Leandro G Braz
- GENOTOX Laboratory, Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - Mariana G Braz
- GENOTOX Laboratory, Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil.
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Braz MG, Figueiredo DBS, Golim MA, Grassi TF, da Costa BRB, De Martinis BS, Braz LG. Veterinarians exposed to inhaled anesthetic present chromosome damage, apoptosis and cell cycle changes. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2024; 65:96-102. [PMID: 38333941 DOI: 10.1002/em.22586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/17/2024] [Accepted: 01/24/2024] [Indexed: 02/10/2024]
Abstract
This cross-sectional study evaluated, for the first time, DNA damage, viability, and cell death of lymphocytes and cell cycle phases of mononuclear and polymorphonuclear cells in veterinarians exposed to the volatile anesthetic isoflurane. Veterinarians who were occupationally exposed to isoflurane (exposed group; n = 20) and matched-unexposed individuals (volunteers without occupational exposure; n = 20) were enrolled in the study. DNA damage was assessed in lymphocytes by micronucleus (MN) and phosphorylated histone gamma-H2AX (γ-H2AX). Cell viability, cytotoxicity, and the cell cycle were evaluated by flow cytometry. Isoflurane was detected in urine samples by headspace gas chromatography-mass spectrometry. Compared with unexposed subjects, veterinarians occupationally exposed to isoflurane (25.7 ± 23.7 μg/L urine) presented statistically higher MN frequencies, lymphocytic apoptosis rates, and numbers of polymorphonuclear cells in the G0/G1 stage. Additionally, the exposed group presented statistically lower proportions of viable lymphocytes and G2/M polymorphonuclear cells. Our findings indicate that veterinarians who are frequently exposed to inhaled anesthetic exhibit chromosomal and cell damage in addition to changes in peripheral blood cell proliferation.
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Affiliation(s)
- Mariana G Braz
- Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | | | - Marjorie A Golim
- Clinical Hospital of Botucatu Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - Tony F Grassi
- Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
| | - Bruno R B da Costa
- Faculty of Pharmaceutical Sciences, University of Sao Paulo - USP, Ribeirao Preto, Brazil
| | - Bruno S De Martinis
- Faculty of Philosophy, Sciences and Letters, University of Sao Paulo - USP, Ribeirao Preto, Brazil
| | - Leandro G Braz
- Medical School, Sao Paulo State University - UNESP, Botucatu, Brazil
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Lestari MI, Murti K, Liberty IA, Hafy Z, Linardi V, Khoirudin M, Umar TP. Waste anesthetic gases have a significant association with deoxyribonucleic acid (DNA) damage: A systematic review and meta-analysis of 2,732 participants. Heliyon 2023; 9:e19988. [PMID: 37810053 PMCID: PMC10559673 DOI: 10.1016/j.heliyon.2023.e19988] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 08/17/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023] Open
Abstract
Introduction Operating room workers are at risk of experiencing adverse effects due to occupational exposure to waste anesthetic gases (WAGs). One of the consequences of long-term WAGs exposure is the probability of developing deoxyribonucleic acid (DNA) damage. This systematic review investigated the link between WAGs and DNA damage in operating room workers. Methods PubMed, Science Direct, ProQuest, Scopus, and EbscoHost, as well as hand-searching, were used to find literature on the relationship between WAGs and DNA damage. Three independent reviewers independently assessed the study's quality. Meta-analysis was conducted for several DNA damage indicators, such as comet assay (DNA damage score, tail's length, tail's DNA percentage), micronuclei formation, and total chromosomal aberration. Results This systematic review included 29 eligible studies (2732 participants). The majority of the studies used a cross-sectional design. From our meta-analysis, which compared the extent of DNA damage in operating room workers to the unexposed group, operating room workers exposed to WAGs had a significantly higher DNA damage indicator, including DNA damage score, comet tail's length, comet tail's DNA percentage, micronuclei formation, and total chromosomal aberration (p < 0.05) than non-exposed group. Conclusion Waste anesthetic gases have been found to significantly impact DNA damage indicators in operating room personnel, including comet assay, micronuclei development, and chromosomal aberration. To reduce the impact of exposure, hospital and operating room personnel should take preventive measures, such as by adapting scavenger method.
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Affiliation(s)
- Mayang Indah Lestari
- Doctoral Study Program in Biomedical Science, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sriwijaya, Dr. RSUP. Mohammad Hoesin Palembang, RS. Siti Fatimah, Palembang, Indonesia
| | - Krisna Murti
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Sriwijaya-RSUP Dr. Mohammad Hoesin, Palembang, Indonesia
| | - Iche Andriyani Liberty
- Department of Public Health, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Zen Hafy
- Doctoral Study Program in Biomedical Science, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Violantina Linardi
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Muhammad Khoirudin
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
| | - Tungki Pratama Umar
- Department of Anesthesiology and Intensive Therapy, Faculty of Medicine, Universitas Sriwijaya, Palembang, Indonesia
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Schnider TW, Nieuwenhuijs-Moeke GJ, Beck-Schimmer B, Hemmerling TM. Pro-Con Debate: Should All General Anesthesia Be Done Using Target-Controlled Propofol Infusion Guided by Objective Monitoring of Depth of Anesthesia? Anesth Analg 2023; 137:565-575. [PMID: 37590801 DOI: 10.1213/ane.0000000000006293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
In this Pro-Con commentary article, we discuss whether all general anesthesia should be done using target-controlled propofol anesthesia guided by monitoring of depth of anesthesia. This is an ongoing debate since more than 25 years, representing a scientific, cultural as well as geographical divide in the anesthesia community. The Pro side argues that total intravenous anesthesia causes less postoperative nausea and higher patient satisfaction than anesthesia using volatile anesthetics. Target-controlled infusion (TCI) of anesthetic agents allows for better titration of intravenous anesthesia using pharmacokinetic models. Processed EEG monitors, such as bispectral index monitoring, allows for better assessing the effect of TCI anesthesia than solely assessment of clinical parameters, such as ECG or blood pressure. The combination of TCI propofol and objective depth of anesthesia monitoring allows creating a pharmacokinetic-pharmacodynamic profile for each patient. Finally, anesthesia using volatile anesthetics poses health risks for healthcare professionals and contributes to greenhouse effect. The Con side argues that for procedures accompanied with ischemia and reperfusion injury of an organ or tissue and for patients suffering from a severe inflammation' the use of volatile anesthetics might well have its advantages above propofol. In times of sudden shortage of drugs, volatile anesthetics can overcome the restriction in the operating theater or even on the intensive care unit, which is another advantage. Volatile anesthetics can be used for induction of anesthesia when IV access is impossible, end-tidal measurements of volatile anesthetic concentration allows confirmation that patients receive anesthetics. Taking environmental considerations into account, both propofol and volatile anesthetics bear certain harm to the environment, be it as waste product or as greenhouse gases. The authors therefore suggest to carefully considering advantages and disadvantages for each patient in its according environment. A well-balanced choice based on the available literature is recommended. The authors recommend careful consideration of advantages and disadvantages of each technique when tailoring an anesthetic to meet patient needs. Where appropriate, anesthesia providers are encouraged to account for unique features of anesthetic drug behavior, patient-reported and observed postoperative outcomes, and economic and environmental considerations when choosing any of the 2 described techniques.
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Affiliation(s)
- Thomas W Schnider
- From the Department for Anesthesiology, Intensive, Rescue and Pain medicine, Kantonsspital St Gallen, St Gallen, Switzerland
| | - Gertrude J Nieuwenhuijs-Moeke
- Department of Anesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, the Netherlands
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Aun AG, Damasceno DC, Sinzato YK, Nogueira FR, Souza KM, Lawi YSA, Guedes JL, Silva MAP, de Carvalho LR, Braz LG, Braz MG. High anesthetic exposure leads to oxidative damage and gene expression changes in physicians during medical residency: a cohort study. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023:10.1007/s11356-023-27577-y. [PMID: 37184787 DOI: 10.1007/s11356-023-27577-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
Evaluation of the possible toxic effects of occupational exposure to anesthetics is of great importance, and the literature is limited in assessing the possible association between occupational exposure to anesthetics and oxidative stress and genetic damage. To contribute to the gap of knowledge in relation to cause-effect, this cohort study was the first to monitor exposure assessment and to evaluate oxidative stress, DNA damage, and gene expression (OGG1, NRF2, HO-1, and TP53) in young adult physicians occupationally exposed to the most modern halogenated anesthetics (currently the commonly used inhalational anesthetics worldwide) in addition to nitrous oxide gas during the medical residency period. Therefore, the physicians were evaluated before the beginning of the medical residency (before the exposure to anesthetics-baseline), during (1 1/2 year) and at the end (2 1/2 years) of the medical residency. Anesthetic air monitoring was performed in operating rooms without adequate ventilation/scavenging systems, and biological samples were analyzed for lipid peroxidation, protein carbonyl content, primary and oxidative DNA damage, antioxidant enzymes and plasma antioxidant capacity, and expression of some key genes. The results showed induction of lipid peroxidation, DNA damage, glutathione peroxidase activity, and NRF2 and OGG1 expression up to the end of medical residency. Plasma antioxidant capacity progressively increased throughout medical residency; oxidative DNA damage levels started to increase during medical residency and were higher at the end of residency than at baseline. Protein carbonyls increased during but not at the end of medical residency compared to baseline. The antioxidant enzyme superoxide dismutase activity remained lower than baseline during and at the end of medical residency, and HO-1 (related to antioxidant defense) expression was downregulated at the end of medical residency. Additionally, anesthetic concentrations were above international recommendations. In conclusion, high concentrations of anesthetic in the workplace induce oxidative stress, gene expression modulation, and genotoxicity in physicians during their specialization period.
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Affiliation(s)
- Aline G Aun
- UNIPEX, Botucatu Medical School, São Paulo State University-UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, São Paulo, 18618-687, Brazil
| | - Débora C Damasceno
- UNIPEX, Botucatu Medical School, São Paulo State University-UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, São Paulo, 18618-687, Brazil
| | - Yuri K Sinzato
- UNIPEX, Botucatu Medical School, São Paulo State University-UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, São Paulo, 18618-687, Brazil
| | - Flávia R Nogueira
- UNIPEX, Botucatu Medical School, São Paulo State University-UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, São Paulo, 18618-687, Brazil
| | - Kátina M Souza
- UNIPEX, Botucatu Medical School, São Paulo State University-UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, São Paulo, 18618-687, Brazil
| | - Youssef S A Lawi
- UNIPEX, Botucatu Medical School, São Paulo State University-UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, São Paulo, 18618-687, Brazil
| | - Júlia L Guedes
- UNIPEX, Botucatu Medical School, São Paulo State University-UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, São Paulo, 18618-687, Brazil
| | - Mariane A P Silva
- UNIPEX, Botucatu Medical School, São Paulo State University-UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, São Paulo, 18618-687, Brazil
| | - Lídia R de Carvalho
- Department of Biostatistics, Institute of Biosciences, São Paulo State University-UNESP, Botucatu, São Paulo State, Brazil
| | - Leandro G Braz
- UNIPEX, Botucatu Medical School, São Paulo State University-UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, São Paulo, 18618-687, Brazil
| | - Mariana G Braz
- UNIPEX, Botucatu Medical School, São Paulo State University-UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, São Paulo, 18618-687, Brazil.
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Kević Dešić S, Viljetić B, Wagner J. Assessment of the Genotoxic and Cytotoxic Effects of Turpentine in Painters. Life (Basel) 2023; 13:life13020530. [PMID: 36836885 PMCID: PMC9966049 DOI: 10.3390/life13020530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Turpentine is a fluid used mainly as a solvent for thinning oil-based paints, obtained by distilling the resin of coniferous trees. Fine art painters use turpentine on a daily basis. The aim of this study was to investigate the genotoxic effect of turpentine and to determine the lymphocyte proliferation index in the peripheral blood of individuals occupationally exposed to turpentine. For this purpose, the cytokinesis-block micronucleus assay (CBMN) was used to determine the total number of micronuclei (MNi), nucleoplasmic bridges (NPB), and nuclear buds (NBUD), as well as the cell proliferation index (CBPI) in the peripheral blood lymphocytes of the subjects. Twenty-two subjects exposed to turpentine daily through their work participated in the study and were compared to twenty subjects in the control group. The results showed a significant increase in the number of micronuclei and other genotoxicity parameters, as well as significant cytotoxicity based on CBPI values. In addition, the genotoxic and cytotoxic effects of turpentine were found to be time-dependent, i.e., the deleterious effects of turpentine on genetic material increase with prolonged exposure. These results strongly suggest that exposure to turpentine vapors may affect genome stability and that occupational safety measures should be taken when using turpentine.
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Affiliation(s)
- Sara Kević Dešić
- Department of Medical Biology and Genetics, Faculty of Medicine, Josip Juraj Strossmayer University, 31000 Osijek, Croatia
| | - Barbara Viljetić
- Department of Medical Chemistry, Biochemistry and Clinical Chemistry, Faculty of Medicine, Josip Juraj Strossmayer University, 31000 Osijek, Croatia
- Correspondence: (B.V.); (J.W.)
| | - Jasenka Wagner
- Department of Medical Biology and Genetics, Faculty of Medicine, Josip Juraj Strossmayer University, 31000 Osijek, Croatia
- Correspondence: (B.V.); (J.W.)
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Silva MAP, Figueiredo DBS, Lara JR, Paschoalinotte EE, Braz LG, Braz MG. Evaluation of genetic instability, oxidative stress, and metabolism-related gene polymorphisms in workers exposed to waste anesthetic gases. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:9609-9623. [PMID: 36057057 DOI: 10.1007/s11356-022-22765-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
Professionals who work in operating rooms (ORs) may be exposed daily to waste anesthetic gases (WAGs) due to the use of inhalational anesthetics. Considering the controversial findings related to genetic damage and redox status in addition to a lack of knowledge about the effect of polymorphisms in genes related to phase I and II detoxification upon occupational exposure to WAGs, this cross-sectional study is the first to jointly evaluate biomarkers of genetic instability, oxidative stress, and susceptibility genes in professionals occupationally exposed to high trace amounts of halogenated (≥ 7 ppm) and nitrous oxide (165 ppm) anesthetics in ORs and in individuals not exposed to WAGs (control group). Elevated rates of buccal micronucleus (MN) and nuclear bud (NBUD) were observed in the exposure group and in professionals exposed aged more than 30 years. Exposed males showed a higher antioxidant capacity, as determined by the ferric reducing antioxidant power (FRAP), than exposed females; exposed females had higher frequencies of MN and NBUD than nonexposed females. Genetic instability (MN) was observed in professionals with greater weekly WAG exposure, and those exposed for longer durations (years) exhibited oxidative stress (increased lipid peroxidation and decreased FRAP). Polymorphisms in metabolic genes (cytochrome P450 2E1 (CYP2E1) and glutathione S-transferases (GSTs)) did not exert an effect, except for the effects of the GSTP1 (rs1695) AG/GG polymorphism on FRAP (both groups) and GSTP1 AG/GG and GSTT1 null polymorphisms, which were associated with greater FRAP values in exposed males. Minimizing WAG exposure is necessary to reduce impacts on healthcare workers.
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Affiliation(s)
- Mariane A P Silva
- Medical School - São Paulo State University (UNESP), Prof. Mario Rubens G. Montenegro Av. Botucatu, São Paulo, 18618-687, Brazil
| | - Drielle B S Figueiredo
- Medical School - São Paulo State University (UNESP), Prof. Mario Rubens G. Montenegro Av. Botucatu, São Paulo, 18618-687, Brazil
| | - Juliana R Lara
- Medical School - São Paulo State University (UNESP), Prof. Mario Rubens G. Montenegro Av. Botucatu, São Paulo, 18618-687, Brazil
| | - Eloisa E Paschoalinotte
- Medical School - São Paulo State University (UNESP), Prof. Mario Rubens G. Montenegro Av. Botucatu, São Paulo, 18618-687, Brazil
| | - Leandro G Braz
- Medical School - São Paulo State University (UNESP), Prof. Mario Rubens G. Montenegro Av. Botucatu, São Paulo, 18618-687, Brazil
| | - Mariana G Braz
- Medical School - São Paulo State University (UNESP), Prof. Mario Rubens G. Montenegro Av. Botucatu, São Paulo, 18618-687, Brazil.
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Kargar-Shouroki F, Halvani GH, Sharmandehmola FA. Effect of simultaneous exposure to inhalational anesthetics and radiation on the adaptive response in operating room personnel. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:10128-10135. [PMID: 36070043 DOI: 10.1007/s11356-022-22873-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/31/2022] [Indexed: 06/15/2023]
Abstract
Some operating room personnel, such as orthopedic surgeons, are exposed simultaneously to inhalational anesthetics (IAs) and radiation that both can cause DNA damage. Some studies have shown that low doses of radiation reduce DNA damage when the cells are followed by a higher dose of the same or related agent. This study, therefore, set out to compare DNA damage in the anesthesiologists, radiologists, orthopedic surgeons, and healthcare staff (non-exposed group). In this cross-sectional study, breathing zone concentrations of anesthetic gas nitrous oxide (N2O) were measured in the studied groups using standard method. Additionally, DNA damage was measured by micronucleus (MN) assay. The mean concentrations of N2O in the anesthesiologists and orthopedic surgeons were 450.27 ± 327.44 ppm and 313.64 ± 216.14 ppm, respectively. The mean annual exposure to X-rays radiation in radiologists and orthopedic surgeons was 15.65 ± 8.46 mSy/year and 3.56 ± 1.32 mSy/year, respectively. MN frequencies were significantly higher in anesthesiologists and radiologists exposed to IAs and X-rays radiation respectively than in the non-exposed healthcare staff. While, there were no statistically significant differences between MN frequencies of orthopedic surgeons exposed to both IAs and radiation and healthcare staff. These findings suggest that an earlier exposure of orthopedic surgeons to a small dose of ionizing radiation can increase their resistance to genotoxicity caused by high doses of N2O, a phenomenon that is called adaptive response.
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Affiliation(s)
- Fatemeh Kargar-Shouroki
- Occupational Health Research Center, Department of Occupational Health Engineering, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
| | - Gholam Hossein Halvani
- Occupational Health Research Center, Department of Occupational Health Engineering, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Fatemeh Alsadat Sharmandehmola
- Occupational Health Research Center, Department of Occupational Health Engineering, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Olika MK, Dessalegn ZM, Mekonin GT, Aboye MB, Wedajo MB, Ilala TT, Abebe DM, Demissie WR. Effect of Inhalational Anesthetics Exposure on Reproductive Outcomes and Its Predictors Among Healthcare Personnel in Jimma Zone Public Hospitals: A Comparative Cross-Sectional Study. Int J Womens Health 2022; 14:1555-1568. [DOI: 10.2147/ijwh.s376459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 10/05/2022] [Indexed: 11/11/2022] Open
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Figueiredo DBS, Aun AG, Souza KM, Nishimoto IH, Silva MAP, de Carvalho LR, Braz LG, Braz MG. High anesthetic (isoflurane) indoor pollution is associated with genetic instability, cytotoxicity, and proliferative alterations in professionals working in a veterinary hospital. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:71774-71784. [PMID: 35606583 DOI: 10.1007/s11356-022-20444-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/21/2022] [Indexed: 06/15/2023]
Abstract
This is the first study to monitor anesthetic pollution in veterinary operating rooms (VOR) and assess the toxicological impact of the inhalational anesthetic isoflurane (exposed group) compared to matched volunteers (control group). DNA damage was evaluated in mononuclear cells by the comet assay while genetic instability (including micronucleus-MN), cell proliferation, and cell death markers were assessed by the buccal MN cytome assay. Residual isoflurane concentrations in VOR (air monitoring) lacking the scavenging system were assessed by infrared spectrophotometry; the mean concentration was 11 ppm (≥ 5 times above the international recommended threshold). Comet assay results did not differ between groups; however, both younger exposed professionals (with higher week workload) compared to older individuals exposed for the same period and older professionals with greater time of exposure (years) compared to those in the same age group with fewer years of exposure presented higher DNA damage. The exposed group had a higher frequency of MN, nuclear buds, binucleated cells, karyorrhexis, and karyolysis and a lower frequency of basal cells than the control group. Exposed women were more vulnerable to genetic instability and proliferative index; exposed men presented more cytotoxicity. High WAG exposure has deleterious effects on exposed professionals.
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Affiliation(s)
- Drielle B S Figueiredo
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Aline G Aun
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Kátina M Souza
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Igor H Nishimoto
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Mariane A P Silva
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Lídia R de Carvalho
- Institute of Biosciences, São Paulo State University - UNESP, 250, Prof. Dr. Antônio Celso Wagner Zanin, Botucatu, 18618-689, Brazil
| | - Leandro G Braz
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Mariana G Braz
- GENOTOX Laboratory, Botucatu Medical School, São Paulo State University - UNESP, Prof. Mario Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil.
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Arbo MD, Garcia SC, Sarpa M, Da Silva Junior FM, Nascimento SN, Garcia ALH, Da Silva J. Brazilian workers occupationally exposed to different toxic agents: A systematic review on DNA damage. MUTATION RESEARCH/GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2022; 879-880:503519. [PMID: 35914865 DOI: 10.1016/j.mrgentox.2022.503519] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/23/2022] [Accepted: 06/21/2022] [Indexed: 10/17/2022]
Abstract
The evaluation of genotoxicity in workers exposed to different toxic agents is very important, especially considering the association between these exposures in a chronic context and DNA damage. Assessing biomarkers of exposure and, when possible, early biomarkers of effect, contributes to elucidating the potential toxic mechanisms involved in genotoxicity and its contribution to chronic non-communicable diseases. In Brazil, the biggest country in South America, workers are exposed to hazardous physical and chemical agents. Considering that these exposures occur, in most cases, throughout the worker's whole life, this is an important public health concern in Brazil. Therefore, this systematic review aims to analyze occupational exposure to chemical and physical agents and the association with DNA damage in studies carried out in Brazil from 1980 to 2021. A systematic and comprehensive literature search was performed in different databases based on occupational exposure to chemical and physical agents and DNA damage. Only full articles on studies that investigated experimental evidence on occupational exposure in Brazil and assessed DNA damage were included, amounting to 89 articles. Five main occupational exposure groups were identified: pesticides (36%), organic solvents (20%), dust and particles (16%), metals (11%), and ionizing radiation (6%). Another group called "others" included studies (11%) that did not fall into these main groups. It was found that comet assay and micronucleus tests are the most adopted methods to detect DNA damage. Occupational exposures were most associated with DNA damage. However, further improvements in study design would be needed to better characterize the association between biomonitoring and DNA damage, particularly to account for confounding factors.
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Neghab M, Kargar-Shouroki F, Mozdarani H, Yousefinejad S, Alipour H, Fardid R. Association between genotoxic properties of inhalation anesthetics and oxidative stress biomarkers. Toxicol Ind Health 2021; 36:454-466. [PMID: 32787740 DOI: 10.1177/0748233720935696] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Exposure to inhalation anesthetics (IAs) has been associated with DNA damage as reflected in the increased frequency of micronuclei (MN) and chromosomal aberrations (CAs). The present study was undertaken to ascertain whether there was any correlation between increased MN and CA and the extent of oxidative stress as well as the antioxidant status of a group of operating room personnel exposed to a mixture of IAs, including nitrous oxide, isoflurane, and sevoflurane. In this cross-sectional study, 60 operating room personnel (exposed group) in whom the frequencies of MN and CA had already been shown to be significantly higher than those of a referent group, as well as 60 unexposed nurses, were studied. Venous blood samples were taken from all participants, and malondialdehyde (MDA) levels as an index of oxidative stress (OS) and the activity of superoxide dismutase (SOD) and levels of total antioxidant capacity (TAC) as indices of antioxidant status were measured. The level of TAC (1.76 ± 0.59 mM vs. 2.13 ± 0.64 mM, p = 0.001) and the activity of SOD (11.22 ± 5.11 U/ml vs. 13.36 ± 4.12 U/ml, p = 0.01) were significantly lower, while the mean value of MDA was significantly higher (2.46 ± 0.66 µM vs. 2.19 ± 0.68 µM, p = 0.03) in the exposed group than in the nonexposed group. After adjusting for potential confounders, there were statistically significant associations between exposure to IAs, gender, SOD, and TAC with MN frequency and between exposure to IAs and SOD with numbers of CA. The findings of the present study indicated that exposure to IAs was associated with OS, and this, in turn, may be causally linked with DNA damage.
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Affiliation(s)
- Masoud Neghab
- Research Center for Health Sciences, Institute of Health, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Kargar-Shouroki
- Occupational Health Research Center, School of Public Health, 125423Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Hossein Mozdarani
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Saeed Yousefinejad
- Department of Occupational Health Engineering, School of Health, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hamzeh Alipour
- Research Center for Health Sciences, Institute of Health, 48435Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Fardid
- Department of Radiology, School of Paramedical Sciences, 48435Shiraz University of Medical Sciences, Shiraz, Iran
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Gaya da Costa M, Kalmar AF, Struys MMRF. Inhaled Anesthetics: Environmental Role, Occupational Risk, and Clinical Use. J Clin Med 2021; 10:1306. [PMID: 33810063 PMCID: PMC8004846 DOI: 10.3390/jcm10061306] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 03/14/2021] [Accepted: 03/18/2021] [Indexed: 12/17/2022] Open
Abstract
Inhaled anesthetics have been in clinical use for over 150 years and are still commonly used in daily practice. The initial view of inhaled anesthetics as indispensable for general anesthesia has evolved during the years and, currently, its general use has even been questioned. Beyond the traditional risks inherent to any drug in use, inhaled anesthetics are exceptionally strong greenhouse gases (GHG) and may pose considerable occupational risks. This emphasizes the importance of evaluating and considering its use in clinical practices. Despite the overwhelming scientific evidence of worsening climate changes, control measures are very slowly implemented. Therefore, it is the responsibility of all society sectors, including the health sector to maximally decrease GHG emissions where possible. Within the field of anesthesia, the potential to reduce GHG emissions can be briefly summarized as follows: Stop or avoid the use of nitrous oxide (N2O) and desflurane, consider the use of total intravenous or local-regional anesthesia, invest in the development of new technologies to minimize volatile anesthetics consumption, scavenging systems, and destruction of waste gas. The improved and sustained awareness of the medical community regarding the climate impact of inhaled anesthetics is mandatory to bring change in the current practice.
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Affiliation(s)
- Mariana Gaya da Costa
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, 9713GZ Groningen, The Netherlands;
| | - Alain F. Kalmar
- Department of Anesthesia and Intensive Care Medicine, Maria Middelares Hospital, 9000 Ghent, Belgium;
- Department of Basic and Applied Medical Sciences, Ghent University, 9000 Ghent, Belgium
| | - Michel M. R. F. Struys
- Department of Anesthesiology, University of Groningen, University Medical Center Groningen, 9713GZ Groningen, The Netherlands;
- Department of Basic and Applied Medical Sciences, Ghent University, 9000 Ghent, Belgium
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Effects of sevoflurane exposure on apoptosis and cell cycle of peripheral blood lymphocytes, and immunologic function. BMC Anesthesiol 2021; 21:87. [PMID: 33743600 PMCID: PMC7980647 DOI: 10.1186/s12871-021-01305-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Accepted: 02/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Waste anesthetic gases (WAGs) leaked from new-type halogenated inhalational anesthetics such as sevoflurane have been were reported to pose a risk for the health of operating room personnel. The effects of WAGs on peripheral blood lymphocytes, however, remain yet controversial. The present study was undertaken to examine the effects of occupational sevoflurane exposure on the peripheral blood lymphocytes of medical personnel who work in the operating room. METHODS A cohort of 56 medical residents were divided into exposed group (n = 28) and control group (non-exposed group) (n = 28). Gas chromatography was used to measure the concentration of sevoflurane in the medical resident's breathing zone during surgeries under inhalation anesthesia in the exposure group. The gas collection lasted an hour. Peripheral blood lymphocytes were isolated from venous blood, and then apoptosis and cell cycle were analyzed by flow cytometry. EDTA-anticoagulated whole blood was harvested to analyze the lymphocyte subsets by flow cytometry. Immunoglobulins (IgA, IgM, IgG) were quantified by immunoturbidimetry. RESULTS The average concentration of sevoflurane in the exposed group was 1.03 ppm with a range from 0.03 ppm to 2.24 ppm. No significant effects were found on the apoptosis rates or cell cycles of peripheral blood lymphocytes in the exposed group relative to the control group (P > 0.05). Similarly, there were no significant differences in the lymphocyte subsets or the levels of immunoglobulins (IgA, IgM, IgG) between the two groups (P > 0.05). CONCLUSIONS Occupational exposure to low-level sevoflurane has no significant effect on the peripheral blood lymphocytes of operating room staff, but this conclusion needs to be confirmed by multicenter and long-term follow-up studies with large samples. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION ChiCTR2000040772 , December 9, 2020 (Retrospective registration).
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Oliveira LA, P El Dib R, Figueiredo DBS, Braz LG, Braz MG. Spontaneous abortion in women occupationally exposed to inhalational anesthetics: a critical systematic review. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:10436-10449. [PMID: 33415631 DOI: 10.1007/s11356-020-11684-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 11/15/2020] [Indexed: 06/12/2023]
Abstract
Occupational exposure to inhalational anesthetics has been associated with health problems, including reproductive issues. Considering the scarcity and outdated nature of reviews concerning this relevant topic, which has implications for indoor pollution/environmental science/public health, this critical review aimed to systematically evaluate whether exposure to inhalational anesthetics is associated with abortion. Seven databases were searched with no language or year restrictions. Of the 3881 search results, 18 observational studies were included. Some studies demonstrated a significant association between occupational exposure to inhalational anesthetics and spontaneous abortion, especially among professionals who work for longer periods and/or in an environment without gas scavenging/ventilation systems, which may favor the occurrence of abortion in this population. Due to considerable heterogeneity and limitations, it cannot be concluded whether an association exists between occupational exposure to anesthetics and the occurrence of abortion. However, more well-designed studies should be performed, especially in less economically developed countries that do not have access to quality anesthetic gas scavenging/ventilation systems, thereby bringing this issue into sharp focus. This review highlights the need for scientific knowledge in this area and the extensive use of scavenging equipment and in the workplace to minimize exposure and reduce the risk of abortion.
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Affiliation(s)
- Lara A Oliveira
- Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Regina P El Dib
- Evidence-Based Medicine Unit, São Paulo State University - UNESP, Botucatu, Brazil
- McMaster University, Hamilton, Canada
| | - Drielle B S Figueiredo
- Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Leandro G Braz
- Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil
| | - Mariana G Braz
- Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Professor Mário Rubens G. Montenegro Av., Botucatu, 18618-687, Brazil.
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Measurement of anesthetic pollution in veterinary operating rooms for small animals: Isoflurane pollution in a university veterinary hospital. Braz J Anesthesiol 2021; 71:517-522. [PMID: 33685758 PMCID: PMC9373702 DOI: 10.1016/j.bjane.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 10/25/2020] [Indexed: 11/28/2022] Open
Abstract
Introduction Inhaled anesthetics are used worldwide for anesthesia maintenance both in human and veterinary operating rooms. High concentrations of waste anesthetic gases can lead to health risks for the professionals exposed. Considering that anesthetic pollution in a veterinary surgical center in developing countries is unknown, this study aimed, for the first time, to measure the residual concentration of isoflurane in the air of operating rooms for small animals in a Brazilian university hospital. Method Residual isoflurane concentrations were measured by an infrared analyzer at the following sites: corner opposite to anesthesia machine; breathing zones of the surgeon, anesthesiologist, and patient (animal); and in front of the anesthesia machine at three time points, that is, 5, 30 and 120 minutes after anesthesia induction. Results Mean residual isoflurane concentrations gradually increased in the corner opposite to anesthesia machine and in the breathing zones of the surgeon and the anesthesiologist (p < 0.05). There was an increase at 30 minutes and 120 minutes when compared to the initial time points in the animal's breathing zone, and in the front of the anesthesia machine (p < 0.05). There was no significant difference at measurement sites regardless of the moment of assessment. Conclusion This study reported high residual isoflurane concentrations in veterinary operating rooms without an exhaust system, which exceeds the limit recommended by an international agency. Based on our findings, there is urgent need to implement exhaust systems to reduce anesthetic pollution and decrease occupational exposure.
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Souza KM, De Vivo I, Chen CY, Nogueira FR, Aun AG, Arruda NM, Lara JR, Silva MAP, Figueiredo DBS, Corrêa CR, de Carvalho LR, Braz JRC, Braz LG, Braz MG. Oxidative stress, DNA damage, inflammation and gene expression in occupationally exposed university hospital anesthesia providers. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2021; 62:155-164. [PMID: 33341964 DOI: 10.1002/em.22420] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 12/08/2020] [Accepted: 12/16/2020] [Indexed: 06/12/2023]
Abstract
Considering the importance and lack of data of toxicogenomic approaches on occupational exposure to anesthetics, we evaluated possible associations between waste anesthetic gases (WAGs) exposure and biological effects including oxidative stress, DNA damage, inflammation, and transcriptional modulation. The exposed group was constituted by anesthesia providers who were mainly exposed to the anesthetics sevoflurane and isoflurane (10 ppm) and to a lesser degree to nitrous oxide (150 ppm), and the control group was constituted by physicians who had no exposure to WAGs. The oxidative stress markers included oxidized DNA bases (comet assay), malondialdehyde (high-performance liquid chromatography [HPLC]), nitric oxide metabolites (ozone-chemiluminescence), and antioxidative markers, including individual antioxidants (HPLC) and antioxidant defense marker (ferric reducing antioxidant power by spectrophotometry). The inflammatory markers included high-sensitivity C-reactive protein (chemiluminescent immunoassay) and the proinflammatory interleukins IL-6, IL-8 and IL-17A (flow cytometry). Telomere length and gene expression related to DNA repair (hOGG1 and XRCC1), antioxidant defense (NRF2) and inflammation (IL6, IL8 and IL17A) were evaluated by real-time quantitative polymerase chain reaction. No significant differences (p > .0025) between the groups were observed for any parameter evaluated. Thus, under the conditions of the study, the findings suggest that occupational exposure to WAGs is not associated with oxidative stress or inflammation when evaluated in serum/plasma, with DNA damage evaluated in lymphocytes and leucocytes or with molecular modulation assessed in peripheral blood cells in university anesthesia providers. However, it is prudent to reduce WAGs exposure and to increase biomonitoring of all occupationally exposed professionals.
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Affiliation(s)
| | - Immaculata De Vivo
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Chung-Yen Chen
- Antioxidants Research Laboratory, Jean Mayer Human Nutrition Research Center on Aging (HNRCA), Tufts University, Boston, Massachusetts, USA
| | | | - Aline Garcia Aun
- Medical School, São Paulo State University (UNESP), Botucatu, Brazil
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Aun AG, Souza KM, Guedes JL, Figueiredo DBS, Lara JR, Silva MAP, Braz LG, Braz MG. Hepatotoxic and neuroendocrine effects in physicians occupationally exposed to most modern halogenated anesthetics and nitrous oxide. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2021; 81:103515. [PMID: 33086149 DOI: 10.1016/j.etap.2020.103515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 06/11/2023]
Abstract
The lack of data on hepatic and hormonal markers for occupational exposure to most modern halogenated anesthetics has stimulated our research, which assessed liver enzymes, high-sensitivity C-reactive protein (hs-CRP) and neuroendocrine response. The study investigated 106 physicians who were categorized in an exposed group (primarily exposed to isoflurane and sevoflurane and less to desflurane and nitrous oxide) as well as as a control group. Anesthetic air monitoring was performed, and biological samples were analyzed for the most important liver enzymes, hs-CRP, adrenocorticotrophic hormone, cortisol and prolactin. No biomarkers were significantly different between the groups. Exposed males showed significant increases in cortisol and prolactin compared to unexposed males. However, values were within the reference ranges, and 22 % of exposed males versus 5 % of unexposed males exhibited higher prolactin values above the reference range. This study suggests that occupational exposure to the most commonly used inhalational anesthetics is not associated with hepatotoxicity or neurohormonal changes.
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Affiliation(s)
- Aline G Aun
- Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Kátina M Souza
- Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Júlia L Guedes
- Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Drielle B S Figueiredo
- Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Juliana R Lara
- Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Mariane A P Silva
- Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Leandro G Braz
- Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Mariana G Braz
- Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil.
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Rohr P, da Silva GF, Vicentini VEP, Almeida IVD, Dos Santos RA, Takahashi CS, Goulart MO, da Silva GN, de Oliveira LB, Grisolia CK, Piau TB, Bassi Branco CL, Reis ÉDM, de Oliveira Galvão MF, de Medeiros SRB, Monteiro MS, de Vasconcelos Lopes RA, Brandão SFI, Batista NJC, Paz MFCJ, da Silva J. Buccal micronucleus cytome assay: Inter-laboratory scoring exercise and micronucleus and nuclear abnormalities frequencies in different populations from Brazil. Toxicol Lett 2020; 333:242-250. [PMID: 32841739 DOI: 10.1016/j.toxlet.2020.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 08/14/2020] [Accepted: 08/20/2020] [Indexed: 11/25/2022]
Abstract
The Buccal Micronucleus Cytome Assay (BMCyt) has become an important biomonitoring tool for assessing cytogenetic damage in many studied populations. Each laboratory applies protocols that vary according to the method of collecting and preparing samples. Besides, Brazil is a country of great territorial extensions that received immigrants from various parts of the world with different genetic backgrounds. Therefore, the present study aimed to evaluate the inter-laboratory variation in scoring the same set of slides using the more comprehensive scoring criteria, to standardize the BMCyt protocol, to observe the basal alterations in populations of different Brazilian regions and to compare it with other places around the world. Our results showed that a valuable number of laboratories participated, ten laboratories from different regions of the country, for the validation of the BMCyt in human biomonitoring studies, resulting in the 804 healthy individuals. This was possible because we observed: a range of measures needs to be considered, such as the baseline frequency of DNA damage and cell death in non-exposed individuals; age when grouped showed an influence on DNA damage, although when evaluated by group we did not see an influence; association between smoking habit and all endpoints of the BMCyt (except karyolytic cells) was evident; the basal MN frequency, in the majority of groups, follows those around the world; and the BMCyt was confirmed as a good health status biomarker. We emphasize the need for constant discussions on the parameters of cell death due to greater difficulty among the analyzers.
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Affiliation(s)
- Paula Rohr
- Laboratório de Genética Toxicológica, Programa de Pós- Graduação em Biologia Celular e Molecular Aplicada à Saúde (PPGBioSaúde), Universidade Luterana do Brasil, ULBRA, Canoas, RS, Brazil.
| | - Gabrieli Flesch da Silva
- Laboratório de Genética Toxicológica, Programa de Pós- Graduação em Biologia Celular e Molecular Aplicada à Saúde (PPGBioSaúde), Universidade Luterana do Brasil, ULBRA, Canoas, RS, Brazil
| | | | - Igor Vivian de Almeida
- Laboratório de Mutagênese e Monitoramento Ambiental, Universidade Estadual de Maringá, UEM, Maringá, PR, Brazil
| | - Raquel Alves Dos Santos
- Laboratório de Genética e Biologia Molecular, Universidade de Franca, UNIFRAN, Franca, SP, Brazil
| | - Catarina Satie Takahashi
- Departmento de Genética, Escola de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil; Departmento de Biologia, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Mirian Oliveira Goulart
- Laboratório de Genética e Biologia Molecular, Universidade de Franca, UNIFRAN, Franca, SP, Brazil
| | - Glenda Nicioli da Silva
- Laboratório de Pesquisas Clínicas, Universidade Federal de Ouro Preto, UFOP, Ouro Preto, MG, Brazil
| | | | - Cesar K Grisolia
- Laboratório de Genética Toxicológica Instituto de Biologia, Universidade de Brasilia, UnB, Brasília, DF, Brazil
| | - Tathyana B Piau
- Laboratório de Genética Toxicológica Instituto de Biologia, Universidade de Brasilia, UnB, Brasília, DF, Brazil
| | | | - Érica de Melo Reis
- Laboratório de Mutagênese, Universidade Federal de Mato Grosso, UFMT, Cuiabá, MT, Brazil
| | | | | | - Magaly Sales Monteiro
- Núcleo Bioprospecção e Experimentação Molecular-NUBEM, Centro Universitário INTA-UNINTA, Sobral, CE, Brazil
| | | | | | | | | | - Juliana da Silva
- Laboratório de Genética Toxicológica, Programa de Pós- Graduação em Biologia Celular e Molecular Aplicada à Saúde (PPGBioSaúde), Universidade Luterana do Brasil, ULBRA, Canoas, RS, Brazil; Laboratório de Genética Toxicológica, Programa de Pós- Graduação Profissional em Saúde e Desenvolvimento Humano (PPGSDH), Universidade La Salle, UniLaSalle, Canoas, RS, Brazil.
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22
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Braz MG, Silva MAP, Figueiredo DBS, Aun AG, Marques LSK, Lara JR, Braz LG. Genetic instability assessed by telomere length and micronucleus in physicians exposed to anesthetics. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2020; 61:843-847. [PMID: 32390193 DOI: 10.1002/em.22380] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 03/21/2020] [Accepted: 04/14/2020] [Indexed: 06/11/2023]
Abstract
This study evaluated both telomere length (TL) and micronucleus (MN) as indicators of genome instability in 40 anesthesiologists occupationally exposed to anesthetics and in 40 physicians without occupational exposure to anesthetics who were matched by age, sex, and lifestyle. Blood and buccal samples were collected from both groups at the same period. Anesthetic exposure assessment was performed. The studied groups were assessed regarding relative TL by quantitative polymerase chain reaction and MN by buccal MN assay. Mean trace concentrations of anesthetics were below two parts per million. No significant differences between groups were found for both biomarkers. However, MN frequency was slightly increased (1.9-fold; p = .094) in the exposed group compared to the control group and in the exposed males (2.4-fold; p = .090) compared to unexposed males. TL and age showed a significant negative correlation. Anesthetic occupational exposure below recommended levels is not associated with changes in TL and MN in anesthesiologists.
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Affiliation(s)
- Mariana G Braz
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Mariane A P Silva
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Drielle B S Figueiredo
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Aline G Aun
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Lais S K Marques
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Juliana R Lara
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Leandro G Braz
- GENOTOX Laboratory, Department of Anesthesiology, Botucatu Medical School, São Paulo State University - UNESP, Botucatu, Brazil
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Magnavita N, Di Prinzio RR, Soave PM. Systemic sclerosis in an anaesthetist. Occup Med (Lond) 2020; 70:442-444. [DOI: 10.1093/occmed/kqaa068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Abstract
Introduction
Systemic sclerosis is a potentially devastating disease in which the aetiology and pathogenesis has not yet been fully understood. It has been associated with occupational exposure to silica, vinyl chloride, solvents and other chemical agents.
Case summary
In this paper, we present the case of an anaesthetist who developed scleroderma after an occupational exposure to volatile anaesthetic gases (halothane, sevoflurane, isoflurane and enflurane) in operating theatres with poor scavenging systems and we discuss the possible causal link between occupational exposure and the disease.
Conclusions
The case reported is the second that we are aware of in recent years. Reporting scleroderma cases in workers may be the first step in assessing the causal link between occupational exposure to anaesthetic gases and the disease.
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Affiliation(s)
- N Magnavita
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Department of Woman/Child & Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - R R Di Prinzio
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
| | - P M Soave
- Post-Graduate School of Occupational Health, Università Cattolica del Sacro Cuore, Rome, Italy
- Poison Control Centre, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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24
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Herzog-Niescery J, Seipp HM, Bellgardt M, Herzog T, Belyaev O, Uhl W, Gude P, Weber TP, Vogelsang H. Comparison of 3 Methods to Assess Occupational Sevoflurane Exposure in Abdominal Surgeons: A Single-Center Observational Pilot Study. Anesth Analg 2020; 131:537-543. [PMID: 31295179 DOI: 10.1213/ane.0000000000004301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Studies demonstrated that operating room personnel are exposed to anesthetic gases such as sevoflurane (SEVO). Measuring the gas burden is essential to assess the exposure objectively. Air pollution measurements and the biological monitoring of urinary SEVO and its metabolite hexafluoroisopropanol (HFIP) are possible approaches. Calculating the mass of inhaled SEVO is an alternative, but its predictive power has not been evaluated. We investigated the SEVO burdens of abdominal surgeons and hypothesized that inhaled mass calculations would be better suited than pollution measurements in their breathing zones (25 cm around nose and mouth) to estimate urinary SEVO and HFIP concentrations. The effects of potentially influencing factors were considered. METHODS SEVO pollution was continuously measured by photoacoustic gas monitoring. Urinary SEVO and HFIP samples, which were collected before and after surgery, were analyzed by a blinded environmental toxicologist using the headspace gas chromatography-mass spectrometry method. The mass of inhaled SEVO was calculated according to the formula mVA = cVA·(Equation is included in full-text article.)·t·ρ VA aer. (mVA: inhaled mass; cVA: volume concentration; (Equation is included in full-text article.): respiratory minute volume; t: exposure time; and ρ VA aer.: gaseous density of SEVO). A linear multilevel mixed model was used for data analysis and comparisons of the different approaches. RESULTS Eight surgeons performed 22 pancreatic resections. Mean (standard deviation [SD]) SEVO pollution was 0.32 ppm (0.09 ppm). Urinary SEVO concentrations were below the detection limit in all samples, whereas HFIP was detectable in 82% of the preoperative samples in a mean (SD) concentration of 8.53 µg·L (15.53 µg·L; median: 2.11 µg·L, interquartile range [IQR]: 4.58 µg·L) and in all postoperative samples (25.42 µg·L [21.39 µg·L]). The mean (SD) inhaled SEVO mass was 5.67 mg (2.55 mg). The postoperative HFIP concentrations correlated linearly to the SEVO concentrations in the surgeons' breathing zones (β = 216.89; P < .001) and to the calculated masses of inhaled SEVO (β = 4.17; P = .018). The surgeon's body mass index (BMI), age, and the frequency of surgeries within the last 24 hours before study entry did not influence the relation between HFIP concentration and air pollution or inhaled mass, respectively. CONCLUSIONS The biological SEVO burden, expressed as urinary HFIP concentration, can be estimated by monitoring SEVO pollution in the personnel's individual breathing zone. Urinary SEVO was not an appropriate biomarker in this setting.
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Affiliation(s)
- Jennifer Herzog-Niescery
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Hans-Martin Seipp
- Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany
| | - Martin Bellgardt
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Torsten Herzog
- Department of Surgery, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Orlin Belyaev
- Department of Surgery, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Waldemar Uhl
- Department of Surgery, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Philipp Gude
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Thomas P Weber
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
| | - Heike Vogelsang
- From the Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany
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25
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Braz MG, Carvalho LIM, Chen CYO, Blumberg JB, Souza KM, Arruda NM, Filho DAA, Resende LO, Faria RTBG, Canário CD, de Carvalho LR, Corrêa CR, Braz JRC, Braz LG. High concentrations of waste anesthetic gases induce genetic damage and inflammation in physicians exposed for three years: A cross-sectional study. INDOOR AIR 2020; 30:512-520. [PMID: 31930534 DOI: 10.1111/ina.12643] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 06/10/2023]
Abstract
This cross-sectional study analyzed the impact of occupational waste anesthetic gases on genetic material, oxidative stress, and inflammation status in young physicians exposed to inhalational anesthetics at the end of their medical residency. Concentrations of waste anesthetic gases were measured in the operating rooms to assess anesthetic pollution. The exposed group comprised individuals occupationally exposed to inhalational anesthetics, while the control group comprised individuals without anesthetic exposure. We quantified DNA damage; genetic instability (micronucleus-MN); protein, lipid, and DNA oxidation; antioxidant activities; and proinflammatory cytokine levels. Trace concentrations of anesthetics (isoflurane: 5.3 ± 2.5 ppm, sevoflurane: 9.7 ± 5.9 ppm, and nitrous oxide: 180 ± 150 ppm) were above international recommended thresholds. Basal DNA damage and IL-17A were significantly higher in the exposed group [27 ± 20 a.u. and 20.7(19.1;31.8) pg/mL, respectively] compared to the control group [17 ± 11 a.u. and 19.0(18.9;19.5) pg/mL, respectively], and MN frequency was slightly increased in the exposed physicians (2.3-fold). No significant difference was observed regarding oxidative stress biomarkers. The findings highlight the genetic and inflammatory risks in young physicians exposed to inhalational agents in operating rooms lacking adequate scavenging systems. This potential health hazard can accompany these subjects throughout their professional lives and reinforces the need to reduce ambient air pollution and consequently, occupational exposure.
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Affiliation(s)
- Mariana G Braz
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Lorena I M Carvalho
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Chung-Yen O Chen
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Jeffrey B Blumberg
- Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - Kátina M Souza
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Nayara M Arruda
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Daniel A A Filho
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Ludimila O Resende
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Renata T B G Faria
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Clara d'A Canário
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Lídia R de Carvalho
- Department of Bioestatistics, Institute of Biosciences, São Paulo State University - UNESP, Botucatu, Brazil
| | - Camila R Corrêa
- Department of Pathology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - José Reinaldo C Braz
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
| | - Leandro G Braz
- GENOTOX Laboratory - UNIPEX, Department of Anesthesiology, Medical School, São Paulo State University - UNESP, Botucatu, Brazil
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26
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Lauder GR, Thomas M, von Ungern-Sternberg BS, Engelhardt T. Volatiles or TIVA: Which is the standard of care for pediatric airway procedures? A pro-con discussion. Paediatr Anaesth 2020; 30:209-220. [PMID: 31886922 DOI: 10.1111/pan.13809] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 12/24/2019] [Accepted: 12/26/2019] [Indexed: 12/21/2022]
Abstract
Anesthesia for pediatric airway procedures constitutes a true art form that requires training and experience. Communication between anesthetist and surgeon to establish procedure goals is essential in determining the most appropriate anesthetic management. But does the mode of anesthesia have an impact? Traditionally, inhalational anesthesia was the most common anesthesia technique used during airway surgery. Introduction of agents used for total intravenous anesthesia (TIVA) such as propofol, short-acting opioids, midazolam, and dexmedetomidine has driven change in practice. Ongoing debates abound as to the advantages and disadvantages of volatile-based anesthesia versus TIVA. This pro-con discussion examines both volatiles and TIVA, from the perspective of effectiveness, safety, cost, and environmental impact, in an endeavor to justify which technique is the best specifically for pediatric airway procedures.
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Affiliation(s)
- Gillian R Lauder
- Department of Anesthesia, BC Children's Hospital, Vancouver, Canada.,Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia, Vancouver, Canada
| | - Mark Thomas
- Department of Anaesthesia, Great Ormond St Hospital, London, UK
| | - Britta S von Ungern-Sternberg
- Department of Anaesthesia and Pain Management, Perth Children's Hospital, Perth, Australia.,Medical School, The University of Western Australia, Perth, Australia.,Telethon Kids Institute, Perth, Australia
| | - Thomas Engelhardt
- Department of Anesthesia, McGill University Health Centre, Montreal Children's Hospital, Montreal, QC, Canada
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27
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Should Total Intravenous Anesthesia Be Used to Prevent the Occupational Waste Anesthetic Gas Exposure of Pregnant Women in Operating Rooms? Anesth Analg 2019; 128:188-190. [PMID: 29750693 DOI: 10.1213/ane.0000000000003410] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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28
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Arruda NM, Braz LG, Nogueira FR, Souza KM, Aun AG, Figueiredo DB, Lara JR, Silva MAP, Golim MA, de Carvalho LR, Braz JRC, Braz MG. Inflammation and DNA damage induction in surgical patients maintained with desflurane anesthesia. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2019; 846:403073. [DOI: 10.1016/j.mrgentox.2019.07.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 01/20/2023]
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29
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Alleva R, Tognù A, Tomasetti M, Benassi MS, Pazzaglia L, van Oven H, Viganò E, De Simone N, Pacini I, Giannone S, Gagic S, Borghi R, Picone S, Borghi B. Effect of different anaesthetic techniques on gene expression profiles in patients who underwent hip arthroplasty. PLoS One 2019; 14:e0219113. [PMID: 31344051 PMCID: PMC6657832 DOI: 10.1371/journal.pone.0219113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 06/15/2019] [Indexed: 11/18/2022] Open
Abstract
Objectives To investigate the modulation of genes whose expression level is indicative of stress and toxicity following exposure to three anaesthesia techniques, general anaesthesia (GA), regional anaesthesia (RA), or integrated anaesthesia (IA). Methods Patients scheduled for hip arthroplasty receiving GA, RA and IA were enrolled at Rizzoli Orthopaedic Institute of Bologna, Italy and the expression of genes involved in toxicology were evaluated in peripheral blood mononuclear cells (PBMCs) collected before (T0), immediately after surgery (T1), and on the third day (T2) after surgery in association with biochemical parameters. Results All three anaesthesia methods proved safe and reliable in terms of pain relief and patient recovery. Gene ontology analysis revealed that GA and mainly IA were associated with deregulation of DNA repair system and stress-responsive genes, which was observed even after 3-days from anaesthesia. Conversely, RA was not associated with substantial changes in gene expression. Conclusions Based on the gene expression analysis, RA technique showed the smallest toxicological effect in hip arthroplasty. Trial registration ClinicalTrials.gov number NCT03585647.
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Affiliation(s)
- Renata Alleva
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- * E-mail:
| | - Andrea Tognù
- Department of Anaesthesia and Postoperative Intensive Care, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Marco Tomasetti
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Maria Serena Benassi
- Laboratory of Experimental Oncology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Laura Pazzaglia
- Laboratory of Experimental Oncology, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Hanna van Oven
- Department of Anaesthesia and Postoperative Intensive Care, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Ettore Viganò
- Department of Anaesthesia and Postoperative Intensive Care, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Nicola De Simone
- Department of Anaesthesia and Postoperative Intensive Care, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Ilaria Pacini
- Department of Anaesthesia and Postoperative Intensive Care, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Sandra Giannone
- Department of Anaesthesia and Postoperative Intensive Care, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Sanjin Gagic
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Research Unit of Anaesthesia and Pain Therapy, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Raffaele Borghi
- Department of Anaesthesia and Postoperative Intensive Care, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Sara Picone
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Research Unit of Anaesthesia and Pain Therapy, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Battista Borghi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- Research Unit of Anaesthesia and Pain Therapy, Rizzoli Orthopaedic Institute, Bologna, Italy
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30
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Hopf NB, Bolognesi C, Danuser B, Wild P. Biological monitoring of workers exposed to carcinogens using the buccal micronucleus approach: A systematic review and meta-analysis. MUTATION RESEARCH-REVIEWS IN MUTATION RESEARCH 2019; 781:11-29. [DOI: 10.1016/j.mrrev.2019.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 02/12/2019] [Accepted: 02/28/2019] [Indexed: 01/22/2023]
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31
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Herzog-Niescery J, Bartz H, Vogelsang H, Bunse J, Maier-Hasselmann A, Bellgardt M, Gude P, Weber TP, Seipp HM. Kinetics of isoflurane and sevoflurane in a unidirectional displacement flow and the relevance to anesthetic gas exposure by operating room personnel. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2019; 16:294-301. [PMID: 30852983 DOI: 10.1080/15459624.2019.1577965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
International guidelines recommend the use of ventilation systems in operating rooms to reduce the concentration of potentially hazardous substances such as anesthetic gases. The exhaust air grilles of these systems are typically located in the lower corners of the operating room and pick up two-thirds of the air volume, whereas the final third is taken from near the ceiling, which guarantees an optimal perfusion of the operating room with a sterile filtered air supply. However, this setup is also employed because anesthetic gases have a higher molecular weight than the components of air and should pool on the floor if movement is kept to a minimum and if a ventilation system with a unidirectional displacement flow is employed. However, this anticipated pooling of volatile anesthetics at the floor level has never been proven. Thus, we herein investigated the flow behaviors of isoflurane, sevoflurane, and carbon dioxide (for comparison) in a measuring chamber sized 2.46 × 1.85 × 5.40 m with a velocity of 0.3 m/sec and a degree of turbulence <20%. Gas concentrations were measured at 1,728 measuring positions throughout the measuring chamber, and the flow behaviors of isoflurane and sevoflurane were found to be similar, with an overlap of 90%. The largest spread of both gases was 55 cm at 5.4 m from the emission source. Interestingly, neither isoflurane nor sevoflurane was detected at floor level, but a continuous cone-like spreading was observed due to gravity. In contrast, carbon dioxide accumulated at floor level in the form of a gas cloud. Thus, floor level exhaust ventilation systems are likely unsuitable for the collection and removal of anesthetic gases from operating rooms.
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Affiliation(s)
- Jennifer Herzog-Niescery
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Horst Bartz
- b Department of Life Science Engineering , University of Applied Sciences , Giessen , Germany
| | - Heike Vogelsang
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Jörg Bunse
- c Department of Surgery , Sana Hospital Lichtenberg , Berlin , Germany
| | | | - Martin Bellgardt
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Philipp Gude
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Thomas P Weber
- a Katholisches Krankenhaus Bochum , St. Josef Hospital, Department of Anesthesiology , Ruhr-University Bochum , Germany
| | - Hans-Martin Seipp
- b Department of Life Science Engineering , University of Applied Sciences , Giessen , Germany
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32
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Kargar Shouroki F, Neghab M, Mozdarani H, Alipour H, Yousefinejad S, Fardid R. Genotoxicity of inhalational anesthetics and its relationship with the polymorphisms of GSTT1, GSTM1, and GSTP1 genes. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2019; 26:3530-3541. [PMID: 30519912 DOI: 10.1007/s11356-018-3859-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/26/2018] [Indexed: 06/09/2023]
Abstract
Due to their wide applications, concern exists regarding possible genotoxic effects of inhalational anesthetics (IAs) among operating room personnel. This study was undertaken to examine genotoxic properties of co-exposure to nitrous oxide, sevoflurane, and isoflurane on induction of micronucleus (MN) and chromosomal aberrations (CAs) and to determine whether any associations exist between polymorphisms of GST genes and the level of genomic damage measured by MN and CAs assays. Sixty operating room personnel and 60 unexposed referent nurses were studied. The workers' exposure to the IAs was determined. DNA damage was evaluated by MN and CAs assays. Additionally, the GSTM1, GSTT1, and GSTP1 polymorphisms were detected. The mean concentrations of nitrous oxide, isoflurane, and sevoflurane were found to be 850.92 ± 919.78, 2.40 ± 0.86, and 0.18 ± 0.14 ppm, respectively. The frequency of MN and CAs in the exposed group was significantly higher than that of the non-exposed group. The frequency of MN was significantly higher in referent nurses with null GSTT1, compared to referent nurses with positive GSTT1. The frequency of MN was significantly higher in exposed individuals carrying the combined genotype of GSTT1 (-), GSTM1 (-), and GSTP1 AG as compared with subjects carrying a combination of GSTT1 (+), GSTM1 (+), and GSTP1 AA. Statistically significant associations were noted between exposure to the IAs, gender, and the combination of the three GSTs genotypes with MN frequency. These findings indicate that inhalation exposure to IAs induces genotoxic response and the polymorphisms of GSTs genes might modulate the effect of exposure to IAs on MN.
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Affiliation(s)
| | - Masoud Neghab
- Department of Occupational Health Engineering, Research Center for Health Sciences, Institute of Health, School of Health, Shiraz University of Medical Sciences, P.O. Box: 71645-111, Shiraz, Iran.
| | - Hossein Mozdarani
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Hamzeh Alipour
- Research Center for Health Sciences, Institute of health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeed Yousefinejad
- Department of Occupational Health Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Fardid
- Department of Radiology, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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33
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Herzog-Niescery J, Vogelsang H, Bellgardt M, Seipp HM, Weber TP, Gude P. The Personnel's Sevoflurane Exposure in the Postanesthesia Care Unit Measured by Photoacoustic Gas Monitoring and Hexafluoroisopropanol Biomonitoring. J Perianesth Nurs 2019; 34:606-613. [PMID: 30665744 DOI: 10.1016/j.jopan.2018.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 10/22/2018] [Accepted: 10/27/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Room ventilation in the postanesthesia care unit (PACU) is often poor, although patients exhale anesthetic gases. We investigated the PACU personnel's environmental and biological sevoflurane (SEVO) burden during patient care. DESIGN Prospective, observational study. METHODS Air pollution was measured by photoacoustic gas monitoring in the middle of the PACU, above the patient's face, and on the PACU corridor. Urinary SEVO and hexafluoroisopropanol concentrations were determined. FINDINGS Mean air pollution was 0.34 ± 0.07 ppm in the middle of the PACU, 0.56 ± 0.17 ppm above the patient's face, and 0.47 ± 0.06 ppm on the corridor. Biological preshift exposure levels were 0.13 ± 0.03 mcg/L (SEVO) and 4.72 ± 5.41 mcg/L (hexafluoroisopropanol). Postshift concentrations increased significantly to 0.20 ± 0.06 mcg/L (P = .004) and 42.18 ± 27.82 mcg/L (P < .001). CONCLUSIONS PACU personnel were environmentally and biologically exposed to SEVO, but exposure levels were minimal according to current recommendations.
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Herzog-Niescery J, Vogelsang H, Gude P, Seipp HM, Uhl W, Weber TP, Bellgardt M. Environmental safety: Air pollution while using MIRUS™ for short-term sedation in the ICU. Acta Anaesthesiol Scand 2019; 63:86-92. [PMID: 30088264 DOI: 10.1111/aas.13222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 06/16/2018] [Accepted: 06/21/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND MIRUS™ is a device for target-controlled inhalational sedation in the ICU in combination with use of isoflurane, or sevoflurane, or desflurane. The feasibility of this device has recently been proven; however, ICU staff exposure may restrict its application. We investigated ICU ambient room pollution during daily work to estimate ICU personnel exposure while using MIRUS™. METHODS This observational study assessed pollution levels around 15 adult surgical patients who received volatile anaesthetics-based sedation for a median of 11 hours. Measurements were performed by photoacoustic gas monitoring in real-time at different positions near the patient and in the personnel's breathing zone. Additionally, the impact of the Clean Air™ open reservoir scavenging system on volatile agent pollution was evaluated. RESULTS Baseline concentrations [ppm] during intervention and rest periods were isoflurane c ¯ mean = 0.58 ± 0.49, c ¯ max = 5.72; sevoflurane c ¯ mean = 0.22 ± 0.20, c ¯ max = 7.93; and desflurane c ¯ mean = 0.65 ± 0.57, c ¯ max = 6.65. Refilling MIRUS™ with liquid anaesthetic yielded gas concentrations of c ¯ mean = 2.18 ± 1.48 ppm and c ¯ max = 13.03 ± 9.37 ppm in the personnel's breathing zone. Air pollution in the patient's room was approximately five times higher without a scavenging system. CONCLUSION Ambient room pollution was minimal in most cases, and the measured values were within or below the recommended exposure limits. Caution should be taken during refilling of the MIRUS™ system, as this was accompanied by higher pollution levels. The combined use of air-conditioning and gas scavenging systems is strongly recommended.
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Affiliation(s)
| | - Heike Vogelsang
- Department of Anaesthesiology; St. Josef Hospital; Ruhr-University Bochum; Bochum Germany
| | - Philipp Gude
- Department of Anaesthesiology; St. Josef Hospital; Ruhr-University Bochum; Bochum Germany
| | - Hans-Martin Seipp
- Department of Life Science Engineering; University of Applied Sciences; Giessen Germany
| | - Waldemar Uhl
- Department of Surgery; St. Josef Hospital; Ruhr-University Bochum; Bochum Germany
| | - Thomas P. Weber
- Department of Anaesthesiology; St. Josef Hospital; Ruhr-University Bochum; Bochum Germany
| | - Martin Bellgardt
- Department of Anaesthesiology; St. Josef Hospital; Ruhr-University Bochum; Bochum Germany
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Kim DD, Kimura Jr A, Pontes DKL, Oliveira MLS, Cumino DO. Evaluation of anesthesiologists' knowledge about occupational health: Pilot study. BMC Anesthesiol 2018; 18:193. [PMID: 30567562 PMCID: PMC6300909 DOI: 10.1186/s12871-018-0661-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 12/03/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND An anesthesiologists' work presents with numerous occupational risks owing to the large amount of time spent inside the operating room where constant noise, anesthetic vapors, ionizing radiation, infectious agents, and psychological stress are present. Herein, we evaluated anesthesiologists' knowledge about occupational health. METHODS A cross-sectional study was conducted to assess 158 anesthesiologists from a tertiary hospital on their knowledge about occupational health using a structured questionnaire. RESULTS The survey revealed a lack of knowledge on the forms of prevention of occupational accidents (74.6% did not know how to act in case of a fire during surgery, 56% failed to identify the post-anesthesia care unit as the place with the highest contamination by inhalation anesthetics, and 42.7% failed to identify all personal protective equipment) and a surprisingly high rate of lack of observance of preventive measures (30.3% washed their hands before touching every patient, 52.5% did not use gloves during intravenous access, and 88.6% used protective equipment against ionizing radiation). CONCLUSIONS Despite improvements in safety standards in healthcare facilities, our research showed lack of knowledge about major topics on occupational health by physicians. Improving safety awareness is an important goal of training programs and continued medical education.
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Affiliation(s)
- Daniel Dongiu Kim
- Department of Anesthesiology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr, 112, Sao Paulo, SP Brazil
| | - Aldemar Kimura Jr
- Department of Anesthesiology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr, 112, Sao Paulo, SP Brazil
| | - Dayanne Karla Lopes Pontes
- Department of Anesthesiology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr, 112, Sao Paulo, SP Brazil
| | - Maycon Luiz Silva Oliveira
- Department of Anesthesiology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr, 112, Sao Paulo, SP Brazil
| | - Debora Oliveira Cumino
- Department of Anesthesiology, Irmandade da Santa Casa de Misericordia de Sao Paulo, Rua Dr. Cesario Motta Jr, 112, Sao Paulo, SP Brazil
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Aun AG, Golim MA, Nogueira FR, Souza KM, Arruda NM, Braz JRC, Braz LG, Braz MG. Monitoring early cell damage in physicians who are occupationally exposed to inhalational anesthetics. Mutat Res 2018; 812:5-9. [PMID: 30388507 DOI: 10.1016/j.mrfmmm.2018.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 10/08/2018] [Indexed: 11/30/2022]
Abstract
Worldwide, millions of professionals who work in operating rooms are occupationally exposed to inhalational anesthetics. Thus, the potential health effects of the continuous exposure to inhalational anesthetics on individuals in the operating room remain a subject of debate. Human biomonitoring is a potentially useful tool for assessing the health of exposed professionals. No report has yet evaluated the possible cytotoxic and genotoxic effects of the most commonly used inhalational anesthetics on young professionals who are occupationally exposed. Considering the importance of this issue, we monitored physicians who were exposed to inhalational anesthetics during their first year of a medical residency program to evaluate the possible early damage events. Twenty-six young physicians who had been occupationally exposed to the anesthetics isoflurane, sevoflurane, desflurane, and nitrous oxide and who worked in operating rooms using modern anesthesia workstations during their medical residency program, participated in this study. Blood samples were evaluated before the start of the program (before the exposure), and after 1/2 year and 1 year of exposure. We monitored the subjects by assessing the cytotoxicity (early apoptosis and loss of the mitochondrial membrane potential) using flow cytometry and genotoxicity using the comet assay. No significant changes were observed in the biomarkers of cytotoxicity or genotoxicity (p > 0.05). Thus, biomonitoring showed that short-term exposure to inhalational anesthetics did not induce early cell damage during the first year of medical residency. Based on the results, brief occupational exposure to anesthetics does not induce either cytotoxicity or genotoxicity in mononuclear cells under the conditions of this study. Thus, young physicians should undergo additional biomonitoring at the beginning of their careers to determine possible toxic effects on their cells and genetic material, and further investigations are warranted to determine whether a longer exposure to inhalational anesthetics results in mitochondrial depolarization, apoptosis and DNA breaks.
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Affiliation(s)
- Aline G Aun
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil
| | - Marjorie A Golim
- UNESP - Universidade Estadual Paulista, Hospital das Clínicas de Botucatu, Hemocentro, Laboratório de Citometria de Fluxo, Brazil
| | - Flávia R Nogueira
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil
| | - Kátina M Souza
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil
| | - Nayara M Arruda
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil
| | - José Reinaldo C Braz
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil
| | - Leandro G Braz
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil
| | - Mariana G Braz
- UNESP - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, Departamento de Anestesiologia, Laboratório GENOTOX, Brazil.
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Jafari A, Jafari F, Mohebbi I. Effects of occupational exposure to trace levels of halogenated anesthetics on the liver, kidney, and oxidative stress parameters in operating room personnel. TOXIN REV 2018. [DOI: 10.1080/15569543.2018.1498898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Abbas Jafari
- Department of Occupational Health, School of Health, Urmia University of Medical Sciences, Urmia, Iran
| | - Fatemeh Jafari
- Department of Operating Room School of Paramedical Sciences, Urmia University of Medical Sciences, Urmia, Iran
| | - Iraj Mohebbi
- Social Determinants of Health Research Center, Occupational Medicine Center, Urmia University of Medical Sciences, Urmia, Iran
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Petak F, Habre W. MacGyver or Machiavellian approaches to delivery of sevoflurane in neonates. Paediatr Anaesth 2018; 28:756-757. [PMID: 30175436 DOI: 10.1111/pan.13453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ferenc Petak
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Walid Habre
- Pediatric Anesthesia Unit, Department of Anesthesiology Pharmacology and Intensive Care, University Hospitals of Geneva, Geneva, Switzerland.,University of Geneva, Geneva, Switzerland
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Braz MG, Souza KM, Lucio LMC, Di Renzo GCC, Feliciano LM, Marcondes JPC, Chen CYO, Braz JRC, Braz LG. Detrimental effects detected in exfoliated buccal cells from anesthesiology medical residents occupationally exposed to inhalation anesthetics: An observational study. MUTATION RESEARCH-GENETIC TOXICOLOGY AND ENVIRONMENTAL MUTAGENESIS 2018; 832-833:61-64. [PMID: 30057022 DOI: 10.1016/j.mrgentox.2018.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/20/2018] [Accepted: 07/02/2018] [Indexed: 11/28/2022]
Abstract
Operating room professionals are scarcely aware of their individual occupational exposure to waste anesthetic gases (WAGs). Medical residents spend several hours per day in operating rooms and consequently experience occupational exposure to WAGs. Considering that no studies have yet evaluated the potential toxicity in medical residents exposed to WAGs using the buccal micronucleus cytome (BMCyt) assay, this pioneering study aimed to compare the BMCyt assay markers, including DNA damage, cell proliferation, and cell death in the exfoliated buccal cells of surgery and anesthesiology residents occupationally exposed to WAGs. The study enrolled a total of 60 physicians, including internal medicine residents (unexposed group), and residents from surgery and anesthesiology programs who were occupationally exposed to sevoflurane, isoflurane and nitrous oxide. WAGs were measured, and the mean values were higher than the international recommendation. The anesthesiology residents (high exposure) showed statistically significant lower frequencies of basal cells, and statistically significant higher frequencies of micronuclei, karyorrhexis, pyknosis, and differentiated cells than did the unexposed group; karyolysis frequencies were significantly higher in anesthesiology residents than were those in the unexposed group or in surgical residents (low exposure). The findings suggest a genetic risk for young professionals exposed to WAGs at the beginning of their careers. Thus, exposure to high WAGs concentrations leads to impairment of the buccal cell proliferative potential, genomic instability and cell death, especially in anesthesiology residents, demonstrating an early impact on their health.
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Affiliation(s)
- Mariana G Braz
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brazil.
| | - Kátina M Souza
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Lorena M C Lucio
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Giulia C C Di Renzo
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Luciana M Feliciano
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Instituto de Biociências, Departamento de Genética, Botucatu, SP, Brazil
| | - João Paulo C Marcondes
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Instituto de Biociências, Departamento de Genética, Botucatu, SP, Brazil
| | - C-Y Oliver Chen
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA
| | - José Reinaldo C Braz
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Leandro G Braz
- Universidade Estadual Paulista Universidade Estadual Paulista - UNESP, Faculdade de Medicina, Departamento de Anestesiologia, Botucatu, SP, Brazil
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Zafirova Z, Sheehan C, Hosseinian L. Update on nitrous oxide and its use in anesthesia practice. Best Pract Res Clin Anaesthesiol 2018; 32:113-123. [DOI: 10.1016/j.bpa.2018.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 06/22/2018] [Indexed: 01/22/2023]
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Joob B, Wiwanitkit V. Occupational hazards due to exposure to waste anesthetic gases. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 29174180 PMCID: PMC9391693 DOI: 10.1016/j.bjane.2017.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Beuy Joob
- Medical Academic Center, Bangkok, Thailândia.
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Joob B, Wiwanitkit V. Riscos devido à exposição ocupacional aos resíduos de gases anestésicos. Braz J Anesthesiol 2018; 68:216-217. [DOI: 10.1016/j.bjan.2017.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 09/26/2017] [Indexed: 11/30/2022] Open
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Deng HB, Li FX, Cai YH, Xu SY. Waste anesthetic gas exposure and strategies for solution. J Anesth 2018; 32:269-282. [PMID: 29404778 DOI: 10.1007/s00540-018-2448-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 01/02/2018] [Indexed: 12/15/2022]
Abstract
As inhaled anesthetics are widely used, medical staff have inevitably suffered from exposure to anesthetic waste gases (WAGs). Whether chronic exposure to WAGs has an impact on the health of medical staff has long been a common concern, but conclusions are not consistent. Many measures and equipment have been proposed to reduce the concentration of WAGs as far as possible. This review aims to dissect the current exposure to WAGs and its influence on medical staff in the workplace and the environment, and summarize strategies to reduce WAGs.
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Affiliation(s)
- Hai-Bo Deng
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, 253 Gongye Ave, Guangzhou, 510282, China
| | - Feng-Xian Li
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, 253 Gongye Ave, Guangzhou, 510282, China
| | - Ye-Hua Cai
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, 253 Gongye Ave, Guangzhou, 510282, China.
| | - Shi-Yuan Xu
- Department of Anesthesiology, Zhujiang Hospital of Southern Medical University, 253 Gongye Ave, Guangzhou, 510282, China.
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Kesimci E, Çoşkun E, Uğur G, Müderris T, İzdeş S, Karahalil B. Can Sevoflurane Induce Micronuclei Formation in Nasal Epithelial Cells of Adult Patients? Turk J Anaesthesiol Reanim 2017; 45:264-269. [PMID: 29114410 DOI: 10.5152/tjar.2017.09475] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 08/07/2017] [Indexed: 12/27/2022] Open
Abstract
Objective Volatile anaesthetics can inhibit the bronchociliary clearence in a dose- and time-dependend way. Moreover, they can have potential mutagenic/carcinogenic effects under chronic exposure. A genotoxicity test -micronuclei assay- was carried out in nasal epithelial cells to analyze the genotoxic effect of sevoflurane in adult patients undergoing general anesthesia. Methods In this study, micronucleus (MN) assay was conducted using nasal epithelial cells of 37 adult patients (age, 18-65 years) who underwent elective, minor, short surgical procedures under general anaesthesia with sevoflurane. Anaesthesia was induced and maintained using 8% sevoflurane (in 6 L min-1 of oxygen) and an inspired concentration of 2% in O2-air mixture, respectively. Nasal epithelial samples were collected at three time points: before anaesthesia induction (T1), after recovery from anaesthesia in the postanaesthesia care unit (T2) and on postoperative day 21 (T3). Results Sevoflurane significantly increased mean MN (‰) frequencies in nasal epithelial cells at T2 (6.97±2.33) and T3 (6.22±2.47) compared with those at T1 (3.84±1.89) (p<0.001). Similar result were observed for MN frequencies if the patients were analysed with regard to age (>40 or <40 years) or sex. Conclusion Short-term administration of sevoflurane anaesthesia induces MN formation in nasal epithelial cells of this patient population. Further studies are required for evaluation of the results. The prolonged administration of volatile anaesthetics in various risk groups and surgical protocols should be conducted for evaluating their safety.
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Affiliation(s)
- Elvin Kesimci
- Clinic of Anaesthesiology and Reanimation, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Erdem Çoşkun
- Department of Toxicology, Gazi University School of Pharmacy Ankara, Turkey
| | - Gökçer Uğur
- Clinic of Anaesthesiology and Reanimation, Atatürk Training and Research Hospital, Ankara, Turkey
| | - Togay Müderris
- Clinic of Ear Nose and Throat Surgery, Ataturk Training and Research Hospital, Ankara, Turkey
| | - Seval İzdeş
- Department of Anaesthesiology and Reanimation, Yıldırım Beyazıt University School of Medicine, Ankara, Turkey
| | - Bensu Karahalil
- Department of Toxicology, Gazi University School of Pharmacy Ankara, Turkey
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