Risk assessment of occupational exposure to anesthesia Isoflurane in the hospital and veterinary settings

Doping Strategy of Monolayer MoS2 to Realize the Monitoring of Environmental Concentration of Desflurane: A First-Principles Study

Desflurane is a new volatile inhalation anesthetic that is widely used in medical operation. However, various diseases can be caused by chronic exposure to desflurane, which is also a greenhouse gas. Therefore, it is urgent to find a suitable method for monitoring desflurane. In this paper, the process of doping of Pd, Pt, and Ni on the MoS2 surface is simulated to determine the stability of the doping structure based on first-principles. The adsorption properties and sensing properties of Pd-MoS2, Pt-MoS2, and Ni-MoS2 on desflurane are explored by parameters including independent gradient model based on Hirshfeld partition (IGMH), electron localization function (ELF), and density of states (DOS), sensibility, and recovery time, subsequently. The doping results show that the three doping systems (Pd-MoS2, Pt-MoS2, and Ni-MoS2) are structurally stable, and the chemical bonds are formed with MoS2. The adsorption results show the best chemisorption between Pt-MoS2 and desflurane with the chemical bonds between them. The results of IGMH, ELF, and DOS also confirm it. The sensing characterization results show that the recovery time of Pt-MoS2 ranges between 85.27 and 0.027 s, and the sensitivity ranges from 99.26 to 25.69%, all of which can meet the requirements of the sensor. Considering the adsorption effect and sensing characteristics, Pt-MoS2 can be used as a gas-sensitive material for detecting the concentration of desflurane.

Peri-anesthetic Environmental and Occupational Exposure to Desflurane Waste Anesthetic Gas in a Large Animal Veterinary Hospital

OBJECTIVES

The goals were to determine the environmental levels of desflurane waste anesthetic gas and the desflurane occupational exposure of operating room staff during the anesthesia of large animal veterinary patients.

METHODS

Active environmental sampling was performed using single-beam infrared spectrophotometry. Passive sampling with dosimeter badges was used to measure the occupational exposure of anesthesia and operating room staff.

RESULTS

Higher concentrations of desflurane (n = 16) were measured at all recovery timepoints relative to the concentrations measured at all locations and timepoints at the start of anesthesia and surgery ( P < 0.05). Time-weighted average desflurane concentrations from dosimeter badges (n = 310) were higher for anesthesia staff than for other operating room personnel ( P < 0.0001).

CONCLUSIONS

The anesthetic recovery of large animal patients is a period of increased exposure to desflurane waste anesthetic gas for veterinary staff.

Veterinarians exposed to inhaled anesthetic present chromosome damage, apoptosis and cell cycle changes

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.

Associations between maternal occupational exposures and pregnancy outcomes among Chinese nurses: a nationwide study

BACKGROUND

Several studies have provided evidence about adverse pregnancy outcomes of nurses involved in occupational exposure. However, the pregnancy outcomes among nurses in middle-income countries are not well demonstrated. The main aim of this study is to present the prevalence and influencing factors of pregnancy outcomes among female nurses in China.

METHODS

We included 2243 non-nurse health care workers, and 4230 nurses in this national cross-sectional study in China. Information on occupational exposures and pregnancy outcomes was collected using a face-to-face investigation. Odds ratios (ORs) were estimated through logistic regression.

RESULTS

The proportion of threatened abortion, spontaneous abortion, and stillbirth of female nurses was 2.6%, 7%, and 2.1%, respectively. We found an increased risk of threatened abortion among nurses with overtime work (OR = 1.719, 95% CI 1.158-2.550). The risk of threatened abortion and spontaneous abortion was elevated among nurses handling disinfectant (OR = 2.293 and 1.63, respectively). We found a nearly twofold increased risk of premature birth (OR = 2.169, 95% CI 1.36-3.459) among nurses handling anti-cancer drugs.

CONCLUSIONS

Our findings suggested that maternal occupational exposures might be associated with the risk of adverse pregnancy outcomes among female nurses in China. We recommend that policy-markers and hospital managers work together to reduce exposure to occupational hazards and improve pregnancy outcomes among female nurses.

Establishing a health-based recommended occupational exposure limit for isoflurane using experimental animal data: a systematic review protocol

BACKGROUND

Isoflurane is used as an inhalation anesthetic in medical, paramedical, and veterinary practice. Epidemiological studies suggest an increased risk of miscarriages and malformations at birth related to maternal exposure to isoflurane and other inhalation anesthetics. However, these studies cannot be used to derive an occupational exposure level (OEL), because exposure was not determined quantitatively and other risk factors such as co-exposures to other inhalation anesthetics and other work-related factors may also have contributed to the observed adverse outcomes. The aim of this systematic review project is to assess all available evidence on the effects of isoflurane in studies of controlled exposures in laboratory animals to derive a health-based recommended OEL.

METHODS

A comprehensive search strategy was developed to retrieve all animal studies addressing isoflurane exposure from PubMed, EMBASE, and Web of Science. Title-abstract screening will be performed by machine learning, and full-text screening by one reviewer. Discrepancies will be resolved by discussion. We will include primary research in healthy, sexually mature (non human) vertebrates of single exposure to isoflurane. Studies describing combined exposure and treatments with >  = 1 vol% isoflurane will be excluded. Subsequently, details regarding study identification, study design, animal model, and intervention will be summarized. All relevant exposure characteristics and outcomes will be extracted. The risk of bias will be assessed by two independent reviewers using an adapted version of the SYRCLE's risk of bias tool and an addition of the OHAT tool. For all outcomes for which dose-response curves can be derived, the benchmark dose (BMD) approach will be used to establish a point of departure for deriving a recommended health-based recommended OEL for 8 h (workshift exposure) and for 15 min (short-term exposure).

DISCUSSION

Included studies should be sufficiently sensitive to detect the adverse health outcomes of interest. Uncertainties in the extrapolation from animals to humans will be addressed using assessment factor. These factors are justified in accordance with current practice in chemical risk assessment. A panel of experts will be involved to reach consensus decisions regarding significant steps in this project, such as determination of the critical effects and how to extrapolate from animals to humans.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42022308978.

Different damaging effects of volatile anaesthetics alone or in combination with 1 and 2 Gy gamma-irradiation in vivo on mouse liver DNA: a preliminary study

As the number of radiotherapy and radiology diagnostic procedures increases from year to year, so does the use of general volatile anaesthesia (VA). Although considered safe, VA exposure can cause different adverse effects and, in combination with ionising radiation (IR), can also cause synergistic effects. However, little is known about DNA damage incurred by this combination at doses applied in a single radiotherapy treatment. To learn more about it, we assessed DNA damage and repair response in the liver tissue of Swiss albino male mice following exposure to isoflurane (I), sevoflurane (S), or halothane (H) alone or in combination with 1 or 2 Gy irradiation using the comet assay. Samples were taken immediately (0 h) and 2, 6, and 24 h after exposure. Compared to control, the highest DNA damage was found in mice receiving halothane alone or in combination with 1 or 2 Gy IR treatments. Sevoflurane and isoflurane displayed protective effects against 1 Gy IR, while with 2 Gy IR the first adverse effects appeared at 24 h post-exposure. Although VA effects depend on liver metabolism, the detection of unrepaired DNA damage 24 h after combined exposure with 2 Gy IR indicates that we need to look further into the combined effects of VA and IR on genome stability and include a longer time frame than 24 h for single exposure as well as repeated exposure as a more realistic scenario in radiotherapy treatment.

Drug Delivery and Safety Considerations

Anesthetic drugs must be delivered at the appropriate dose and route of administration to produce the expected anesthetic effects. This is important for patient safety because anesthetic drugs function by depressing the central nervous and cardiovascular systems, which if improperly dosed or administered could cause potentially life-threatening effects. Several routes of administration and different drug delivery methods are available to safely and reliably anesthetize zoologic companion animal patients. Because of the nature of zoologic companion animal practice, anesthetic procedures pose risks that the anesthetist should understand to carefully plan procedures that are as safe and efficient as possible.

Association of Occupational Exposure to Inhaled Agents in Operating Rooms With Incidence of Chronic Obstructive Pulmonary Disease Among US Female Nurses

IMPORTANCE

Employment in operating rooms (ORs) may involve exposure to several inhaled agents, including surgical smoke and disinfectants, which are associated with adverse respiratory health effects. However, the association of long-term employment in ORs and chronic obstructive pulmonary disease (COPD) remains unknown.

OBJECTIVE

To examine the association of working in an OR with incidence of COPD among female nurses in the US.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study used data from the Nurses' Health Study for US female registered nurses who provided information on questionnaires regarding OR employment history in 1984 and job type in 1982 and who had no history of COPD in 1984 (baseline). Data analyses were conducted from April 1, 2020, to January 31, 2021.

EXPOSURES

Duration of nursing in the OR and job type.

MAIN OUTCOMES AND MEASURES

The associations of any employment as an OR nurse, duration of employment, and duration and job type with incidence of self-reported, physician-diagnosed COPD. Hazard ratios (HRs) and 95% CIs were estimated using Cox proportional hazards regression models stratified by age and calendar year. Models were adjusted for covariates, with model 1 adjusting for age, model 2 also adjusting for cigarette smoking status and pack-year of smoking, and model 3 also adjusting for race and ethnicity, US Census region, and body mass index.

RESULTS

Among 75 011 female nurses included in the analyses, the mean (SD) age at baseline was 50.5 (7.2) years; 29% had a history of employment in an OR, and 3% had 15 or more years of OR experience. In model 3, employment in an OR for 15 or more years was associated with a 46% increased risk of developing COPD compared with no history of OR employment (HR, 1.46; 95% CI, 1.10-1.93). Compared with nurses who never worked in an OR and had an administrative or nursing education function or a nonnursing job in 1982, the risk of developing COPD was greater among nurses who provided outpatient care (HR, 1.24; 95% CI, 1.04-1.47) and nurses employed in inpatient units (HR, 1.31; 95% CI, 1.07-1.59) who had no history of OR employment and was 69% greater among nurses with OR experience of 15 years or more (HR, 1.69; 95% CI, 1.25-2.28).

CONCLUSIONS AND RELEVANCE

In this cohort study, OR employment of 15 years or more was associated with an increased risk of developing COPD among female nurses. Additional studies with more recent and direct environmental monitoring data of multiple occupational exposures are needed to assess the relative role of exposure to surgical smoke and disinfectants in the observed association.