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Potter J, Harðardóttir H, Liebenberg N, Trimble T. A few thoughts on workplace safety. Vet Anaesth Analg 2024; 51:315-321. [PMID: 38796348 DOI: 10.1016/j.vaa.2024.02.003] [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: 11/29/2022] [Revised: 01/31/2024] [Accepted: 02/09/2024] [Indexed: 05/28/2024]
Abstract
In an industry known for its workplace hazards, such as the management and manipulation of animals that could bite, kick or cause considerable damage simply because of their size, combined with long working hours, lifting of heavy loads and the general mental stress, it is perhaps surprising that the veterinary industry is not also known for its safety culture and structures. One would expect that where such hazards and risks have been identified, there would be many and varied levels of education on risk and hazard management, a comprehensive set of tools with which to mitigate these risks as well as discussion and debriefing of significant adverse events to ensure they do not occur again. One would also assume that there would be a strong sense of safety culture in the workplace and that personnel would expect each other to ensure that the health and safety of themselves and their colleagues was a number one priority. Yet, is this the case in the veterinary industry? A request was made by the Association of Veterinary Anaesthetists (AVA) to provide 'safety guidelines' for use in general practice, particularly pertaining to pregnancy. The AVA set up a task force to address these concerns and to determine if guidelines could be created. This article is offered as a starting point for considering safety in the veterinary industry in a broad sense, with the hope that in the future there may be development of such guidelines. It is hoped that this article also provides the stimulus for further research in this area.
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Affiliation(s)
- Joanna Potter
- Veterinary Clinical Sciences, University College Dublin, Dublin, Ireland.
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2
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Xu X, Hu L. Impact of anesthesia-related genes on prognosis and tumor microenvironment in hepatocellular carcinoma: A comprehensive analysis. ENVIRONMENTAL TOXICOLOGY 2024. [PMID: 38700446 DOI: 10.1002/tox.24317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/04/2024] [Accepted: 04/22/2024] [Indexed: 05/05/2024]
Abstract
Hepatocellular carcinoma (HCC), renowned for its bleak prognosis and high recurrence rates, necessitates innovative strategies for prognosis assessment and therapeutic intervention. In this pursuit, we systematically investigated the influence of anesthesia-related genes (ANARGs) on HCC outcomes. Leveraging data from The Cancer Genome Atlas (TCGA), our study scrutinized RNA sequencing data and clinical profiles from 374 HCC patients alongside 50 non-tumor liver samples to unravel ANARG expression patterns and their clinical relevance. Employing consensus clustering, we segregated HCC samples into two distinct subtypes based on ANARG profiles, unveiling significant survival disparities between them. Further differential expression analysis pinpointed pivotal genes and pathways distinguishing these subtypes, notably implicating lipid metabolism and the MTOR signaling pathway in HCC pathogenesis. A prognostic model, comprising five key ANARGs (DAGLA, CYP26B, HAVCR, G6PD and AKR1B), exhibited robust predictive capability for patient outcomes, validated across independent patient cohorts. Furthermore, immune infiltration analysis uncovered a nuanced interplay between ANARG expression and the tumor immune microenvironment, spotlighting variations in immune cell infiltration and function across the identified HCC subtypes. This comprehensive analysis underscores not only the prognostic significance of ANARGs in HCC but also their potential to modulate the tumor microenvironment, providing novel insights for tailoring anesthetic management and therapeutic strategies in HCC care. Our findings advocate for a more integrative approach to HCC management, amalgamating molecular profiling with traditional clinical parameters to refine patient stratification and personalize treatment strategies.
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Affiliation(s)
- Xia Xu
- Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
| | - Lihong Hu
- Department of Anesthesiology, The Affiliated Lihuili Hospital of Ningbo University, Ningbo, China
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3
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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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Tomei KL, Hodges TR, Ragsdale E, Katz T, Greenfield M, Sweet JA. Best practices for the pregnant neurosurgical resident: balancing safety and education. J Neurosurg 2023; 138:1758-1765. [PMID: 36683192 DOI: 10.3171/2022.9.jns221727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/30/2022] [Indexed: 11/19/2022]
Abstract
Establishment of a diverse neurosurgical workforce includes increasing the recruitment of women in neurosurgery. The impact of pregnancy on the training and career trajectory of female neurosurgeons poses a barrier to recruitment and retention of women in neurosurgery. A recent Women in Neurosurgery survey evaluated female neurosurgeons' perception and experience regarding childbearing of female neurosurgeons and identified several recommendations regarding family leave policies. Additionally, pregnancy may carry higher risk in surgical fields, yet little guidance exists to aid both the pregnant resident and her training program in optimizing the safety of the training environment with specific considerations to risks inherent in neurosurgical training. This review of current literature aims to address best practices that can be adopted by pregnant neurosurgery residents and their training programs to improve the well-being of these residents while considering the impact on their education and the educational environment for their colleagues.
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Affiliation(s)
- Krystal L Tomei
- 1Department of Neurological Surgery, University Hospitals, Cleveland
- 2Division of Pediatric Neurological Surgery, Rainbow Babies & Children's Hospital, Cleveland
- 3Case Western Reserve University School of Medicine, Cleveland; and
| | - Tiffany R Hodges
- 1Department of Neurological Surgery, University Hospitals, Cleveland
- 3Case Western Reserve University School of Medicine, Cleveland; and
| | - Ellie Ragsdale
- 3Case Western Reserve University School of Medicine, Cleveland; and
- 4Department of Obstetrics and Gynecology, University Hospitals, Cleveland, Ohio
| | - Tyler Katz
- 3Case Western Reserve University School of Medicine, Cleveland; and
- 4Department of Obstetrics and Gynecology, University Hospitals, Cleveland, Ohio
| | - Marjorie Greenfield
- 3Case Western Reserve University School of Medicine, Cleveland; and
- 4Department of Obstetrics and Gynecology, University Hospitals, Cleveland, Ohio
| | - Jennifer A Sweet
- 1Department of Neurological Surgery, University Hospitals, Cleveland
- 3Case Western Reserve University School of Medicine, Cleveland; and
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Occupational Exposure to Inhalational Anesthetics and Teratogenic Effects: A Systematic Review. Healthcare (Basel) 2023; 11:healthcare11060883. [PMID: 36981540 PMCID: PMC10048231 DOI: 10.3390/healthcare11060883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/27/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
(1) Background: In the current healthcare environment, there is a large proportion of female staff of childbearing age, so, according to existing conflicting studies, the teratogenic effects that inhalational anesthetics may have on exposed pregnant workers should be assessed. This investigation aims to analyze the teratogenic effects of inhalational anesthetics in conditions of actual use, determining any association with spontaneous abortion or congenital malformations. (2) Methods: A systematic review was carried out according to the PRISMA statement based on PICO (problem of interest–intervention to be considered–intervention compared–outcome) (Do inhalational anesthetics have teratogenic effects in current clinical practice?). The level of evidence of the selected articles was evaluated using the SIGN scale. The databases used were PubMed, Embase, Scopus, Web of Science, Google academic and Opengrey. Primary studies conducted in professionals exposed to inhalational anesthetics that evaluate spontaneous abortions or congenital malformations, conducted in any country and language and published within the last ten years were selected. (3) Results: Of the 541 studies identified, 6 met all inclusion criteria in answering the research question. Since many methodological differences were found in estimating exposure to inhalational anesthetics, a qualitative systematic review was performed. The selected studies have a retrospective cohort design and mostly present a low level of evidence and a low grade of recommendation. Studies with the highest level of evidence do not find an association between the use of inhalational anesthetics and the occurrence of miscarriage or congenital malformations. (4) Conclusions: The administration of inhalational anesthetics, especially with gas extraction systems (scavenging systems) and the adequate ventilation of operating rooms, is not associated with the occurrence of spontaneous abortions or congenital malformations.
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Aroosa S, Sattar A, Javeed A, Usman M, Hafeez MA, Ahmad M. Protective Effects of Dexmedetomidine Infusion on Genotoxic Potential of Isoflurane in Patients Undergoing Emergency Surgery. Int J Clin Pract 2023; 2023:7414655. [PMID: 36874382 PMCID: PMC9977554 DOI: 10.1155/2023/7414655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 12/13/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Isoflurane (ISO) has been extensively uses in general anesthesia and reported to cause deoxyribonucleic acid (DNA) damage in prolonged surgical procedures. Dexmedetomidine (DEX) is an adrenergic agonist and having antioxidant activity that may reduce the genotoxic potential (DNA damage) and oxidative stress induced by ISO in patients undergoing major neurosurgical procedures. Methods and Findings. Twenty-four patients of ASA (American Society of Anesthesiologists) classes I and II were randomly divided into two groups (n = 12). Group A patients received ISO, while group B patients received DEX infusion for maintenance of anesthesia. Venous blood samples were collected at different time intervals and used to evaluate the oxidative stress marker malondialdehyde (MDA) and endogenous antioxidants superoxide dismutases (SOD) and catalases (CAT). A single-cell gel electrophoresis (SCGE)-comet assay was used to investigate the genotoxic potential of ISO. CONCLUSION Increased level of antioxidants and decreased value of MDA and genetic damage index were seen in group B (P < 0.001) in a time-dependent manner. Genetic damage was highest at point T 2 (0.77 vs. 1.37), and continued to decrease till T 3 (0.42 vs. 1.19), with respect to negative controls or baseline values following DEX infusion. Significantly, higher level of MDA was recorded in serum of group A (P < 0.001) as compared to group B (1.60 ± 0.33 vs. 0.03 ± 0.001). Enzymatic activities of CAT and SOD were significantly higher in group B than group A (10.11 ± 2.18 vs. 5.71 ± 0.33), (1.04 ± 0.05 vs. 0.95 ± 0.01), respectively. It may play a contributing role in daily anesthesia practice and improve the toxic effects on patients as well as anesthesia personnel. Trial Registration. Ethical Committee of Post Graduate Medical Institute (PGMI), Lahore General Hospital approved the use of humans in this study vide human subject application number ANS-6466 dated February 04, 2019. Furthermore, as the clinical trials required registration from an appropriate registry approved by World Health Organization (WHO), this trail also retrospectively registered at Thai Clinical Trials Registry (an approved WHO registry for clinical trials registration) under reference ID TCTR20211230001 on December 30, 2021.
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Affiliation(s)
- Sadaf Aroosa
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Adeel Sattar
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Aqeel Javeed
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Usman
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mian Abdul Hafeez
- Department of Parasitology, Faculty of Veterinary Science, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mehmood Ahmad
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Pakistan
- Department of Pharmacology, Riphah International University, Lahore, Pakistan
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Escher J, Yan W, Rissman EF, Wang HLV, Hernandez A, Corces VG. Beyond Genes: Germline Disruption in the Etiology of Autism Spectrum Disorders. J Autism Dev Disord 2022; 52:4608-4624. [PMID: 34596807 PMCID: PMC9035896 DOI: 10.1007/s10803-021-05304-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2021] [Indexed: 01/31/2023]
Abstract
Investigations into the etiology of autism spectrum disorders have been largely confined to two realms: variations in DNA sequence and somatic developmental exposures. Here we suggest a third route-disruption of the germline epigenome induced by exogenous toxicants during a parent's gamete development. Similar to cases of germline mutation, these molecular perturbations may produce dysregulated transcription of brain-related genes during fetal and early development, resulting in abnormal neurobehavioral phenotypes in offspring. Many types of exposures may have these impacts, and here we discuss examples of anesthetic gases, tobacco components, synthetic steroids, and valproic acid. Alterations in parental germline could help explain some unsolved phenomena of autism, including increased prevalence, missing heritability, skewed sex ratio, and heterogeneity of neurobiology and behavior.
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Affiliation(s)
- Jill Escher
- Escher Fund for Autism, 1590 Calaveras Avenue, San Jose, CA, USA.
| | - Wei Yan
- The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Emilie F Rissman
- Center for Human Health and the Environment and Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Hsiao-Lin V Wang
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
| | - Arturo Hernandez
- Maine Medical Center Research Institute, MaineHealth, Scarborough, ME, USA
- Tufts University School of Medicine, Boston, MA, USA
| | - Victor G Corces
- Department of Human Genetics, Emory University School of Medicine, Atlanta, GA, USA
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Abstract
BACKGROUND Nitrous oxide (N2O) is a frequently used anaesthetic. Since the year 2000, recreational use of N2O, also known as 'laughing gas', became popular as a recreational drug due to its mild psychedelic effect. In the 1980s, several reports warned against N2O-induced reproductive risks among healthcare personnel, questioning the occupational safety of N2O in health care. METHODS Data about the reproductive risks of N2O were collected from literature. RESULTS Particularly in the past, professionals working in dental and midwifery practices, operating theatres and ambulance transport were exposed to high levels of N2O. Adverse reproduction effects included congenital anomalies, spontaneous abortion and reduced fertility rates in females. Following occupational measures, like maximal exposure limits for ambient N2O, this occupational risk was considerably reduced. Recreational users of N2O, however, voluntarily and repeatedly expose themselves to (very) high doses of N2O. As such, they exceed the health exposure limits some hundred times, but they are fully unaware of the related reproductive risks. CONCLUSION We advocate to increase the awareness in recreational N2O-users about its potential reproductive risks, especially in heavy users, pregnant users or those who intend to become pregnant.
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Affiliation(s)
- Jan van Amsterdam
- Jan van Amsterdam, Department of
Psychiatry, Academic Medical Center, University of Amsterdam, P.O. Box
22660, 1100 DD Amsterdam, The Netherlands. Emails:
;
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9
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Luan T, Li Y, Sun L, Xu S, Wang H, Wang J, Li C. Systemic immune effects of anesthetics and their intracellular targets in tumors. Front Med (Lausanne) 2022; 9:810189. [PMID: 35966857 PMCID: PMC9365985 DOI: 10.3389/fmed.2022.810189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 07/06/2022] [Indexed: 11/30/2022] Open
Abstract
According to the result released by the World Health Organization (WHO), non-communicable diseases have occupied four of the top 10 current causes for death in the world. Cancer is one of the significant factors that trigger complications and deaths; more than 80% cancer patients require surgical or palliative treatment. In this case, anesthetic treatment is indispensable. Since cancer is a heterogeneous disease, various types of interventions can activate oncogenes or mutate tumor suppressor genes. More and more researchers believe that anesthetics have a certain effect on the long-term recurrence and metastasis of tumors, but it is still controversial whether they promote or inhibit the progression of cancer. On this basis, a series of retrospective or prospective randomized clinical trials have been conducted, but it seems to be difficult to reach a conclusion within 5 years or longer. This article focuses on the effects of anesthetic drugs on immune function and cancer and reviews their latest targets on the tumor cells, in order to provide a theoretical basis for optimizing the selection of anesthetic drugs, exploring therapeutic targets, and improving the prognosis of cancer patients.
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Affiliation(s)
- Ting Luan
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, China
| | - Yi Li
- Department of Anesthesiology, Peking University Third Hospital, Beijing, China
| | - Lihui Sun
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Zhongke Jianlan Medical Research Institute, Beijing, China
| | - Siqi Xu
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Zhongke Jianlan Medical Research Institute, Beijing, China
| | - Haifeng Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, China
- *Correspondence: Haifeng Wang,
| | - Jiansong Wang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Yunnan Institute of Urology, Kunming, China
- Jiansong Wang,
| | - Chong Li
- Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
- Zhongke Jianlan Medical Research Institute, Beijing, China
- Chong Li,
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Pokhrel LR, Grady KD. Risk assessment of occupational exposure to anesthesia Isoflurane in the hospital and veterinary settings. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 783:146894. [PMID: 33865128 DOI: 10.1016/j.scitotenv.2021.146894] [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: 02/06/2021] [Revised: 03/08/2021] [Accepted: 03/29/2021] [Indexed: 06/12/2023]
Abstract
Despite the modern ventilation and waste anesthetic gas (WAG) scavenging systems, occupational exposure to common volatile anesthesia, isoflurane, can occur in the hospital and veterinary settings, but limited information exists on potential exposure and health risk of isoflurane. We assessed exposure dose rates and risks among clinicians and veterinary professionals from occupational exposure to isoflurane. Through a critical review of open literature (1965 to 2020), we summarized potential adverse effects and exposure scenarios of isoflurane among the professional groups, including anesthetists, nurses, operating room personnel, researchers, and/or veterinarians. Deterministic United States National Research Council/Environmental Protection Agency's risk assessment framework (hazard identification, dose-response relationship, exposure assessment and risk characterization) was used to compute inhalation Reference Doses (RfDs), Average Daily Doses (ADDs), and Hazard Quotient (HQ) values-an established measure of non-carcinogenic (systemic) risks-from exposure to isoflurane to workers in hospital and veterinary settings. We identified the central nervous system as the main target for isoflurane, and that isoflurane has dose-dependent effects on cardiac hemodynamics, can impair pulmonary functions and potentially cross the utero-placental barrier leading to congenital malformation in fetus. Based on the modelled RfDs (range 0.8003-7.55 mg/kg-day) and ADDs (range 0.071-1.9617 mg/kg-day), we estimated 56 different HQ values, of which 5 HQs were higher than 1 (range 1.099-2.4512) under high exposure scenarios. Our results suggest a significant non-carcinogenic risk from isoflurane exposures among workers in the occupational settings. The findings underscore the need to significantly minimize isoflurane release to protect workers' health in the hospital and veterinary environments.
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Affiliation(s)
- Lok R Pokhrel
- Department of Public Health, The Brody School of Medicine, East Carolina University, Greenville, NC, USA; Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA.
| | - Kisha D Grady
- Environmental Health and Radiation Safety, Temple University, Philadelphia, PA, USA
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A Roadmap for Navigating Occupational Exposures for Surgeons: A Special Consideration for the Pregnant Surgeon. Plast Reconstr Surg 2021; 147:513-523. [PMID: 33235051 DOI: 10.1097/prs.0000000000007581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
SUMMARY Surgeons are exposed to occupational hazards daily. Risks include chemical, biological, and physical hazards that place providers at risk of serious harm. Departmental policies or written guides to help pregnant surgeons navigate the hospital are lacking. In response to the scarcity in the literature, the authors have summarized current guidelines and recommendations to aid surgeons in making an informed decision. In addition, the authors present a brief narrative of the impact of these exposures during pregnancy and methods of transmission and, where relevant, include specialties that are at risk of these exposures.
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Landford WN, Ngaage LM, Lee E, Rasko Y, Yang R, Slezak S, Redett R. Occupational exposures in the operating room: Are surgeons well-equipped? PLoS One 2021; 16:e0253785. [PMID: 34214125 PMCID: PMC8253435 DOI: 10.1371/journal.pone.0253785] [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: 03/11/2021] [Accepted: 06/14/2021] [Indexed: 12/05/2022] Open
Abstract
Background Occupational health hazards are ubiquitously found in the operating room, guaranteeing an inevitable risk of exposure to the surgeon. Although provisions on occupational health and safety in healthcare exist, they do not address non-traditional hazards found in the operating room. In order to determine whether surgeons or trainees receive any form of occupational health training, we examine the associations between occupational health training and exposure rate. Study design A cross-sectional survey was distributed. Respondent characteristics included academic level, race/ethnicity, and gender. The survey evaluated seven surgical disciplines and 13 occupational hazards. Multivariable logistic regression was used to examine the association between academic level, surgical specialty, and exposure rate. Results Our cohort of 183 respondents (33.1% response rate) consisted of attendings (n = 72, 39.3%) and trainees (n = 111, 60.7%). Surgical trainees were less likely to have been trained in cytotoxic drugs (OR 0.22, p<0.001), methylmethacrylate (OR 0.15, p<0.001), patient lifting (OR 0.43, p = 0.009), radiation (OR 0.40, p = 0.007), and surgical smoke (OR 0.41, p = 0.041) than attending surgeons. Additionally, trainees were more likely to experience frequent exposure to bloodborne pathogens (OR 5.26, p<0.001), methylmethacrylate (OR 2.86, p<0.001), cytotoxic drugs (OR 3.03, p<0.001), and formaldehyde (2.08, p = 0.011), to name a few. Conclusion Although surgeon safety is not a domain in residency training, standardized efforts to educate and change the culture of safety in residency programs is warranted. Our study demonstrates a disparity between trainees and attendings with a recommendation to provide formal training to trainees independent of their anticipated risk of exposure.
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Affiliation(s)
- Wilmina N. Landford
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
- * E-mail:
| | - Ledibabari M. Ngaage
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Erica Lee
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Yvonne Rasko
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, United States of America
| | - Robin Yang
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Sheri Slezak
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Maryland Medical Center, Baltimore, Maryland, United States of America
| | - Richard Redett
- Department of Plastic and Reconstructive Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
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Yu H, Yu W, Zhu M, Zhang G, Shi Y, Sun Y. Changes in NSE and S-100β during the perioperative period and effects on brain injury in infants with biliary atresia undergoing parent donor liver transplantation. Exp Ther Med 2021; 22:724. [PMID: 34007333 PMCID: PMC8120510 DOI: 10.3892/etm.2021.10156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 07/23/2020] [Indexed: 12/02/2022] Open
Abstract
The present study aimed to investigate the effects of parental donor liver transplantation on the perioperative changes of serum calcium-binding protein β (S-100β) and neuron-specific enolase (NSE) levels, two markers of brain injury, and on postoperative cognitive function. The present study was a prospective observational study of infants with congenital biliary atresia who underwent selective liver transplantation in 2017 at Tianjin First Central Hospital (Tianjin, China). Blood samples were collected prior to, during and following surgery, and S-100β and NSE levels were measured using ELISA. The pediatric patients were assessed using the Bayley Scales of Infant Development 1 day prior to and 3 months after surgery. Additionally, the pediatric anesthesia emergence delirium scores were evaluated. The results demonstrated that serum NSE and S100β were increased during and after surgery compared with prior to surgery (P<0.05). Furthermore, serum S-100β and NSE levels peaked 1 h after the neohepatic phase compared with prior to surgery (P<0.05). Compared with 1 day before surgery, mental development index (MDI) and psychomotor development index (PDI) were decreased 3 months after surgery (MDI, 87.7±8.4 vs. 84.5±8.5, P=0.015; PDI, 82.9±8.7 vs. 79.6±8.8, P=0.016). In conclusion, parental donor liver transplantation may cause a certain degree of brain injury in pediatric patients with end-stage liver disease, as revealed by increased serum NSE and S100β levels.
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Affiliation(s)
- Hongli Yu
- Department of Anesthesiology, Tianjin First Center Hospital, Tianjin 300192, P.R. China
| | - Wenli Yu
- Department of Anesthesiology, Tianjin First Center Hospital, Tianjin 300192, P.R. China
| | - Min Zhu
- Department of Anesthesiology, Tianjin First Center Hospital, Tianjin 300192, P.R. China
| | - Guicheng Zhang
- Department of Anesthesiology, Tianjin First Center Hospital, Tianjin 300192, P.R. China
| | - Yiwei Shi
- Department of Anesthesiology, Tianjin First Center Hospital, Tianjin 300192, P.R. China
| | - Ying Sun
- Department of Anesthesiology, Tianjin First Center Hospital, Tianjin 300192, P.R. China
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14
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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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15
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Emara AM, Alrasheedi KA, Alrashidi SD, Elgharabawy RM. Effect of inhaled anesthetic gases on immune status alterations in health care workers. J Immunotoxicol 2021; 18:13-22. [PMID: 33616475 DOI: 10.1080/1547691x.2020.1869872] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The objective of this research was to evaluate consequences to the immune system of long-term exposure to waste anesthetic gases (WAG) by medical theater personnel. Two groups were recruited: (i) 60 healthy male controls; (ii) 120 medical professionals exposed to WAG, subdivided according to theater role, i.e. surgeons, surgical assistants (SA), anesthetists, anesthetic assistants (AA), nurses, and workers. Serum levels of fluoride, hexafluoroisopropanol (HFIP), total lymphocyte counts, as well as of CD3, CD4, and CD8 cells, CD4/CD8 ratios, and immunoglobulins IgA, IgG, IgM, and IgE were assayed. The results showed that fluoride and HFIP titers were significantly increased in anesthetists and AA compared with the other exposed groups. All exposed groups demonstrated significant elevation in lymphocyte count, CD4+ cell levels, CD4/CD8 ratios, as well as levels of IgE, IgM and IgG compared with the controls. With regard to the latter outcomes, a significant increase in IgE was seen in the surgeon, nurse, and worker groups compared with the other professions. Surgeons, anesthetists and AA exhibited higher IgM titers compared with their colleagues. Significantly higher IgG levels were identified in the SA, anesthetists, AA, and workers than in their nurses and surgeon coworkers. Of the six sub-groups, only the anesthetists and their assistants (AA) displayed a significant increase in CD4+ cells and CD4/CD8 ratios and a decrease of CD8+ cells compared with the controls. This spectrum of results suggests that variation exists in immunomodulatory responses to WAG exposure amongst hospital personnel.
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Affiliation(s)
- Ashraf Mahmoud Emara
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Qassim, Saudi Arabia.,Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Salha Dihim Alrashidi
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | - Rehab Mohamed Elgharabawy
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Qassim, Saudi Arabia.,Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
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16
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Emara AM, Alrasheedi KA, Aldubayan MA, Alhowail AH, Elgarabawy RM. Effect of inhaled waste anaesthetic gas on blood and liver parameters among hospital staff. Hum Exp Toxicol 2020; 39:1585-1595. [DOI: 10.1177/0960327120938840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
A significant health risk exists within a section of health workers that are exposed to anaesthetic gas and vapours, found in the atmosphere of treatment or operating rooms. These compounds are classified as waste anaesthetic gases (WAG). The present study aimed at identifying alterations in hepatic and haematological parameters occurring as a result of chronic exposure to WAG potentially affecting the health of team members working in hospitals. Therefore, operating room operatives, vulnerable to long-standing WAG exposure, were recruited for this study. Sevoflurane anaesthesia metabolites (inorganic fluoride and hexafluoroisopropanol (HFIP)), haematological indices and liver toxicity markers (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase and osteopontin) were measured. The collected results showed increased plasma inorganic fluoride, HFIP and liver toxicity markers, as well as disturbances in haematological parameters. In conclusion, exposure to halogenated inhalational anaesthetics, in general, and Sevoflurane, in particular, induces alterations in hepatic markers and haematological indices.
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Affiliation(s)
- AM Emara
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - KA Alrasheedi
- Khyber General Hospital, Ministry of Health, Khyber, Saudi Arabia
| | - MA Aldubayan
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
| | - AH Alhowail
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
| | - RM Elgarabawy
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tanta University, Tanta, Egypt
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17
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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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18
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Escher J, Ford LD. General anesthesia, germ cells and the missing heritability of autism: an urgent need for research. ENVIRONMENTAL EPIGENETICS 2020; 6:dvaa007. [PMID: 32704384 PMCID: PMC7368377 DOI: 10.1093/eep/dvaa007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/31/2020] [Accepted: 04/14/2020] [Indexed: 05/08/2023]
Abstract
Agents of general anesthesia (GA) are commonly employed in surgical, dental and diagnostic procedures to effectuate global suppression of the nervous system, but in addition to somatic targets, the subject's germ cells-from the embryonic primordial stage to the mature gametes-may likewise be exposed. Although GA is generally considered safe for most patients, evidence has accumulated that various compounds, in particular the synthetic volatile anesthetic gases (SVAGs) such as sevoflurane, can exert neurotoxic, genotoxic and epigenotoxic effects, with adverse consequences for cellular and genomic function in both somatic and germline cells. The purpose of this paper is to review the evidence demonstrating that GA, and in particular, SVAGs, may in some circumstances adversely impact the molecular program of germ cells, resulting in brain and behavioral pathology in the progeny born of the exposed cells. Further, we exhort the medical and scientific communities to undertake comprehensive experimental and epidemiological research programs to address this critical gap in risk assessment.
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Affiliation(s)
- Jill Escher
- Correspondence address. Escher Fund for Autism, 1590 Calaveras Avenue, San Jose, CA 95126, USA. E-mail:
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19
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Cavalcanti BC, de Andrade Neto JB, de Sousa Silva AA, Barreto FS, de Oliveira Ferreira JR, da Silva CR, Aires do Nascimento FBS, do Amaral Valente Sá LG, Magalhães HIF, Nobre Júnior HV, de Moraes MO. Evaluation of Genotoxicity and Mutagenicity of Ketamine on Human Peripheral Blood Leukocytes and in Salmonella typhimurium. Toxicol In Vitro 2019; 62:104718. [PMID: 31706955 DOI: 10.1016/j.tiv.2019.104718] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/23/2019] [Accepted: 11/06/2019] [Indexed: 01/02/2023]
Abstract
Ketamine is a potent uncompetitive NMDA receptor antagonist that provides amnesia, analgesia, environmental dissociation and immobility, where it has its cytotoxic effect well described in the literature. However, the work on its genotoxic/mutagenic potentials are scarce and insufficient and does not allow a reasonable evaluation of its role. Thus, in the present work, we decided to evaluate the genotoxic and mutagenic effects of ketamine on human peripheral blood leukocytes (PBLs) and Salmonella typhimurium (TA98, TA97a, TA100, and TA102) through several well-established experimental protocols based on different parameters in the presence or not of exogenous metabolizing S9 fraction. Our data revealed that ketamine induces a weak cytotoxic effect on human PBLs after 24 h and is devoided of hemolytic effects. A small amount of DNA strand breaks levels were detected in the modified comet assay (employment of FPG enzyme) only at highest concentrations (500 and 700 μg/mL) of ketamine, highlighting our pro-oxidant data regarding ketamine. However, the oxidative DNA lesions were almost completely repaired which reflects in the lack of mutagenesis (micronuclei and chromosomal aberrations) on human PBLs and no increases in revertants numbers on S. typhimurium/microsome test (500 to 5000 μg/plate). In summary, ketamine is a weak oxidative DNA damaging agent and is devoid of mutagenic properties on eukaryotic and prokaryotic models.
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Affiliation(s)
- Bruno Coêlho Cavalcanti
- Department of Physiology and Pharmacology, Federal University of Ceara, Fortaleza, CE, Brazil; Drug Research and Development Center, Federal University of Ceara, Fortaleza, CE, Brazil.
| | - João Batista de Andrade Neto
- School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceara, Fortaleza, CE, Brazil; Christus University Center (UNICHRISTUS), Fortaleza, CE, Brazil; Drug Research and Development Center, Federal University of Ceara, Fortaleza, CE, Brazil
| | | | | | | | - Cecília Rocha da Silva
- School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceara, Fortaleza, CE, Brazil; Drug Research and Development Center, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Francisca Bruna S Aires do Nascimento
- School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceara, Fortaleza, CE, Brazil; Drug Research and Development Center, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Lívia Gurgel do Amaral Valente Sá
- School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceara, Fortaleza, CE, Brazil; Drug Research and Development Center, Federal University of Ceara, Fortaleza, CE, Brazil
| | | | - Hélio Vitoriano Nobre Júnior
- School of Pharmacy, Laboratory of Bioprospection in Antimicrobial Molecules (LABIMAN), Federal University of Ceara, Fortaleza, CE, Brazil; Drug Research and Development Center, Federal University of Ceara, Fortaleza, CE, Brazil
| | - Manoel Odorico de Moraes
- Department of Physiology and Pharmacology, Federal University of Ceara, Fortaleza, CE, Brazil; Drug Research and Development Center, Federal University of Ceara, Fortaleza, CE, Brazil
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20
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Yousefi Moghadam M. Greenhouse gases and halogenated volatiles: the choice of airway device matters. Can J Anaesth 2019; 66:468-469. [DOI: 10.1007/s12630-018-01270-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 11/07/2018] [Indexed: 11/28/2022] Open
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21
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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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22
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Çakmak G, Eraydın D, Berkkan A, Yağar S, Burgaz S. Genetic damage of operating and recovery room personnel occupationally exposed to waste anaesthetic gases. Hum Exp Toxicol 2018; 38:3-10. [PMID: 29932008 DOI: 10.1177/0960327118783532] [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] [Indexed: 11/15/2022]
Abstract
Occupational exposure to the waste anaesthetic gases (WAGs) is a crucial problem for healthcare personnel. Cancer is among the potential long-term adverse effects of WAGs. The present occupational molecular epidemiology study was conducted in healthcare personnel (anaesthetists, nurses and technicians; n = 46), working in operating rooms (ORs; n = 34) and recovery units (RUs; n = 12) of the same hospital, to assess the genotoxicity risk of WAGs exposure. Twenty-one healthy available hospital staff allocated to other wards, without the history of working in ORs and RUs were the control group. A micronucleus test was carried out for peripheral blood lymphocytes (PBLs) and buccal epithelial cells (BECs). Exposure to the anaesthetics was assessed with sevoflurane concentrations and inorganic fluoride levels in post-shift urine samples of the healthcare staff. As an exposure marker, sevoflurane concentrations in ORs and RUs were measured using passive samplers. The micronuclei frequencies were increased in both PBLs (approximately two times) and BECs (approximately three times) of the healthcare personnel. Urinary sevoflurane concentrations exceeded the biological equivalent level in 23 personnel. Air sevoflurane levels in the breathing zone in three ORs and one RU did not exceed the established occupational exposure limits. Both in surrogate tissue (PBLs) and in target tissue (BECs) of the personnel of RUs and ORs of the same hospital, the genotoxicity risk was evident and similar. Originality of this study, in addition to the WAGs exposure confirmation of the healthcare personnel, was the involvement of the RU personnel for the genotoxicity assessment, which was the first time in the scientific literature.
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Affiliation(s)
- G Çakmak
- 1 Department of Toxicology, Faculty of Pharmacy, Gazi University, Ankara, Turkey
| | - D Eraydın
- 1 Department of Toxicology, Faculty of Pharmacy, Gazi University, Ankara, Turkey
| | - A Berkkan
- 2 Department of Analytical Chemistry, Faculty of Pharmacy, Gazi University, Ankara, Turkey
| | - S Yağar
- 3 Clinic of Anaesthesiology and Reanimation, Türkiye Yüksek Ihtisas Training and Research Hospital, Ankara, Turkey
| | - S Burgaz
- 1 Department of Toxicology, Faculty of Pharmacy, Gazi University, Ankara, Turkey
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23
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Nogueira FR, Braz LG, Souza KM, Aun AG, Arruda NM, Carvalho LR, Chen CYO, Braz JRC, Braz MG. Comparison of DNA Damage and Oxidative Stress in Patients Anesthetized With Desflurane Associated or Not With Nitrous Oxide. Anesth Analg 2018; 126:1198-1205. [DOI: 10.1213/ane.0000000000002729] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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24
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Tallent R, Corcoran J, Sebastian J. Evaluation of a novel waste anaesthetic gas scavenger device for use during recovery from anaesthesia. Anaesthesia 2018; 73:59-64. [DOI: 10.1111/anae.14100] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2017] [Indexed: 11/28/2022]
Affiliation(s)
| | - J. Corcoran
- Department of Anaesthesia; Salford Royal NHS Foundation Trust; Salford UK
| | - J. Sebastian
- Department of Anaesthesia; Salford Royal NHS Foundation Trust; Salford UK
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25
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Nogueira FR, Braz LG, de Andrade LR, de Carvalho ALR, Vane LA, Módolo NSP, Aun AG, Souza KM, Braz JRC, Braz MG. Evaluation of genotoxicity of general anesthesia maintained with desflurane in patients under minor surgery. ENVIRONMENTAL AND MOLECULAR MUTAGENESIS 2016; 57:312-316. [PMID: 27062561 DOI: 10.1002/em.22012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 02/18/2016] [Indexed: 06/05/2023]
Abstract
There is controversy over the genotoxic effects of volatile anesthetics. The available literature on the genotoxicity of desflurane, one of the newest volatile halogenated agents used for general anesthesia maintenance, is scarce. This study aimed to evaluate the genotoxic potential of desflurane in 15 patients without comorbidities, of both sexes, who underwent minor surgeries lasting at least 90 min. Patients enrolled in the study received desflurane anesthesia (6%); blood samples were collected before anesthesia induction (T0), 90 min after the beginning of anesthesia (T1), and on the day following surgery (T2). DNA damage was evaluated in lymphocytes using the alkaline comet assay. We found statistically significant increases in DNA damage in T2 samples compared to T0. The findings suggest that desflurane anesthesia induces DNA strand breaks/alkali-labile sites on the day after minimally invasive surgery in healthy patients.
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Affiliation(s)
- Flávia R Nogueira
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Leandro G Braz
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Leonardo R de Andrade
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Ana Lygia R de Carvalho
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Luiz A Vane
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Norma Sueli P Módolo
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Aline G Aun
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Kátina M Souza
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - José Reinaldo C Braz
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
| | - Mariana G Braz
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, SP, Brazil
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Molina Aragonés JM, Ayora AA, Ribalta AB, Aparici AG, Lavela JAM, Vidiella JS, López MH. Occupational exposure to volatile anaesthetics: a systematic review. Occup Med (Lond) 2015; 66:202-7. [DOI: 10.1093/occmed/kqv193] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Anesthetic techniques and cancer recurrence after surgery. ScientificWorldJournal 2014; 2014:328513. [PMID: 24683330 PMCID: PMC3933020 DOI: 10.1155/2014/328513] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 10/22/2013] [Indexed: 12/19/2022] Open
Abstract
Many of the most common anesthetics are used in surgical oncology, yet effects on cancer cells are still not known. Anesthesia technique could differentially affect cancer recurrence in oncologic patients undergoing surgery, due to immunosuppression, stimulation of angiogenesis, and dissemination of residual cancer cells. Data support the use of intravenous anesthetics, such as propofol anesthesia, thanks to antitumoral protective effects inhibiting cyclooxygenase 2 and prostaglandins E2 in cancer cells, and stimulation of immunity response; a restriction in the use of volatile anesthetics; restriction in the use of opioids as they suppress humoral and cellular immunity, and their chronic use favors angiogenesis and development of metastases; use of locoregional anesthesia compared with general anesthesia, as locoregional appears to reduce cancer recurrence after surgery. However, these findings must be interpreted cautiously as there is no evidence that simple changes in the practice of anesthesia can have a positive impact on postsurgical survival of cancer patients.
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