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Martínez Ruíz A, Maroño Boedo MJ, Guereca Gala A, Escontrela Rodríguez BA, Bergese SD. [ Zero Emissions. A shared responsibility. Gas capture and recycling project at the Cruces University Hospital (Spain).]. Rev Esp Salud Publica 2023; 97:e202301001. [PMID: 36625131 PMCID: PMC10540894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The use of volatile anesthetics plays an important role in the production of greenhouse gases and other environmental pollutants that negatively affect global health. Programs to reduce anesthesia contaminants have been shown to be effective and reduce costs. For this reason, we conducted a study to implementing a Zero Emissions Program for zero carbon dioxide emissions derived from anesthetic gases used in the operating room, as recommended by the Green Deal of the European Union by 2030 and be climate neutral in 2050, maintaining satisfaction and current clinical results. METHODS A Zero Emissions Program was implemented within the Zero safety programs of the Cruces University Hospital in order to produce zero emissions of carbon dioxide derived from the anesthetic gases used in the operating rooms. The contribution of anesthetic gases to carbon dioxide production before and after implementation of program was determined. Data analysis was conducted descriptively to analyze program effectiveness. RESULTS The implementation of a Zero Emissions Program allowed us to achieve a reduction in emissions to zero. CONCLUSIONS Anesthesiologists must understand that minimizing our harmful impact on environmental health sustainability is not only desirable, but ethically necessary. A way to contribute to this ethical responsibility is Zero Emissions Programs which are effective in reducing emissions to zero, probably improving our impact on planet health.
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Affiliation(s)
- Alberto Martínez Ruíz
- Departmento de Anestesia, Reanimación y Terapéutica del Dolor, Hospital Universitario de Cruces. Biocruces Instituto de Investigación Médica. Barakaldo. España
- Facultad de Medicina, Universidad del País Vasco. Leioa. España
| | - María Jesús Maroño Boedo
- Departmento de Anestesia, Reanimación y Terapéutica del Dolor, Hospital Universitario de Cruces. Biocruces Instituto de Investigación Médica. Barakaldo. España
| | - Ane Guereca Gala
- Departmento de Anestesia, Reanimación y Terapéutica del Dolor, Hospital Universitario de Cruces. Biocruces Instituto de Investigación Médica. Barakaldo. España
| | - Blanca Anuncia Escontrela Rodríguez
- Departamento de Anestesia y Reanimación, Hospital Universitario Infanta Leonor. Unidad de Cuidados Intensivos, Hospital de Emergencias Isabel Zendal. Madrid. España
| | - Sergio D Bergese
- Departamento de Anestesiología, Universidad Stony Brook. Nueva York. Estados Unidos
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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. Environ Sci Pollut Res Int 2023; 30:9609-9623. [PMID: 36057057 DOI: 10.1007/s11356-022-22765-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Inhalational anesthetics have been used for induction and maintenance of general anesthesia for more than 150 years. All of the currently used inhalational anesthetics are chlorinated and fluorinated derivatives of ether. Dosing is carried out using the minimal alveolar concentration (MAC) concept. The pharmacokinetic properties of the various inhalational anesthetics are governed by the specific distribution coefficients. Mechanisms of action include specific modulations of various receptors of the central nervous system as well as an unspecific interaction with the cell membrane. Organ toxicity of modern inhalational anesthetics is considered to be minimal. The role of inhalational anesthetics in the context of postoperative nausea and vomiting (PONV) has been reassessed in recent years. The superiority of inhalational anesthetics over intravenous hypnotics with respect to intraoperative awareness is undisputed. The organ protective mechanism of preconditioning is an exclusive property of inhalational anesthetics among all the currently available hypnotics.
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Affiliation(s)
- Jan Jedlicka
- Klinik für Anaesthesiologie, Chirurgische Klinik Nußbaumstraße, LMU Klinikum, Campus Innenstadt, Nußbaumstr. 20, 80336, München, Deutschland.
| | - Philipp Groene
- Klinik für Anaesthesiologie, Chirurgische Klinik Nußbaumstraße, LMU Klinikum, Campus Innenstadt, Nußbaumstr. 20, 80336, München, Deutschland
| | - Julia Linhart
- Klinik für Anaesthesiologie, Chirurgische Klinik Nußbaumstraße, LMU Klinikum, Campus Innenstadt, Nußbaumstr. 20, 80336, München, Deutschland
| | - Elisabeth Raith
- Klinik für Anaesthesiologie, Chirurgische Klinik Nußbaumstraße, LMU Klinikum, Campus Innenstadt, Nußbaumstr. 20, 80336, München, Deutschland
| | - Da Vy Mu Stapha
- Klinik für Anaesthesiologie, Chirurgische Klinik Nußbaumstraße, LMU Klinikum, Campus Innenstadt, Nußbaumstr. 20, 80336, München, Deutschland
| | - Peter Conzen
- Klinik für Anaesthesiologie, Chirurgische Klinik Nußbaumstraße, LMU Klinikum, Campus Innenstadt, Nußbaumstr. 20, 80336, München, Deutschland
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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. Mutat Res Genet Toxicol Environ Mutagen 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Souza KM, Braz LG, Nogueira FR, Souza MB, Bincoleto LF, Aun AG, Corrente JE, Carvalho LR, Braz JRC, Braz MG. Occupational exposure to anesthetics leads to genomic instability, cytotoxicity and proliferative changes. Mutat Res 2016; 791-792:42-48. [PMID: 27639372 DOI: 10.1016/j.mrfmmm.2016.09.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 09/03/2016] [Accepted: 09/08/2016] [Indexed: 11/28/2022]
Abstract
Data on the genotoxic and mutagenic effects of occupational exposure to the most frequently used volatile anesthetics are limited and controversial. The current study is the first to evaluate genomic instability, cell death and proliferative index in exfoliated buccal cells (EBC) from anesthesiologists. We also evaluated DNA damage and determined the concentrations of the anesthetic gases most commonly used in operating rooms. This study was conducted on physicians who were allocated into two groups: the exposed group, which consisted of anesthesiologists who had been exposed to waste anesthetic gases (isoflurane, sevoflurane, desflurane and nitrous oxide - N2O) for at least two years; and the control group, which consisted of non-exposed physicians matched for age, sex and lifestyle with the exposed group. Venous blood and EBC samples were collected from all participants. Basal DNA damage was evaluated in lymphocytes by the comet assay, whereas the buccal micronucleus (MN) cytome (BMCyt) assay was applied to evaluate genotoxic and cytotoxic effects. The concentrations of N2O and anesthetics were measured via a portable infrared spectrophotometer. The average concentration of waste gases was greater than 5 parts per million (ppm) for all of the halogenated anesthetics and was more than 170ppm for N2O, expressed as a time-weighted average. There was no significant difference between the groups in relation to lymphocyte DNA damage. The exposed group had higher frequencies of MN, karyorrhexis and pyknosis, and a lower frequency of basal cells compared with the control group. In conclusion, exposure to modern waste anesthetic gases did not induce systemic DNA damage, but it did result in genomic instability, cytotoxicity and proliferative changes, which were detected in the EBC of anesthesiologists. Thus, these professionals can be considered at risk for developing genetic alterations resulting from occupational exposure to these gases, suggesting the need to minimize this exposure.
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Affiliation(s)
- Kátina M Souza
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - Leandro G Braz
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - Flávia R Nogueira
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - Marajane B Souza
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - Lahis F Bincoleto
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - Aline G Aun
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - José E Corrente
- Instituto de Biociências de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Bioestatística, Botucatu, Brazil
| | - Lídia R Carvalho
- Instituto de Biociências de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Bioestatística, Botucatu, Brazil
| | - José Reinaldo C Braz
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil
| | - Mariana G Braz
- Faculdade de Medicina de Botucatu, UNESP - Univ Estadual Paulista, Departamento de Anestesiologia, Botucatu, Brazil.
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Casale T, Caciari T, Rosati MV, Gioffrè PA, Schifano MP, Capozzella A, Pimpinella B, Tomei G, Tomei F. Anesthetic gases and occupationally exposed workers. Environ Toxicol Pharmacol 2014; 37:267-274. [PMID: 24374387 DOI: 10.1016/j.etap.2013.12.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Revised: 11/29/2013] [Accepted: 12/02/2013] [Indexed: 06/03/2023]
Abstract
The aim of this study is to estimate whether the occupational exposure to low dose anesthetic gases could cause alterations of blood parameters in health care workers. 119 exposed subjects and 184 not exposed controls were included in the study. Each worker underwent the complete blood count test (CBC), proteinaemia, leukocyte count, serum lipids, liver and kidney blood markers. The liver blood markers show statistically significant differences in health care workers compared with controls (p<0.05), a statistically significant decrease in neutrophils and an increase of lymphocytes in health care workers compared with controls (p<0.05). The prevalence of values outside the range for GPT, GGT, total bilirubin, lymphocytes and neutrophils was statistically significant in health care workers compared with controls (p<0.05). The results suggest that occupational exposure to low dose anesthetic gases could influence some haematochemical hepatic and hematopoietic parameters in exposed health care workers.
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Affiliation(s)
- Teodorico Casale
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy.
| | - Tiziana Caciari
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Maria Valeria Rosati
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Pier Agostino Gioffrè
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Maria Pia Schifano
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Assunta Capozzella
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Benedetta Pimpinella
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
| | - Gianfranco Tomei
- Department of Psychiatric and Psychological Science, University of Rome "Sapienza", Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Francesco Tomei
- Department of Anatomy, Histology, Medical-Legal and the Orthopedics, Unit of Occupational Medicine, University of Rome "Sapienza", Viale Regina Elena 336, 00161 Rome, Italy
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