Optimising storage conditions and processing of sheep urine for nitrogen cycle and gaseous emission measurements from urine patches

In grazing systems, urine patches deposited by livestock are hotspots of nutrient cycling and the most important source of nitrous oxide (N2O) emissions. Studies of the effects of urine deposition, including, for example, the determination of country-specific N2O emission factors, require natural urine for use in experiments and face challenges obtaining urine of the same composition, but of differing concentrations. Yet, few studies have explored the importance of storage conditions and processing of ruminant urine for use in subsequent gaseous emission experiments. We conducted three experiments with sheep urine to determine optimal storage conditions and whether partial freeze-drying could be used to concentrate the urine, while maintaining the constituent profile and the subsequent urine-derived gaseous emission response once applied to soil. We concluded that filtering of urine prior to storage, and storage at - 20 °C best maintains the nitrogen-containing constituent profile of sheep urine samples. In addition, based on the 14 urine chemical components determined in this study, partial lyophilisation of sheep urine to a concentrate represents a suitable approach to maintain the constituent profile at a higher overall concentration and does not alter sheep urine-derived soil gaseous emissions.

Dietary supplementation of rumen-protected methionine decreases the nitrous oxide emissions of urine of beef cattle through decreasing urinary excretions of nitrogen and urea

BACKGROUND

Two consecutive trials were carried out to study the effects of dietary supplementation of rumen-protected methionine (RPM) on nutrient digestibility, nitrogen (N) metabolism (Trial 1), and consequently the nitrous oxide (N₂ O) emissions from urine in beef cattle (Trial 2). Eight 24-month-old castrated Simmental bulls with liveweights of 494 ± 28 kg, and four levels of dietary supplementation of RPM at 0, 10, 20, and 30 g head^-1 d^-1 , were allocated in a replicated 4 × 4 Latin square for Trial 1 and the N₂ O emissions from the urine samples collected in Trial 1 were measured using a static incubation technique in Trial 2.

RESULTS

Supplementation of RPM at 0, 10, 20, and 30 g head^-1 d^-1 to a basal ration deficient in methionine (Met) did not affect the apparent digestibility of dry matter, organic matter, neutral detergent fiber, or acid detergent fiber (P > 0.05), but decreased the urinary excretions of total N (P < 0.05) and urea (P < 0.001), increased the ratio of N retention / digested N (P < 0.05) in beef cattle, and decreased the estimated cattle urine N₂ O-N emissions by 19.5%, 23.4%, and 32.6%, respectively (P < 0.001).

CONCLUSION

Supplementation of RPM to Met-deficient rations was effective in improving the utilization rate of dietary N and decreasing the N₂ O emissions from urine in beef cattle. © 2019 Society of Chemical Industry.

Nitrous oxide occupational exposure in conscious sedation procedures in dental ambulatories: a pilot retrospective observational study in an Italian pediatric hospital

BACKGROUND

Nitrous oxide has a proven clinical efficacy in conscious sedation. At certain environmental concentrations it may pose a health risk to chronically exposed healthcare workers. The present pilot study aims at evaluating the exposure to nitrous oxide of dental ambulatory personnel of a pediatric hospital.

METHODS

A descriptive study design was conducted in two phases: a bibliographic analysis on the environmental safety policies and a gas concentration analysis in the dental ambulatories of a pediatric hospital, detected every 6 months from December 2013 to February 2017 according to law provisions. The surveys were carried out using for gas analysis a photoacoustic spectrometer Innova-B&K "Multi-gas monitor model 1312" and Innova-B&K "Multi-sampler model 1309". The biological analysis and monitoring have been carried out on staff urine.

RESULTS

The analyses were performed during 11 dental outpatient sessions on pediatric patients. All the patients were submitted to the same dental procedures, conservative care and dental extractions. The pediatric patients were 47 (23 males, 24 females; age range 3-17 years; mean age 6,63, SD ± 2,69) for a mean of 4,27 (SD ± 1,49) per session., The mean environmental concentration of nitrous oxide during the sessions was 24.7 ppm (SD ±16,16). A correlation was found between urinary nitrous oxide concentration of dentists (Pearson's correlation 0.786; p = 0.007) and dental assistants urines (Pearson's correlation 0.918; p < 0.001) and environmental concentrations of nitrous oxide. Weak negative correlations were found between age and sex of patients and environmental concentrations of nitrous oxide. The mean values of the biological monitoring data referring to all the outpatient sessions are lower than the reference values foreseen in accordance to the regulations in force on nitrous oxide concentration.

CONCLUSIONS

The mean environmental concentration values recorded in our study are below the limit of 50 ppm considered as a reference point, a value lower than those reported in other similar surveys. The results of the present study provide a contribution to the need to implement technical standards, criteria and system requirements for the dental ambulatories, to date not yet completely defined, and cannot be assimilated to the ones established for the surgical rooms.

[Monitoring occupational exposure to volatile anaesthetics in the operating theatre: environmental and biological measurements]

Concentrations of nitrous oxide (N2O) and isoflurane were measured in environmental and urinary samples from subjects occupationally exposed to volatile anaesthetics in operating theatres in a hospital in northern Italy. The aim was to establish whether: an automatic analyzer (Brüel & Kjaer 1302 spectrometer) can be used for fixed position sampling ("anaesthetist zone" and "surgeon/instrument nurse zone"); periodic monitoring of anaesthetics will reduce exposure; exposure to N2O and isoflurane is within legal limits; exposure differs between anaesthetists and surgeons/instrument nurses. Exposure to anaesthetics was monitored twice at six-month intervals. In the first test time spent in the operating theatre was noted and exposure levels were measured automatically. In the second test levels were monitored with passive personal sampling devices. Environmental concentrations of N2O determined by the spectrometer were correlated to urinary levels. Urinary levels of N2O calculated from the regression line were the same as those obtained with the personal samplers. Environmental and urinary levels of N2O decreased significantly from the first to second test. In the second sampling 70% of subjects had levels of exposure to N2O and isoflurane within prescribed environmental limits (50 ppm for N2O and 0.5 ppm for isoflurane). At the first test anaesthetists had significantly higher levels of exposure to N2O than surgeons/instrument nurses. The survey demonstrated that: fixed position sampling data related to time spent in the operating theatre can be used to gauge individual exposure levels; exposure levels decrease after tests following implementation of preventive measures; monitoring needs to be repeated because exposure levels often exceed legal limits; occupational exposure decreases when pollution in the anaesthetic zone is reduced.

Occupational exposure of midwives to nitrous oxide on delivery suites

AIMS

To compare environmental and biological monitoring of midwives for nitrous oxide in a delivery suite environment.

METHODS

Environmental samples were taken over a period of four hours using passive diffusion tubes. Urine measurements were taken at the start of the shift and after four hours.

RESULTS

Environmental levels exceeded the legal occupational exposure standards for nitrous oxide (100 ppm over an 8 hour time weighted average) in 35 of 46 midwife shifts monitored. There was a high correlation between personal environmental concentrations and biological uptake of nitrous oxide for those midwives with no body burden of nitrous oxide at the start of a shift, but not for others.

CONCLUSIONS

Greater engineering control measures are needed to reduce daily exposure to midwives to below the occupational exposure standard. Further investigation of the toxicokinetics of nitrous oxide is needed.

Biological indices of kidney involvement in personnel exposed to sevoflurane in surgical areas

BACKGROUND

Fluoride, a main metabolite, and one degradation product of sevoflurane (SEV), called Compound A, are known to cause kidney effects in experimental animals. Other than in volunteers and patients, no research is available on exposed workers. The possible effects on the kidney in workers exposed in surgical areas were studied.

METHODS

Subjects exposed to SEV and nitrous oxide (N(2)O) in surgical areas (N = 61) using open (N = 25) or semi-closed (N = 36) circuits were submitted to biological monitoring. The same biological indices were determined in 43 controls also. Sevoflurane (SEVU), nitrous oxide (N(2)OU), total urinary proteins (TUP), N-acetyl-beta-D-glucosaminidase (NAGU), and glutamine synthetase (GSU) were measured in urine.

RESULTS

The mean values of environmental exposure were 31.3 ppm (range 0.9-111.6 ppm) for N(2)O and 0.28 ppm (range 0-1.88 ppm) for SEV. Exposed subjects had significantly higher excretion of TUP; a higher, not significant, excretion of GSU was also observed in subjects using open circuits. A significant correlation was found in all exposed subjects between NAGU and SEVU (r = 0.303, P < 0.05), GSU and N(2)OU (r = 0.382, P < 0.01) and, especially, GSU and SEVU (r = 0.650, P < 0.001). These correlations appeared to be influenced by the use of open circuits; infact, NAGU was well correlated to N(2)OU (r = 0.770, P < 0.001) and SEVU (r = 0.863, P < 0.001); GSU to N(2)OU (r = 0.468, P < 0.05) and SEVU (r = 0.735, P < 0.001).

CONCLUSIONS

Results show that no relevant effect on the kidney is present for the levels of exposure studied. Nevertheless, correlation between dose and response urinary indices supports that SEV, other than N(2)O, may influence kidney function, especially when open circuits are used.

Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels

OBJECTIVES

Assessment of individual exposures to sevoflurane plus nitrous oxide (N(2)O) by biological monitoring of unmodified analytes in post-shift urine of exposed personnel.

METHODS

Anaesthetics in urine and breathing area were monitored in 124 subjects in 11 operating theatres. Passive samplers were collected after 2.5-7 h of exposure, at the same time as post-shift urinary samples, to evaluate the individual time-weighted average (TWA) exposures to sevoflurane and N(2)O. A static headspace sampler coupled with a gas chromatograph mass spectrometer was used for analytical determinations (sensitivity sufficient to reveal biological/environmental exposures of 0.1 microg/l(urine) and 50 ppb for sevoflurane, and 1 microg/l(urine) and 80 ppb for N(2)O).

RESULTS

Median (range) post-shift urinary and environmental values were 1.2 microg/l(urine) (0.1-5.0) and 0.4 ppm (0.05-3.0) for sevoflurane ( n=107) and 10.9 microg/l(urine) (0.5-74.9) and 8.6 ppm (0.2-123.4) for N(2)O ( n=121) (all low-exposure range). At log-log regression, urinary levels closely correlated with environmental data (sevoflurane, r(2)=0.7538; N(2)O, r(2)=0.8749). Biological equivalent limits (BELs) based on National Institute for Occupational Safety and Health (NIOSH) TWA exposure limits, calculated as means of regression slope and y-intercept, were 3.6 microg/l(urine) for sevoflurane (corresponding to 2 ppm) and 22.3 microg/l(urine) for N(2)O (corresponding to 25 ppm). Individual "mixture BELs", which we calculated by applying the American Conference of Governmental Industrial Hygienists (ACGIH) threshold limit value (TLV) mix formula to biomarker values and using the obtained NIOSH-based BELs as a reference, closely correlated with mixture TLVs (rho=0.816, Lin's concordance test). CONCLUSIONS. We propose urinary sevoflurane as a new, specific, internal dose biomarker for routine biological monitoring of personal exposures among operating-theatre personnel, and use of reliable "mixture BELs" to provide safer levels of internal exposure for workers exposed to mixtures of sevoflurane and N(2)O, and conceivably also to other mixtures of toxicants with possible additive effects.

Biomonitoring of exposure to nitrous oxide, sevoflurane, isoflurane and halothane by automated GC/MS headspace urinalysis

OBJECTIVES

The goal of the present study was to develop an automated method to assess by biological monitoring, the volatile-anaesthetic exposure (nitrous oxide, sevoflurane, isoflurane and halothane) in operating theatre personnel.

METHODS

Post-shift urine samples were analysed by gas chromatography-mass spectrometry coupled with static headspace sampling (GC-MS/ HSS); intra-assay %-RSD (n= 10) was less than 5% for nitrous oxide and less than 7% for each halogenated vapour. The biomonitoring method was validated with air monitoring data, obtained by personal samplers and a similar GC-MS method. The sensitivity achieved by single ion monitoring (SIM) was sufficient to reveal low biological and environmental exposure averages down to 1 microg/l(urine) and 0.5 ppm for nitrous oxide and 0.1 microg/l(urine) and 50 ppb for halogenated compounds, respectively.

RESULTS

In 1998 we collected and analysed 714 post-shift urine samples for the biological monitoring of volatile anaesthetics in the urine of the operating-theatre personnel of Sant'Orsola-Malpighi Hospital (Bologna, Italy). Our data showed that nitrous oxide (N20), the anaesthetic most largely used in general anaesthesia, is still the decisive factor in operating-theatre pollution. Moreover, on the basis of our results, working in close contact with anaesthetics seems to be the main determinant of risk: surgical nurses and anaesthesiologists are the most-exposed professional categories (mean post-shift urinary N2O approximately 65 microg/l(urine)) while general theatre staff, surgeons, and auxiliary personnel have significantly lower exposure.

CONCLUSIONS

The biological monitoring of post-shift unmodified urinary volatile anaesthetics was confirmed to be a useful tool for evaluating individual exposure to these chemicals. The urinary concentrations of N2O and of halogenated vapours might reflect, to a certain extent, the external exposure to these compounds, and respiratory air-monitoring data support the validity of biological monitoring. Furthermore, the good relationship between air and urinary concentration of anaesthetics in people working in closer contact with these chemicals may be a good indirect means of revealing the bad air conditions of operating rooms, and may contribute to the highlighting and correction of service defects in anaesthesiology equipment and of human errors.

Effects of dung and urine amendments on the isotopic content of N(2)O released from grasslands

The temporal and diurnal changes in nitrous oxide (N(2)O) fluxes were measured between 29(th) September and 2(nd) November 1999 from urine and dung patches from cattle deposited on grazed grassland. The delta(15)N and delta(18)O values of the N(2)O emitted from soil from both treatments were examined on four occasions during this period. The diurnal fluxes of N(2)O were measured by a chamber technique that provides hourly measurement of N(2)O fluxes. The (15)N and (18)O analysis of N(2)O were determined by isotope ratio mass spectrometry. N(2)O fluxes from the excreta patches were large, with peak emissions up to 1893 ng N m(-2) s(-1) occurring after heavy precipitation, measured one month after the treatment applications. Emissions from the urine patches were significantly greater than from the dung. The results showed that excretal patches are an important source of atmospheric N(2)O. The flux pattern showed a strong diurnal variation with maximum fluxes generally occurring in late afternoon or early morning, and generally not in phase with the soil temperature changes. The isotopic content of (15)N and (18)O in the N(2)O showed a similar trend to that of the N(2)O flux. The (15)N and (18)O values of the N(2)O emitted from the soil indicated that denitrification was the major process involved. After heavy precipitation on the 6(th) October, the larger delta(15)N and delta(18)O values suggested a consumption of the N(2)O by total denitrification.

Solid-phase microextraction gas chromatographic-mass spectrometric method for the determination of inhalation anesthetics in urine

Solid-phase microextraction (SPME) has been applied to the headspace sampling of inhalation anesthetics (i.e. nitrous oxide, isoflurane and halothane) in human urine. Analysis was carried out by gas chromatography-mass spectrometry using a capillary column with a divinylbenzene porous polymeric stationary phase. A SPME divinylbenzene-Carboxen-polydimethylsiloxane coated fiber, 2 cm long, was used, and its performances were compared with those of a Carboxen-PDMS in terms of sensitivity, extraction efficiency, extraction time, fiber coating-urine distribution coefficient. For both fibers, linearity was established over four orders of magnitude, limits of detection were below 100 ng/l for nitrous oxide and below 30 ng/l for halogenated. Precision calculated as %RSD was within 3-13% for all intra- and inter-day determinations. The method was applied to the quantitative analysis of anesthetics in the urine of occupationally exposed people (operating room personnel).

The biological monitoring of inhalation anaesthetics

The biological monitoring of inhalation anaesthetics. Occupational exposure to inhalation anaesthetics is an undesired consequence of the work in the operating theatre. Anaesthesia is currently practised using nitrous oxide associated with one or more potent anaesthetics (halothane, enflurane, isoflurane). In the present study we evaluated the occupational exposure to inhalation anaesthetics during anaesthesia in 190 operating theatres of 41 hospitals in Italy. Nitrous oxide, halothane, enflurane, isoflurane were detected in the urine of 1521 exposed subjects (anaesthetists, surgeons and nurses). Significant correlations were found between the anaesthetic concentrations in urine produced during the shift (Cu) and anaesthetic environmental concentrations (CI). The results show that the urinary anaesthetic concentration can be used as an appropriate biological exposure index. The biological threshold values (urinary concentration values) proposed are the following: nitrous oxide, 15, 28 and 57 micrograms/L for an environmental exposure of 25, 50 and 100 ppm respectively; halothane, 97 micrograms/L (for an environmental exposure of 50 ppm), 6.1 micrograms/L (for an environmental exposure of 2 ppm) and 3.3 micrograms/L (for an environmental exposure of 0.5 ppm); enflurane, 145 micrograms/L (for an environmental exposure of 50 ppm), 22.7 micrograms/L (for an environmental exposure of 10 ppm), 3.7 micrograms/L (for an environmental exposure of 1 ppm); isoflurane, 5.3 micrograms/L (for an environmental exposure of 2 ppm) and 1.8 micrograms/L (for an environmental exposure of 0.5 ppm). These values apply to urine samples collected at the end of 4-hours' exposure to the anaesthetics.

Neurobehavioral functions in operating theatre personnel: a multicenter study

The study was conducted to evaluate neuropsychological symptoms, subjective stress and response speed functions in subjects occupationally exposed to low levels of anesthetic gases. A group of 112 operating theatre personnel exposed to anesthetic gases (nitrous oxide and isoflurane), and 135 non exposed hospital workers from 10 hospitals in Northern Italy were examined before and after the shift on the first and the last day of the working week. Three different tasks were administered: a complex reaction time test (the Stroop Color Word); a questionnaire for neuropsychological symptoms (EURO-QUEST); the block design subtest (WAIS). Biological and atmospheric indicators of exposure were measured. In the exposed group, the geometric mean of urinary nitrous oxide at the end of the shift was 7.1 micrograms/l (95th percentile 12.4, range 1.5-43) on the first and 7.8 micrograms/l (95th percentile 21.5, range 1.0-73.3) on the last day of the working week. On the same days, end of shift urinary isoflurane was 0.7 microgram/l (95th percentile 2.6, range 0-4.7) on the first day and 0.8 microgram/l (95th percentile 2.0, range 0-5.6) on the last. The exposed and control subjects were comparable for both basic intellectual abilities and subjective stress levels. No statistical differences were observed between exposed and control subjects for neuropsychological tests and symptoms. No dose-effect relationships were observed between the exposure indicators and the test results. In conclusion, no early behavioral effect on the central nervous system was detectable at the exposure levels measured. The biological exposure limits of 13 micrograms/l for nitrous oxide and 1.8 micrograms/l for isoflurane corresponding respectively to the atmospheric concentrations of 25 ppm and 0.5 ppm seem to be adequately protective for the integrity of workers' neurobehavioral functions, as measured with the tests used.

Interferences of urinary tract infection in the measurement of urinary nitrous oxide

OBJECTIVES

To investigate the effective role of micro-organisms in producing N2O.

METHODS

The N2O in either urine samples inoculated with 24 microbial strains or urine samples from patients with urinary tract infections were measured.

RESULTS

Gram negative bacilli generally produced high amounts of nitrous oxide (N2O), whereas Gram positive cocci and yeasts did not. The production of N2O depends on the incubation time and follows exponential kinetics, reaching a plateau at 48 hours. Furthermore, the results of urinocultures agreed well with N2O concentrations found in urine samples: samples negative for bacteria were found to contain very low concentrations of N2O whereas those positive--for example, for Enterobacteriaceae--gave highest N2O values.

CONCLUSION

The urinary tract infections caused by Gram negative bacilli are important confounding factors in biological monitoring practices of exposure to inhalation anaesthetics. The current methods adopted to avoid these factors (urine acidification, storage of samples at 4 degrees C) are not good enough because of the relative acid tolerance of some strains and the production of N2O directly into the bladder.

Nitrous oxide in blood and urine of operating theatre personnel and the general population

Nitrous oxide (N2O) was assayed in 676 urine samples and 101 blood samples provided after exposure by operating theatre personnel from nine hospitals. The blood and urine assays were repeated in 25 subjects 18 h after the end of exposure. For 80 subjects, environmental N2O was also measured during intraoperative exposure. Mean urinary N2O in the 676 subjects at the end of exposure was 40 micrograms/l (range 1-3805 micrograms/l); in 10 of the 676 subjects, urinary N2O was in the range 279-3805 micrograms/l (mean 1202 micrograms/l). The 98th percentile was 120 micrograms/l. Mean blood N2O at the end of exposure, measured in 101 subjects, was 21 micrograms/l (median 16 micrograms/l, range 1-75 micrograms/l). Blood and urine N2O (1.5 micrograms/l and 4.9 micrograms/l, respectively) in 25 subjects, 18 h after exposure, was significantly higher than in occupationally non-exposed subjects (blood 0.91 microgram/l, urine 1 microgram/l). Environmental exposure was significantly related to blood and urinary N2O (r = 0.59 and r = 0.64, respectively). Blood and urinary N2O were significantly related to each other (r = 0.71), and were equivalent to about 25% of the environmental exposure level. The mean urinary N2O of 1202 micrograms/l in 10/676 subjects was not related to environmental exposure in the operating theatre. The highest urinary N2O levels measured in these 10/676 subjects could be explained by an asymptomatic urinary infection.

[The biological monitoring of occupational exposure to anesthetic gas and vapors: the determination of nitrogen protoxide, halothane and isoflurane in the urine]

A gas-chromatographic method has been developed for measuring urinary nitrous oxide, halothane and isoflurane concentrations. A volume of head-space gases obtained from biological samples is analyzed by ECD-GC on a steel column (2 mm ID) serially packed with Porapak Q (1.2 m) and MS-5A (0.30 m), operated at 160 degrees C. The detection limit (ranging from 0.03 micrograms/l for halothane to 1 microgram/l for nitrous oxide), between-day precision (CV < 6%) and working linear range (up to 100 micrograms/l for halothane and 2000 micrograms/l for nitrous oxide) were determined. A two-year experience in biological monitoring of occupationally exposed surgical staff with the proposed method is reported and confounding factors are discussed. The method is easy to perform, free from interferences and suitable for use in routine analysis in toxicological laboratories.

[Evaluation of the risk of anesthetic gases to exposed subjects with different tasks in operating rooms]

A research was carried out on risk evaluation of workers with different tasks in operating theatre. The airborne concentrations were determined by an IR analyzer with two distinct sampling lines: the first was placed in surgical zone and the second one in anesthesiological zone. The anesthetists resulted more at risk than surgical team. Nevertheless when the evaluation was based on N2O urinary concentration and data were stratified according to task a prevalent inhalation absorption resulted for non medical staff (instrumentist and professional nurse). Our data concerning N2O ranged between 95-764 ppm indoor and between 3-92 mcg/l in the urines of exposed subjects.

[Neurobehavioral effects of exposure to anesthetic gases]

Neurobehavioral studies on operating room personnel exposed to anaesthetic gases in hospitals of the Region Lombardia have confirmed findings already reported in the literature. There was high subjective symptomatology and reduced efficiency at psychologic testing among exposed people with protracted exposure. In this group, reaction time was worse at the end of the workshift with respect to the beginning. These changes were reversible after removal from exposure. It was impossible to establish a clear dose/response relationship due to the difficulty to control an important confounding factor, such as stress, in field studies.

[Evaluation of several neuropsychological parameters in subjects occupationally exposed to anesthetics]

51 workers, occupationally exposed to anaesthetic gases and vapours (nitrous oxide, halothane, and isoflurane), were studied monitoring their environmental and biological exposure. Moreover, they were tested for visual reaction times and neurobehavioural batteries. There was no evidence of important neurotoxic effects nor of neurobehavioural problems with low concentrations of anaesthetics.

[Measurements and environmental and biological monitoring of occupational exposure to inhalation anesthetics]

This paper reports the data of nitrous oxide (N2O) environmental pollution in 269 operating rooms of 47 hospitals in Italy in 1989-91. In 40% of the operating rooms the N2O concentrations are lower than 50 ppm, limit value proposed by Health Council for new operating rooms. In 65.4% of the operating room studied, N2O mean environmental concentrations are lower than 100 ppm, value proposed by the above-mentioned Health Council as limit value for the already existing operating rooms. Concerning the biological monitoring, the authors report several N2O data in urine (2193), whose levels confirm the data obtained with environmental monitoring. The authors believe that they presently have reliable methods to perform biological and environmental monitoring: the two techniques are complementary in the assessment of the exposure. The method of measuring N2O concentrations as exposure index, both for the environmental and biological monitoring, is considered very useful to simplify the performance of the analyses. In order to assess exposure more precisely, it is however necessary also to determine the environmental and/or biological measure of the other different anaesthetics used.

Biological monitoring of nitrous oxide exposure in surgical areas

Exposure to nitrous oxide in surgical theaters was evaluated for duration, numbers, and types of surgical procedures. The concentration of the gas in the air was 92-444 ppm. Before and after the surgical sessions, samples of urine and expired air were collected from surgical theater personnel for gas determination. Nitrous oxide concentrations in urine and in expired air showed a good correlation with gas concentration in the air (r = 0.760 and r = 0.921, respectively). Moreover, a good correlation (r = 0.823) between gas concentration in urine and that in expired air was also found. A biological threshold limit value (TLV) of 20.6 micrograms/liter for urine and of 29.6 ppm for expired air was calculated, based on the limit of 50 ppm in the air proposed by the American Conference of Governmental Industrial Hygienists (ACGIH). Other biological TLVs corresponding to higher proposed limits (200 and 500 ppm) were also calculated.

[Evaluation of occupational exposure to inhalation anesthetics. Study Group on Environmental Monitoring, Biological Monitoring and Laboratory Surveillance in Lombardia]

A group of Occupational Medicine researchers in Lombardia prepared a document about the problems of occupational exposure to inhalation anaesthetics referring to the Meeting "Occupational Hazard from Inhalation Anaesthetics. Monitoring and Prevention". (Pavia, May 1988). A survey in 111 operating theatres and 11 hospitals showed high anaesthetics pollution and allowed to find its main causes. On the basis of this survey the authors were able to indicate the methods to control the exposure, both by determining the polluting agents in working environment, and by using the internal dose biological monitoring. For the exposure monitoring the authors suggest determining nitrous oxide (N2O) in various sites of the operating rooms, in the operators respiratory zone and/or in single workers' urine at the end of the work-shift. The environmental and/or biological measurement of nitrous oxide also indicated the pollution due to other inhalation anesthetics used at the same time. The authors also make suggestions about the methods and timing of environmental and biological monitoring and health surveillance.

[Proposal of the biological monitoring of inhalation anesthetics]

The long-term occupational exposure to inhalation anaesthetics might represent a health hazard; mainly it may have an adverse effect on the reproductive outcome. Nitrous oxide is the anaesthetic employed in the largest amount during general anaesthesia and it can be used as an indicator of occupational exposure to all the components the mixture; but if the pattern of dispersion of them (when leaking into the operating theater) are not the same, two indicators should be used: N2O (gas) + another component the mixture (vapour). Our results concern practically 5 points: --Analysis of N2O by means of a diffusive personal sampler (comparison with a conventional sampling method) --Analysis of N2O in urine collected after 4 hours of exposure during routine anaesthetic work (headspace method) --Comparison of environmental and biological data concerning N2O --Comparison of environmental and biological data concerning a component of the anaesthetic mixture, forane --Proposal of biological exposure indices for nitrous oxide and forane. A close relationship between air and urine was found in 363 subjects occupationally exposed to N2O and 45 subjects exposed to forane (r: 0.95 and 0.90 respectively). On the basis of such a relationship the biological exposure index for N2O corresponding to an ambient concentration of 100 ppm (European limit) turned out to be 55 micrograms/L; the ones for forane corresponding to ambient concentrations of 2 or 10 ppm are respectively 3.4 or 14.5 micrograms/L (urinary concentrations in samples collected after 4 hours of exposure).

Nitrous oxide exposure during routine anaesthetic work. Measurement of biologic exposure from urine samples and technical exposure by bag sampling

Nitrous oxide exposure in a modern hospital during routine anaesthetic work was measured using a technical exposure measurement technique and compared to measurement of biologic exposure from urine samples. The study included different anaesthetic situations and also a study of the efficiency of close scavenging and general air-conditioning in reducing nitrous oxide exposure. Exposure to nitrous oxide varied greatly. The mean nitrous oxide exposure in the total material was 53 ppm corresponding to approximately half the Swedish control limit (100 ppm) for 8 h time-weighted average (TWA). The only anaesthetic situation regularly resulting in 8 h TWA exposure exceeding the control limit was paediatric anaesthesia (92 +/- 67 ppm, mean +/- s.d.). The use of close scavenging significantly reduced the 8 h TWA nitrous oxide exposure in paediatric anaesthesia. The reduction of exposure was not significant during other forms of anaesthesia where low levels were found when anaesthetic equipment with excess gas scavenging was used in theatres with non-recirculating air-conditioning. The correlation between conventional technical exposure measurement and urine headspace nitrous oxide measurement was good. Both theoretical arguments and practical experience indicate that this method can be used for assessing nitrous oxide exposure during routine anaesthetic work.

Exposure to trace amounts of nitrous oxide. Evaluation of urinary gas content monitoring in anaesthetic practice

The urinary content of nitrous oxide was monitored during routine anaesthetic practice. There was a linear correlation with simultaneous measurements of technical exposure measured with a personal pump-bag sampling system (r = 0.99). Monitoring of urinary nitrous oxide with headspace extraction and gas chromatographic analysis is a simple and accurate mode of biological monitoring of exposure to nitrous oxide in the atmosphere.