Occupational hazards, DNA damage, and oxidative stress on exposure to waste anesthetic gases

Background and objectives: The waste anesthetic gases (WAGs) present in the ambient air of operating rooms (OR), are associated with various occupational hazards. This paper intends to discuss occupational exposure to WAGs and its impact on exposed professionals, with emphasis on genetic damage and oxidative stress. Content: Despite the emergence of safer inhaled anesthetics, occupational exposure to WAGs remains a current concern. Factors related to anesthetic techniques and anesthesia workstations, in addition to the absence of a scavenging system in the OR, contribute to anesthetic pollution. In order to minimize the health risks of exposed professionals, several countries have recommended legislation with maximum exposure limits. However, developing countries still require measurement of WAGs and regulation for occupational exposure to WAGs. WAGs are capable of inducing damage to the genetic material, such as DNA damage assessed using the comet assay and increased frequency of micronucleus in professionals with long-term exposure. Oxidative stress is also associated with WAGs exposure, as it induces lipid peroxidation, oxidative damage in DNA, and impairment of the antioxidant defense system in exposed professionals. Conclusions: The occupational hazards related to WAGs including genotoxicity, mutagenicity and oxidative stress, stand as a public health issue and must be acknowledged by exposed personnel and responsible authorities, especially in developing countries. Thus, it is urgent to stablish maximum safe limits of concentration of WAGs in ORs and educational practices and protocols for exposed professionals. Resumo: Justificativa e objetivos: Os Resíduos de Gases Anestésicos (RGA) presentes no ar ambiente das Salas de Operação (SO) são associados a riscos ocupacionais diversos. O presente artigo propõe-se a discorrer sobre exposição ocupacional aos RGA e seu impacto em profissionais expostos, com ênfase em danos genéticos e estresse oxidativo. Conteúdo: Apesar do surgimento de anestésicos inalatórios mais seguros, a exposição ocupacional aos RGA ainda é preocupação atual. Fatores relacionados às técnicas anestésicas e estação de anestesia, além da ausência de sistema de exaustão de gases em SO, contribuem para poluição anestésica. Para minimizar os riscos à saúde em profissionais expostos, recomendam-se limites máximos de exposição. Entretanto, em países em desenvolvimento, ainda carece a mensuração de RGA e de regulamentação frente à exposição ocupacional aos RGA. Os RGA são capazes de induzir danos no material genético, como danos no DNA avaliados pelo teste do cometa e aumento na frequência de micronúcleos em profissionais com exposição prolongada. O estresse oxidativo também é associado à exposição aos RGA por induzir lipoperoxidação, danos oxidativos no DNA e comprometimento do sistema antioxidante em profissionais expostos. Conclusões: Por tratar-se de questão de saúde pública, é imprescindível reconhecer os riscos ocupacionais relacionados aos RGA, inclusive genotoxicidade, mutagenicidade e estresse oxidativo. Urge a necessidade de mensuração dos RGA para conhecimento desses valores nas SO, especialmente em países em desenvolvimento, de normatização das concentrações máximas seguras de RGA nas SO, além de se adotarem práticas de educação com conscientização dos profissionais expostos. Keywords: Inhaled anesthetics, Occupational exposure, Environment pollution, Genotoxicity testing, Genomic instability, Oxidative stress, Palavras-chave: Anestésicos inalatórios, Exposição ocupacional, Poluição ambiental, Testes de genotoxicidade, Instabilidade genômica, Estresse oxidativ

Occupational hazards, DNA damage, and oxidative stress on exposure to waste anesthetic gases

Abstract Background and objectives The waste anesthetic gases (WAGs) present in the ambient air of operating rooms (OR), are associated with various occupational hazards. This paper intends to discuss occupational exposure to WAGs and its impact on exposed professionals, with emphasis on genetic damage and oxidative stress. Content Despite the emergence of safer inhaled anesthetics, occupational exposure to WAGs remains a current concern. Factors related to anesthetic techniques and anesthesia workstations, in addition to the absence of a scavenging system in the OR, contribute to anesthetic pollution. In order to minimize the health risks of exposed professionals, several countries have recommended legislation with maximum exposure limits. However, developing countries still require measurement of WAGs and regulation for occupational exposure to WAGs. WAGs are capable of inducing damage to the genetic material, such as DNA damage assessed using the comet assay and increased frequency of micronucleus in professionals with long-term exposure. Oxidative stress is also associated with WAGs exposure, as it induces lipid peroxidation, oxidative damage in DNA, and impairment of the antioxidant defense system in exposed professionals. Conclusions The occupational hazards related to WAGs including genotoxicity, mutagenicity and oxidative stress, stand as a public health issue and must be acknowledged by exposed personnel and responsible authorities, especially in developing countries. Thus, it is urgent to stablish maximum safe limits of concentration of WAGs in ORs and educational practices and protocols for exposed professionals

Does occupational exposure to anesthetic gases lead to increase of pro-inflammatory cytokines?

There is great concern about the possible harmful effects of exposure to volatile anesthetics. The current study aimed at evaluating, for the first time, the effects of occupational exposure to anesthetic gases on physicians who work in operating rooms, by determining several inflammatory cytokines. Plasma inflammatory cytokines (IL-1β, -6, -8, -10, -12, TNF-α) were investigated in 30 individuals who were allocated into two groups of 15: the exposed group, consisting of operating room medical personnel exposed to a mixture of anesthetic gases for 3 years, and a control group composed of medical personnel not exposed to anesthetic gases. The concentrations of volatile anesthetics were measured in the operating room by means of an infrared portable analyzer Our findings suggest an increase of the pro-inflammatory IL-8 (p < 0.05) in medical personnel exposed to high concentrations of anesthetic gases, even for a relatively short period

Complicações das vias aéreas relacionadas à intubação endotraqueal

Descrevemos as principais complicações das vias aéreas relacionadas à intubação endotraqueal, por meio de revisão da literatura e apresentação dos resultados de pesquisas clínicas e experimentais realizadas pelo nosso grupo de estudo. Procuramos alertar os profissionais de saúde quanto à alta incidência de complicações secundárias à intubação, as quais podem ser reduzidas com a adoção de medidas profiláticas simples e de cunho prático, estabelecidas após a compreensão da fisiopatologia das lesões.We reviewed the main airway complications associated with endotracheal intubation, presented some results of our researches and alert health professionals for the high incidence of airway injuries. The knowledge of the physiopathology of these injuries will help to proper prophylactic and practice conducts to prevent the airway complications associated with endotracheal intubation