Irwin Michael G, Trinh Theresa, Yao Che-Lin
Professor and Head, The University of Hong Kong, Queen Mary Hospital, Department of Anaesthesiology, Room 424, Block K, Hong Kong.
Expert Opin Drug Saf. 2009 Jul;8(4):473-83. doi: 10.1517/14740330903003778.
Modern anaesthesia is still mostly administered by the inhalational route and there is increasing concern over its potential for pollution. One of the first gaseous anaesthetic agents was nitrous oxide and this is still widely used today despite being associated with adverse effects caused by depression of vitamin B(12) function and diminished reproductive health. The use of halothane is associated with hepatitis but the adverse effects of newer halogenated hydrocarbons are less well recognised. Chronic exposure may cause reduction in antioxidant activity in plasma and erythrocytes, inhibition of neutrophil apoptosis, depression of central neuro-respiratory activity, increased DNA breaks, effects on cerebral blood circulation and altered renal function. Inhalational anaesthetics also have adverse environmental effects, including ozone damage and greenhouse gas effects. Levels of inhalational anaesthetics in the ambient air of operating theatres and recovery rooms often exceed those stated in national guidelines. Anaesthetic procedures can be modified and air-conditioning and air scavenging systems should be used to minimise the risks from occupational exposure and threats to the environment. Such contamination could be avoided with the use of total intravenous anaesthesia.
现代麻醉大多仍通过吸入途径给药，人们对其潜在的污染问题越来越担忧。最早的气态麻醉剂之一是一氧化二氮，尽管它与维生素B12功能抑制和生殖健康受损引起的不良反应有关，但如今仍被广泛使用。氟烷的使用与肝炎有关，但新型卤代烃的不良反应则鲜为人知。长期接触可能导致血浆和红细胞中抗氧化活性降低、中性粒细胞凋亡受抑制、中枢神经呼吸活动受抑制、DNA断裂增加、影响脑血液循环以及肾功能改变。吸入性麻醉剂还具有不良环境影响，包括破坏臭氧层和温室气体效应。手术室和恢复室环境空气中的吸入性麻醉剂水平常常超过国家指南规定的水平。麻醉程序可以改进，应使用空调和空气清除系统，以尽量减少职业暴露风险和对环境的威胁。使用全静脉麻醉可以避免此类污染。
