Occupational exposure to anaesthetics: liver injury, microsomal enzyme induction and preventive aspects.

Apart from a risk excess of liver disease among operating theatre personnel and of spontaneous abortion in women exposed during pregnancy, no definitive conclusion has been drawn as regards health impairment among anaesthesiology staff. Hepatotoxicity has been detected in experimental and epidemiological studies, suggesting a close relationship between liver disease and anaesthetics, particularly halogenated hydrocarbons (halothane and isoflurane) and nitrous oxide. The liver microsomal enzyme system has received particular attention in order to clarify the mechanism involved in anaesthetics hepatotoxicity and an increased microsomal enzyme activity has been observed in experimental conditions and in humans (both patients treated with anaesthetic mixture and anaesthesiology staff). The prevention of adverse health effect among workers of anaesthesiology staff, is based on (i) the use of less toxic anaesthetics and (ii) the control of working conditions of staff. Attention is focused on biological monitoring by means of indicators, which reflect not only the environmental pollution but can be regarded as liver response of anaesthetics exposed workers. This inductive effect is commonly considered the earliest sign caused by exposure to several chemicals and may be evaluated by means of biomarkers, among which the measure of urinary D-glucaric acid excretion is a well established non invasive tool.