Department of Anesthesiology, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany -
Department of Anesthesiology, Ruhr-University Bochum, St. Josef Hospital, Bochum, Germany.
Minerva Anestesiol. 2018 Jan;84(1):25-32. doi: 10.23736/S0375-9393.17.11770-0. Epub 2017 Jun 14.
Use of anesthetic conserving devices (ACD) for inhalational isoflurane sedation in Intensive Care Units (ICU) has grown in recent years, and healthcare professionals are concerned about isoflurane pollution and exposure-related health risks. Real-time measurements to determine isoflurane exposure in ICU personnel during short-term patient care procedures and ACD handling have not yet been performed.
Isoflurane concentrations in the breathing zones of ICU staff (25 cm around the nose and mouth) were measured, by photoacoustic gas monitoring, during daily practice including tracheal suctioning, oral hygiene, body care, and patient positioning. Isoflurane pollution was further determined during ACD replacement, syringe filling, and after isoflurane spillages.
The average mean isoflurane concentration 25 cm above patients' tracheostoma was 0.3 ppm. Mean (cmean) and maximum (cmax) isoflurane exposure in personnel's breathing zones during patient care ranged from 0.4 to 1.9 ppm and 0.7 to 6.6 ppm, respectively. Isoflurane exposure during ACD replacement was cmean 0.5 to 17.4 ppm and cmax 0.8 to 114.3 ppm. Isoflurane concentrations during ACD syringe filling ranged from 2.4 to 9.1 ppm. The maximum isoflurane concentrations after spillage were dose-dependent.
Use of ACDs and patient physical manipulation are accompanied by isoflurane pollution. Baseline concentrations did not exceed long-term exposure limits, but short-term limits were occasionally exceeded during patient care procedures and ACD handling. Spillages should be avoided, especially when air-conditioning and scavenging systems are unavailable.
近年来，在重症监护病房（ICU）中使用麻醉气体储存器（ACD）来进行异氟烷吸入镇静的情况有所增加，医护人员担心异氟烷污染和与接触相关的健康风险。目前尚未对 ICU 人员在进行短期患者护理程序和 ACD 处理期间的异氟烷暴露进行实时测量。
通过光声气体监测，在日常实践中（包括气管吸痰、口腔卫生、身体护理和患者体位调整）测量 ICU 工作人员（口鼻周围 25cm 处）的呼吸区异氟烷浓度。还进一步在 ACD 更换、注射器填充以及异氟烷溢出后确定异氟烷污染情况。
患者气管造口处上方 25cm 处的平均异氟烷浓度为 0.3ppm。在患者护理过程中，人员呼吸区的平均（cmean）和最大（cmax）异氟烷暴露量分别为 0.4 至 1.9ppm 和 0.7 至 6.6ppm。ACD 更换过程中的 cmean 异氟烷暴露量为 0.5 至 17.4ppm，cmax 异氟烷暴露量为 0.8 至 114.3ppm。ACD 注射器填充过程中的异氟烷浓度范围为 2.4 至 9.1ppm。溢出后最大异氟烷浓度与剂量有关。
使用 ACD 和患者身体操作会伴随异氟烷污染。基线浓度未超过长期暴露限值，但在患者护理程序和 ACD 处理期间偶尔会超过短期限值。应避免溢出，尤其是在空调和清除系统不可用时。
