Herzog-Niescery Jennifer, Seipp Hans-Martin, Weber Thomas Peter, Bellgardt Martin
Department of Anesthesiology, Ruhr-University Bochum, St. Josef Hospital, Gudrunstraße 56, 44791, Bochum, Germany.
Department of Life Science Engineering, University of Applied Sciences, Wiesenstr. 14, 35390, Giessen, Germany.
J Clin Monit Comput. 2018 Aug;32(4):667-675. doi: 10.1007/s10877-017-0055-6. Epub 2017 Aug 31.
There is a growing interest in the use of volatile anesthetics for inhalational sedation of adult critically ill patients in the ICU. Its safety and efficacy has been demonstrated in various studies and technical equipment such as the anaesthetic conserving device (AnaConDa™; Sedana Medical, Uppsala, Sweden) or the MIRUS™ system (Pall Medical, Dreieich, Germany) have significantly simplified the application of volatile anesthetics in the ICU. However, the personnel's exposure to waste anesthetic gas during daily work is possibly disadvantageous, because there is still uncertainty about potential health risks. The fact that average threshold limit concentrations for isoflurane, sevoflurane and desflurane either differ significantly between countries or are not even defined at all, leads to raising concerns among ICU staff. In this review, benefits, risks, and technical aspects of inhalational sedation in the ICU are discussed. Further, the potential health effects of occupational long-term low-concentration agent exposure, the staffs' exposure levels in clinical practice, and strategies to minimize the individual gas exposure are reviewed.
在重症监护病房（ICU）中，使用挥发性麻醉剂对成年重症患者进行吸入镇静越来越受到关注。其安全性和有效性已在各种研究中得到证实，并且诸如麻醉节省装置（AnaConDa™；瑞典乌普萨拉Sedana Medical公司）或MIRUS™系统（德国德赖艾希Pall Medical公司）等技术设备显著简化了挥发性麻醉剂在ICU中的应用。然而，工作人员在日常工作中接触废麻醉气体可能存在不利影响，因为潜在健康风险仍存在不确定性。异氟烷、七氟烷和地氟烷的平均阈限值在不同国家之间差异显著，甚至根本未明确界定，这引发了ICU工作人员的担忧。在这篇综述中，讨论了ICU中吸入镇静的益处、风险和技术方面。此外，还综述了职业长期低浓度接触麻醉剂的潜在健康影响、临床实践中工作人员的接触水平以及将个体气体接触降至最低的策略。
