Department of Anaesthesiology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.
Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany.
Acta Anaesthesiol Scand. 2019 Jan;63(1):86-92. doi: 10.1111/aas.13222. Epub 2018 Aug 7.
MIRUS™ is a device for target-controlled inhalational sedation in the ICU in combination with use of isoflurane, or sevoflurane, or desflurane. The feasibility of this device has recently been proven; however, ICU staff exposure may restrict its application. We investigated ICU ambient room pollution during daily work to estimate ICU personnel exposure while using MIRUS™.
This observational study assessed pollution levels around 15 adult surgical patients who received volatile anaesthetics-based sedation for a median of 11 hours. Measurements were performed by photoacoustic gas monitoring in real-time at different positions near the patient and in the personnel's breathing zone. Additionally, the impact of the Clean Air™ open reservoir scavenging system on volatile agent pollution was evaluated.
Baseline concentrations [ppm] during intervention and rest periods were isoflurane = 0.58 ± 0.49, = 5.72; sevoflurane = 0.22 ± 0.20, = 7.93; and desflurane = 0.65 ± 0.57, = 6.65. Refilling MIRUS™ with liquid anaesthetic yielded gas concentrations of = 2.18 ± 1.48 ppm and = 13.03 ± 9.37 ppm in the personnel's breathing zone. Air pollution in the patient's room was approximately five times higher without a scavenging system.
Ambient room pollution was minimal in most cases, and the measured values were within or below the recommended exposure limits. Caution should be taken during refilling of the MIRUS™ system, as this was accompanied by higher pollution levels. The combined use of air-conditioning and gas scavenging systems is strongly recommended.
MIRUS™ 是一种与异氟烷、七氟烷或地氟烷联合使用的 ICU 内靶控吸入镇静设备。该设备的可行性最近已得到证实；然而，ICU 工作人员的暴露可能会限制其应用。我们研究了 ICU 日常工作中的环境室污染，以评估使用 MIRUS™ 时 ICU 人员的暴露情况。
这项观察性研究评估了 15 名接受基于挥发性麻醉剂镇静的成年外科患者周围的污染水平，每位患者的中位镇静时间为 11 小时。通过实时光声气体监测在患者附近和人员呼吸区域的不同位置进行测量。此外，还评估了 Clean Air™ 开放式储液罐清除系统对挥发性药物污染的影响。
干预和休息期间的基线浓度[ppm]分别为异氟烷为 0.58 ± 0.49， = 5.72；七氟烷为 0.22 ± 0.20， = 7.93；和地氟烷为 0.65 ± 0.57， = 6.65。用液体麻醉剂重新填充 MIRUS™ 后，人员呼吸区的气体浓度为 = 2.18 ± 1.48 ppm 和 = 13.03 ± 9.37 ppm。没有清除系统时，患者房间的空气污染大约高出五倍。
在大多数情况下，环境室污染程度较低，测量值处于或低于推荐的暴露限值内。在重新填充 MIRUS™ 系统时应谨慎，因为这会伴随着更高的污染水平。强烈建议同时使用空调和气体清除系统。
