Allison Serah Joan, Docherty Paul David, Pons Dirk, Chase James Geoffrey
University of Canterbury, Christchurch, New Zealand (Department of Mechanical Engineering).
Int J Occup Med Environ Health. 2021 Dec 13;34(6):767-777. doi: 10.13075/ijomeh.1896.01704. Epub 2021 Jun 1.
Ambulance officers administering methoxyflurane as an inhalational analgesic may be exposed to trace vapor. Fluoride is a methoxyflurane metabolite, and has been associated with acute renal failure in anesthesia patients and skeletal fluorosis with chronic elevated serum levels from other sources. However, there has been no direct measurement of serum fluoride in occupationally exposed ambulance officers. Thus, this study directly measures serum fluoride over a prolonged period in order to determine renal toxic and skeletal fluorosis risk to ambulance officers who are administering methoxyflurane.
Serum inorganic fluoride concentrations were measured in a prospective observational study of 12 emergency medical technicians (EMTs). The study took 7 serum fluoride measurements over 24 months. A meta-analysis of healthy adult serum fluoride ranges was also conducted.
The typical healthy adult serum fluoride range was determined to be 0.21-2.11 μmol/l (p < 0.001). The EMTs' baseline median (IQR) serum fluoride concentrations were 0.4 μmol/l (0.2; 1.0) with maximum 1.6 μmol/l. The EMTs' overall median serum fluoride was 0.4 μmol/l (0.2; 1.3) with maximum 4.0 μmol/l, usually within healthy reference ranges. All results were ≤10% of the suggested single-dose renal toxic threshold. One result was above a threshold for skeletal fluorosis. The highest measured serum fluoride was 24% of the lowest level associated with radiologic evidence of fluorosis. There was no evidence overall of increasing serum fluoride levels.
There was no evidence that EMTs' exposure to methoxyflurane resulted in sustained increased serum fluoride. These results imply EMTs' occupational safety from acute renal toxicity when activated carbon filtration is used on patient exhalation. However, 1 serum fluoride result above a skeletal fluorosis threshold suggests that the risk of mild skeletal fluorosis cannot be excluded. Int J Occup Med Environ Health. 2021;34(6):767-77.
使用甲氟烷作为吸入性镇痛药的救护人员可能会接触到微量蒸气。氟化物是甲氟烷的一种代谢产物，在麻醉患者中与急性肾衰竭有关，而在其他来源导致血清水平长期升高的情况下与骨氟症有关。然而，此前尚未对职业暴露的救护人员的血清氟化物进行直接测量。因此，本研究对血清氟化物进行了长时间的直接测量，以确定使用甲氟烷的救护人员面临的肾毒性和骨氟症风险。
在一项针对12名急救医疗技术员（EMT）的前瞻性观察研究中测量血清无机氟化物浓度。该研究在24个月内进行了7次血清氟化物测量。还对健康成年人血清氟化物范围进行了荟萃分析。
确定典型健康成年人血清氟化物范围为0.21 - 2.11μmol/l（p < 0.001）。急救医疗技术员的基线血清氟化物浓度中位数（IQR）为0.4μmol/l（0.2；1.0），最高为1.6μmol/l。急救医疗技术员的总体血清氟化物中位数为0.4μmol/l（0.2；1.3），最高为4.0μmol/l，通常在健康参考范围内。所有结果均≤建议的单剂量肾毒性阈值的10%。有一个结果高于骨氟症阈值。测得的最高血清氟化物为与氟中毒放射学证据相关的最低水平的24%。总体上没有证据表明血清氟化物水平在升高。
没有证据表明急救医疗技术员接触甲氟烷会导致血清氟化物持续升高。这些结果表明，当对患者呼出气体使用活性炭过滤时，急救医疗技术员可免受急性肾毒性的职业安全风险。然而，有1个血清氟化物结果高于骨氟症阈值，这表明不能排除轻度骨氟症的风险。《国际职业医学与环境卫生杂志》。2021；34(6):767 - 777。
