Research Studies
Study Tracker
Effect of inhaled waste anaesthetic gas on blood and liver parameters among hospital staff.Abstract
A significant health risk exists within a section of health workers that are exposed to anaesthetic gas and vapours, found in the atmosphere of treatment or operating rooms. These compounds are classified as waste anaesthetic gases (WAG). The present study aimed at identifying alterations in hepatic and haematological parameters occurring as a result of chronic exposure to WAG potentially affecting the health of team members working in hospitals. Therefore, operating room operatives, vulnerable to long-standing WAG exposure, were recruited for this study. Sevoflurane anaesthesia metabolites (inorganic fluoride and hexafluoroisopropanol (HFIP)), haematological indices and liver toxicity markers (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, gamma-glutamyl transferase and osteopontin) were measured. The collected results showed increased plasma inorganic fluoride, HFIP and liver toxicity markers, as well as disturbances in haematological parameters. In conclusion, exposure to halogenated inhalational anaesthetics, in general, and Sevoflurane, in particular, induces alterations in hepatic markers and haematological indices.
*Original abstract online at https://journals.sagepub.com/doi/10.1177/0960327120938840
References
1. | Miller, RD, Erikson, LI, Fleisher, LA, et al. Miller’s anesthesia. 7th ed. Philadelphia: Churchill Livingstone Elsevier, 2010. Google Scholar | Crossref |
2. | Lee, JH . Anesthesia for ambulatory surgery. Korean J Anesthesiol 2017; 70(4): 398–406. Google Scholar | Crossref | Medline |
3. | Özelsel1, TJ, Kim, S, Buro, K, et al. Elevated waste anaesthetic gas concentration in the paediatric post anaesthesia care unit. Turk J Anaesthesiol Reanim 2018; 46(5): 362–366. Google Scholar | Crossref | Medline |
4. | Schifilliti, D, Mondello, S, D’Arrigo, MG, et al. Genotoxic effects of anesthetic agents: an update. Expert Opin Drug Saf 2011; 10(6): 891–899. Google Scholar | Crossref | Medline |
5. | Dabbagh, A, Rajaei, S. Halothane: is there still any place for using the gas as an anesthetic? Hepat Mon 2011; 11(7): 511–512. Google Scholar | Medline | ISI |
6. | Boiano, JM, Steege, AL. Precautionary practices for administering anesthetic gases: a survey of physician anesthesiologists, nurse anesthetists and anesthesiologist assistants. J Occup Environ Hyg 2016; 13(10): 782–793. Google Scholar | Crossref | Medline |
7. | Lucchini, R, Placidi, D, Toffoletto, F, et al. Neurotoxicity in operating room personnel working with gaseous and nongaseous anesthesia. Int Arch Occup Environ Health 1996; 68(3): 188–192. Google Scholar | Crossref | Medline | ISI |
8. | Vouriot, A, Gauchard, GC, Chau, N, et al. Chronic exposure to anesthetic gases affects balance control in operating room personnel. Neurotoxicology 2005; 26(2): 193–198. Google Scholar | Crossref | Medline |
9. | Nishiyama, T . Effects of repeat exposure to inhalation anesthetics on liver and renal function. J Anaesthesiol Clin Pharmacol 2013; 29(1): 83–87. Google Scholar | Crossref | Medline |
10. | Kharasch, ED, Karol, MD, Lanni, C, et al. Clinical sevoflurane metabolism and disposition: I. Sevoflurane and metabolite pharmacokinetics. Anesthesiology 1995; 82(6): 1369–1378. Google Scholar | Crossref | Medline |
11. | Raina, R, Baba, NA, Verma, PK, et al. Hepatotoxicity induced by subchronic exposure of fluoride and chlorpyrifos in Wistar rats: mitigating effect of ascorbic acid. Biol Trace Elem Res 2015; 166: 157–162. Google Scholar | Crossref | Medline |
12. | Park, JT, Lee, YB, Kim, JS, et al. Acute liver injury after sevoflurane anesthesia: a case report. Korean J Anesthesiol 2009; 57(2): 221–224. Google Scholar | Crossref | Medline |
13. | Levine, MF, Sarner, J, Lerman, J, et al. Plasma inorganic fluoride concentrations after sevoflurane anesthesia in children. Anesthesiology 1996; 84: 348–353. Google Scholar | Crossref | Medline |
14. | Kharasch, ED, Armstrong, AS, Gunn, K, et al. Clinical sevoflurane metabolism and disposition: II. The role of cytochrome P450 2E1 in fluoride and hexafluoroisopropanol formation. Anesthesiology 1995; 82: 1379–1388. Google Scholar | Crossref | Medline |
15. | Reitman, S, Frankel, S. A colorimetric method for the determination of serum glutamic oxalacetic and glutamic pyruvic transaminases. Am J Clin Pathol 1957; 28(1): 56–63. Google Scholar | Crossref | Medline | ISI |
16. | Tietz, NW . Clinical guide to laboratory tests. 3rd ed. Philadelphia: WB Saunders, 1995. Google Scholar |
17. | Beleta, J, Gella, FJ. Metodo recomendado para la determinacion en rutina de la concentracion catalitica de la gamma-glutamyltransferasa en sero sanguineo humano. Quim Clin 1990; 9: 58–61. Google Scholar |
18. | Henry, RJ . Clinical chemistry. New York: Harper and Row Publisher, 1964. Google Scholar |
19. | Doumas, BT, Watson, WA, Biggs, HG. Albumin standards and the measurement of serum albumin with bromcresol green. Clin Chim Acta 1971; 31: 87–96. Google Scholar | Crossref | Medline | ISI |
20. | Yasny, JS, White, J. Environmental implications of anesthetic gases. Anesth Prog 2012; 59(4): 154–158. Google Scholar | Crossref | Medline |
21. | Dittmar, M, Petermichl, W, Lindner, R, et al. In vitro induction of endothelial apoptosis of the post-hypoxic blood-brain barrier by isoflurane but not by sevoflurane and midazolam. PLoS One 2015; 10(6): e0130408. Google Scholar | Crossref | Medline |
22. | Mazze, RI, Calverley, RK, Smith, NT. Inorganic fluoride nephrotoxicity: prolonged enflurane and halothane anesthesia in volunteers. Anesthesiology 1977; 46: 265–271. Google Scholar | Crossref | Medline |
23. | Perbet, S, Bourdeaux, D, Sautou, V, et al. A pharmacokinetic study of 48-hour sevoflurane inhalation using a disposable delivery system (AnaConDa®) in ICU patients. Minerva Anestesiol 2014; 80(6): 655–665. Google Scholar | Medline |
24. | Abbasa, M, Siddiqia, MH, Khana, K, et al. Haematological evaluation of sodium fluoride toxicity in Oryctolagus cunniculus. Toxicol Rep 2017; 4: 450–454. Google Scholar | Crossref | Medline |
25. | Sayyed, MA, Khan, SA. Effect of acute fluoride intoxication on some hematological changes in chicken (Gallus domesticus). Biologia 2010; 56(1 and 2): 123–127. Google Scholar |
26. | Sharma, S, Sharma, D, Rajawat, A, et al. Comparative study on acute toxicity of fluoride: aluminium and aluminium fluoride to Swiss albino mice. Australas J Ecotoxicol 2010; 16(1): 41–47. Google Scholar |
27. | Peri?, M, Petrovecki, M, Marusi?, M. Age-dependent haematological disturbances in anaesthetic personnel chronically exposed to high occupational concentrations of halothane and nitrous oxide. Anaesthesia 1994; 49(12): 1022–1027. Google Scholar | Crossref | Medline |
28. | Amiri, F, Neghab, M, Shouroki, FK, et al. Early, subclinical hematological changes associated with occupational exposure to high levels of nitrous oxide. Toxics 2018; 6(4): 70–80. Google Scholar | Crossref |
29. | Frink, EJ, Morgan, SE, Coetzee, A, et al. The effects of sevoflurane, halothane, enflurane, and isoflurane on hepatic blood flow and oxygenation in chronically instrumented greyhound dogs. Anesthesiology 1992; 76: 85–90. Google Scholar | Crossref | Medline | ISI |
30. | Hartman, JC, Pagel, PS, Proctor, LT, et al. Influence of desflurane, isoflurane and halothane on regional tissue perfusion in dogs. Can J Anaesth 1992; 39: 877–887. Google Scholar | Crossref | Medline |
31. | Ebert, TJ, Frink, EJ, Kharasch, ED. Absence of biochemical evidence for renal and hepatic dysfunction after 8 hours of 1.25 minimum alveolar concentration sevoflurane anesthesia in volunteers. Anesthesiology 1998; 88: 601–610. Google Scholar | Crossref | Medline |
32. | Obata, R, Bito, H, Ohmura, M, et al. The effects of prolonged low-flow sevoflurane anesthesia on renal and hepatic function. Anesth Analg 2000; 91: 1262–1268. Google Scholar | Medline |
33. | Bito, H, Ikeda, K. Renal and hepatic function in surgical patients after low-flow sevoflurane or isoflurane anesthesia. Anesth Analg 1996; 82(1): 173–176. Google Scholar |
34. | Al-Ghanem, SM, Massad, IM, Al-Barazangi, B, et al. Effects of sevoflurane on postoperative liver functions in morbidly obese as compared to the non-obese patients. Middle East J Anesthesiol 2009; 20: 207–211. Google Scholar | Medline |
35. | Liu, S, Wang, B, Li, S, et al. Immune cell populations decrease during craniotomy under general anesthesia. Anesth Analg 2011; 113: 572–577. Google Scholar | Medline |
36. | Urner, M, Limbach, LK, Herrmann, IK, et al. Fluorinated groups mediate the immunomodulatory effects of volatile anesthetics in acute cell injury. Am J Respir Cell Mol Biol 2011; 45: 617–624. Google Scholar | Crossref | Medline |
37. | Sahin, SH, Cinar, SO, Paksoy, I, et al. Comparison between low flow sevoflurane anesthesia and total intravenous anesthesia during intermediate-duration surgery: effects on renal and hepatic toxicity. Hippokratia 2011; 15: 69–74. Google Scholar | Medline |
38. | de Camargo, AM, Merzel, J. Histological and histochemical appearance of livers and kidneys of rats after long-term treatment with different concentrations of sodium fluoride in drinking water. Acta Anat (Basel) 1980; 108(3): 288–294. Google Scholar | Crossref | Medline |
39. | Pereira, HA, Leite Ade, L, Charone, S, et al. Proteomic analysis of liver in rats chronically exposed to fluoride. PLoS One 2013; 8(9): e75343. Google Scholar | Crossref | Medline | ISI |
40. | Perera, T, Ranasinghe, S, Alles, N, et al. Effect of fluoride on major organs with the different time of exposure in rats. Environ Health Prev Med 2018; 23(1): 17–26. Google Scholar | Crossref | Medline |
41. | Shashi, ATS . Histopathology of fluoride-induced hepatotoxicity in rabbits. Fluoride 2001; 34(1): 34–42. Google Scholar |
42. | Atmaca, N, Atmaca, HT, Kanici, A, et al. Protective effect of resveratrol on sodium fluoride-induced oxidative stress, hepatotoxicity and neurotoxicity in rats. Food Chem Toxicol 2014; 70: 191–197. Google Scholar | Crossref | Medline |
43. | Ihtiyar, E, Algin, C, Haciolu, A, et al. Fatal isoflurane hepatotoxicity without re-exposure. Indian J Gastroenterol 2006; 25(1): 41–42. Google Scholar | Medline |
44. | Frink, EJ . The hepatic effects of sevoflurane. Anesth Analg 1995; 81(6): S46–S50. Google Scholar | Crossref | Medline |
45. | Martin, JL . Volatile anesthetics and liver injury: a clinical update or what every anesthesiologist should know. Can J Anaesth 2005; 52: 125–129. Google Scholar | Crossref | Medline |