The objective of this research was to evaluate consequences to the immune system of long-term exposure to waste anesthetic gases (WAG) by medical theater personnel. Two groups were recruited: (i) 60 healthy male controls; (ii) 120 medical professionals exposed to WAG, subdivided according to theater role, i.e. surgeons, surgical assistants (SA), anesthetists, anesthetic assistants (AA), nurses, and workers. Serum levels of fluoride, hexafluoroisopropanol (HFIP), total lymphocyte counts, as well as of CD3, CD4, and CD8 cells, CD4/CD8 ratios, and immunoglobulins IgA, IgG, IgM, and IgE were assayed. The results showed that fluoride and HFIP titers were significantly increased in anesthetists and AA compared with the other exposed groups. All exposed groups demonstrated significant elevation in lymphocyte count, CD4+ cell levels, CD4/CD8 ratios, as well as levels of IgE, IgM and IgG compared with the controls. With regard to the latter outcomes, a significant increase in IgE was seen in the surgeon, nurse, and worker groups compared with the other professions. Surgeons, anesthetists and AA exhibited higher IgM titers compared with their colleagues. Significantly higher IgG levels were identified in the SA, anesthetists, AA, and workers than in their nurses and surgeon coworkers. Of the six sub-groups, only the anesthetists and their assistants (AA) displayed a significant increase in CD4+ cells and CD4/CD8 ratios and a decrease of CD8+ cells compared with the controls. This spectrum of results suggests that variation exists in immunomodulatory responses to WAG exposure amongst hospital personnel.
Keywords: Inhaled anesthetics, immune status, staff, health
From the data of this study and the findings of other earlier studies, we can conclude that operating room personnel exposures to WAG are associated with changes in blood levels of IgG and IgM, total lymphocytes, CD4+ and CD8+ subtypes, and accordingly, in CD4:CD8 ratios. It is quite possible these changes would likely be associated with immune dysfunction in these WAG-exposed hosts. As it is not yet clear if this might be reflected as reduced host resistance and/or an increased risk for developing autoimmune diseases, programs need to be in place to manage these WAG to reduce potential risks to the health of hospital staff. Further, continuous efforts to monitor exposures to, and the safety of, all volatilizable anesthetic agents should be required.
*Full-text article online at https://www.tandfonline.com/doi/full/10.1080/1547691X.2020.1869872