Nitrous Oxide Biohazards PDF 2020

Summary

This document discusses nitrous oxide biohazards for health personnel, focusing on chronic exposure, scavenging, detection, and preventative measures. The information covers various aspects of minimizing trace gases and potential risks associated with the use of nitrous oxide.

Full Transcript

Nitrous Oxide Biohazards for Health Personnel Chronic Exposure ▪ 1967 Vaisman report reproductive problems in both male and female anesthesiologists in Russia ▪ 1980 study/survey of dentists and dental assistants, long term exposure could be associated with an increase in general health and reproduc...

Nitrous Oxide Biohazards for Health Personnel Chronic Exposure ▪ 1967 Vaisman report reproductive problems in both male and female anesthesiologists in Russia ▪ 1980 study/survey of dentists and dental assistants, long term exposure could be associated with an increase in general health and reproductive problems Chronic Exposure ▪ 1977 NIOSH reviewed scavenging potential of nitrous oxide: OR 25 ppm, Dental setting 50 ppm. Chronic Exposure ▪ Goal is to minimize trace gases Nitrous Oxide ▪ Oxides the cobalt form of cobalamin (Vit B12) ▪ Prevents the B12 acting as a coenzyme for methionine synthase ▪ Methionine synthase involved with DNA production and subsequent cellular reproduction Nitrous Oxide ▪ Concern with fetal development ▪ Pregnant rats at 60% for 24hrs resulted in miscarriage and other fetal abnormalities ▪ Significant demand for folic acid during organogenesis (first trimester), postponement of nitrous oxide sedation is recommended ▪ Staff: important to know levels, use scavenger systems, make decision if needs to avoid office setting in the first trimester Deoxyuridine Suppression Test ▪ Accurately determines the 1st signs of biologic effect associated with chronic exposure ▪ Shows early signs of inactivation of methionine synthase: Nunn et al found that no alterations of this enzyme occurred in anesthetists exposed to between 150 and 400 ppm Sweeney ▪ First signs of biologic effect with the deoxyuridine suppression test was at a chronic exposure level of 1800 ppm ▪ Suppression of methionine synthase activity has been shown to occur in some humans within 1 to 2 hrs following administration of 70% nitrous oxide ▪ B12 deficient individuals, nutritional disorder, malabsorption issues may be at risk ▪ Elderly, alcoholics, modified diets, GI problems/surgery, and those with pernicious anemia ▪ Need medical consultation Neurologic ▪ Disorders associated with chronic nitrous oxide exposure appear as myeloneuropathy ▪ B12 deficiency ▪ Nitrous oxide abusers ▪ Sensory and proprioception impairment: may be permanent, but are usually temporary with slow recovery Scavenging Trace Nitrous Oxide Gas Scavenging Nitrous Oxide ▪ Articles published in the 1990’s ▪ Minimize the trace amounts of gas before, during and after use ▪ It identifies all methods for the comprehensive removal of trace nitrous oxide Scavenging Mask System ▪ Standard on all product lines in the US ▪ Practicing without it is practicing below the standard of care ▪ Expired air through the nose and a vacuum suctioned into the central suction to the outside atmosphere ▪ Evacuation flow rate: 45L/min ▪ Improved mask design Detection and Monitoring of N2O in Ambient Air ▪ Infrared (IR) Spectrophotometry ▪ Uses electromagnetic energy to detect ▪ Can detect levels lower than 1 ppm ▪ Can detect levels of gas immediately in the ambient air ▪ These can be rented, or company hired (check with the hospital) ▪ May want to start with baseline, then have periodic evaluation Detection and Monitoring of N2O in Ambient Air ▪ Time-Weighted Average (TWA) Dosimetry ▪ Determines the amount of exposure of an individual over time ▪ Worn for a set time period, then return to company for analysis ▪ Material in the badge absorbs and is read by IR spectrophotometer in ppm ▪ Inexpensive Detection and Monitoring of N2O in Ambient Air ▪ Hand-Held Monitoring Device ▪ Small portable gas monitor that gives a continuous measure of nitrous oxide in the ambient air ▪ Has both ppm and TWA measurement capabilities ▪ Can store 1000 readings ▪ Needs to be recharged after 8 hrs ▪ Has audible alarms ▪ Can detect leaks around equipment Recommendation and Preventative Measures for Minimizing Waste Nitrous Oxide Gas Sources of Leakage From the Patient: ▪ Patient talking ▪ Poor fitting mask ▪ Displacement of the mask during patient ▪ ▪ ▪ ▪ movement Stuck flutter valve Mouth breathing Presence of facial hair preventing a tight seal Use rubber dam and/or high speed evacuation suction during operative procedures Sources of Leakage Other Than the Patient: ▪ Any place of connection on the equipment: includes the manifold and wall-mounted connections and any hoses associated with each ▪ Conducting tubing and reservoir bag due to breakdown/wear ▪ Soap and water method to determine leaks, or using IR spectrophotometry ▪ Door seals and any place where reentry of contaminated air can occur is a potential problem Vacuum System ▪ 45 L/min ▪ Adjustment of this rate is critical for effective sedation ▪ Important to periodically check during the sedation Adequate Ventilation Under investigation Best Practices ▪ Monitor the Environment for Nitrous Oxide Concentrations ▪ Baseline values, and monitoring HCW ▪ Prevent Leakage From the Delivery System ▪ Proper maintenance and periodic inspections ▪ Control Waste Nitrous Oxide ▪ Evacuation system ▪ Assess the Adequacy of Room Ventilation and Air Exchange

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