Occupational exposure to anaesthetic gases: a role for TIVA

Modern anaesthesia is still mostly administered by the inhalational route and there is increasing concern over its potential for pollution. One of the first gaseous anaesthetic agents was nitrous oxide and this is still widely used today despite being associated with adverse effects caused by depression of vitamin B(12) function and diminished reproductive health. The use of halothane is associated with hepatitis but the adverse effects of newer halogenated hydrocarbons are less well recognised. Chronic exposure may cause reduction in antioxidant activity in plasma and erythrocytes, inhibition of neutrophil apoptosis, depression of central neuro-respiratory activity, increased DNA breaks, effects on cerebral blood circulation and altered renal function. Inhalational anaesthetics also have adverse environmental effects, including ozone damage and greenhouse gas effects. Levels of inhalational anaesthetics in the ambient air of operating theatres and recovery rooms often exceed those stated in national guidelines. Anaesthetic procedures can be modified and air-conditioning and air scavenging systems should be used to minimise the risks from occupational exposure and threats to the environment. Such contamination could be avoided with the use of total intravenous anaesthesia.