Isoflurane waste gas exposure during general anaesthesia: the laryngeal mask compared with tracheal intubation |
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Authors: | Hoerauf K H; Koller C; Jakob W; Taeger K; Hobbhahn J |
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Institution: | University Hospital, Department of Anaesthesiology, Franz-Josef-Strauss-Allee 11, 93042 Regensburg, Germany |
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Abstract: | We have compared exposure to isoflurane while using the laryngeal mask
airway (LMA) during anaesthesia under positive pressure ventilation with
exposure while using tracheal intubation. Trace concentrations of
isoflurane were measured directly using a highly sensitive photoacoustic
infrared spectrometer (Bruel and Kjaer 1302, Denmark) during general
anaesthesia in 20 eye surgery procedures. Measurements were made at six
locations (three personnel-related, three leakage- related) in the
operating theatre. Despite some high isoflurane values (greater than 2000
ppm at one leakage-related measurement point) all measured values at the
personnel-related points were low (the majority were less than isoflurane 2
ppm). In the LMA group, mean trace concentrations were slightly higher than
in the tracheal tube (ET) group. Mean exposure to isoflurane, expressed as
median (range) related to anaesthetic administration, was highest for the
auxiliary nurse (0.64 (0.22-26.89) ppm for the LMA compared with 0.31
(0.02-1.07) ppm for the tracheal tube), followed by the anaesthetist (0.50
(0.28-2.28) ppm for the LMA compared with 0.35 (0.02-0.73) ppm for the
tracheal tube) and the surgeon (0.36 (0.20-3.93) ppm for the LMA compared
with 0.29 (0.01-0.50) ppm for the tracheal tube). We conclude that the use
of the LMA in patients undergoing ventilation is not associated necessarily
with high concentrations of isoflurane in a modern working environment.
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