Acta anaesthesiologica Sinica
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Acta Anaesthesiol. Sin. · Dec 2002
Personnel exposure to waste sevoflurane and nitrous oxide during general anesthesia with cuffed endotracheal tube.
Waste anesthetic gases may have adverse effects on the health of operating room personnel. To reduce the risk of exposure, the United States National Institute of Occupational Safety and Health (US-NIOSH) recommends a time-weighted average (TWA) of 25 ppm (part-per-million) for nitrous oxide (N2O) and a ceiling of 2 ppm for sevoflurane (SEV). This study investigated the concentrations of these two gases in the atmosphere of operating room to which the working personnel (anesthetists) were exposed during anesthetic practice. ⋯ To decrease the exposure of the operating personnel to waste anesthetics, minimization of the use of N2O is recommended. Besides, the three extraordinary conditions as disclosed in this study were tubing flushing, illy managed endotracheal tube cuff and disconnection of scarvenging system, the first of which sometimes is unavoidable but the last two of which should be avoided.
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Acta Anaesthesiol. Sin. · Dec 2002
Case ReportsEndotracheal tube fire induced by electrocautery during tracheostomy--a case report.
Airway fire resulting from ignition of the endotracheal tube (ETT) caused by electrocautery during tracheostomy is a severe and possibly fatal event, and should be avoided. An 88-year-old male because of respiratory failure received elective tracheostomy for ventilatory support on which prolonged dependence was anticipated. Unfortunately, flame was noted to jet out from the trachea incision just after a single burst of electrocautery to coagulate a bleeder in the trachea tissue nearby the incision. ⋯ The patient stood this ordeal of fire well without related sequelae and was returned from the intensive care unit (ICU) to the general ward two weeks later. From this accident, we recommend that, besides emphasis on lowering of the inspired oxygen concentration (FiO2) and careful use of electrocautery during the tracheostomy procedure, special attention should be paid to the integrality of ETT cuff. It serves as a barrier to prevent oxygen leaking out from the trachea to be exposed to the sparks of electrocautery while the surgical procedure is under way, and thus it plays a significant role in the avoidance of airway fire induced by electrocautery.