By Katie Slavin, MS, RN
Waste anesthetic gases (WAGs) occur when small amounts of volatile anesthetic gases leak from a patient’s anesthetic breathing circuit or are exhaled by patients recovering from anesthesia. WAGs include both nitrous oxide and halogenated anesthetic gases (such as halothane, enflurane, isoflurane, desflurane, and sevoflurane). Exposure to WAGs poses a threat to hospital workers, including nurse-anesthetists, operating-room (OR) nurses, recovery-room nurses, surgeons, and other OR/recovery-room staff. Nurses should be aware of the potential effects of WAGs and be knowledgeable on methods to take appropriate precautions.
Exposure to WAGs most frequently occurs in operating facilities with nonexistent or poorly functioning automatic ventilation or scavenging systems, as well as in recovery rooms where WAGs exhaled by recovering patients aren’t properly vented or scavenged. Exposure also may occur from leaks in the anesthetic breathing circuit, when anesthetic gases escape during system hookup and disconnection, during anesthesia induction, and when anesthetic gas seeps over the lip of the patient’s mask—for example, if poorly fitted.
Of great concern is the fact that anesthetic gases can’t be detected by their odor until concentrations are very high. For instance, halothane can’t be detected by 50% of the general population until its concentration is more than 125 times the exposure limit recommended by the National Institute for Occupational Safety and Health.
Health effects of exposure to high concentrations of WAGs (even for a brief period) include headache, irritability, fatigue, nausea, drowsiness, judgment and coordination difficulties, and liver and kidney disease. While some studies report no adverse health effects from long-term exposure to low concentrations of WAGs, several studies have linked such exposure to miscarriages, genetic damage, and cancer among OR workers.
Nurses working in OR and recovery-room units must advocate for reduction of exposure to WAGs in their departments to protect their health and the health of surrounding staff.
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Katie Slavin is a Senior Staff Specialist in ANA’s Center for Occupational and Environmental Health.