Atmospheric pollution in theatre

• Atmospheric pollution in theatre


  Harmful effect of anesthetic gases and vapours on operating theatre personnel
• Minimizing or stopping continuous hazardous exposure to anesthetic agents


  1. Venting out the exhaled anesthetic vapours

  2. Maintaining a vapour-free theatre environment
• Causes of pollution


  • Anesthetic techniques
  • Anesthetic machine
  • Other causes like cryosurgery units and cardiopulmonary bypass circuit
• Anesthetic techniques causing pollution


  • Incomplete scavenging of the gases from ventilator and pressure limiting valve
  • Poorly fitting mask, uncuffed tracheal tubes, filling of vaporizers
  • Pediatric breathing systems e.g. T-piece
  • Failure to turn off fresh gas or vaporizers at the end of operation
  • Exhalation of gases/vapours during recovery
• Anesthetic machine causing pollution


  Leaks from various connections adapting parts of machine
• Measurement of pollution


  • No universally agreed on the recommended maximum accepted concentrations of polluting gases and vapour
  • Unit for measurement is (ppm) - particles per million
• Maximum accepted concentrations in UK over 8 hour, time-weighted average


  • 100 ppm for nitrous oxide
  • 50 ppm for enflurane
  • 50 ppm for isoflurane
  • 50 ppm for desflurane
  • 10 ppm for halothane
  • 20 ppm for sevoflurane
• Methods used to decrease theatre pollution


  • Adequate theatre ventilation and air conditioning
  • Use of the circle breathing system
  • Total intravenous anesthesia
  • Regional anesthesia
  • Avoiding spillage and using fume cupboards during vapourizer filling
  • Scavenging
• Adequate theatre ventilation and air conditioning


  Frequent and rapid changing of the circulating air (15-20) times per hour is most important and useful factor, the non-recirculating system is usually used the recirculating system not recommended
• Use of the circle breathing system


  Recycles the exhaled anesthetic vapours, absorbing CO2 and it requires a very low fresh gas flow so reducing the inhalational agents used
• Monitoring of pollution includes leak testing of equipment and sampling air in the theatre personnel breathing zone
• All anesthetic equipment, gas scavenging, gas supply, flowmeters and ventilation system must be subject to a planned preventative maintenance programme
• The general ventilation system and the scavenging equipment should be examined and tested by a responsible person at least once yearly
• In scavenged there is no relation between occupational exposure to anesthetic agents trace levels and adverse health effects
• Occupational Hazards In Anesthesiology


  • Chronic exposure to anesthetic agent: increase risk of abortion
  • Infectious diseases like respiratory inf., dermatological inf.(herpetic whitlow, hepatitis B, hepatitis C, HIV
  • Ionizing Radiation Exposure
  • Substance abuse
• Measures to reduce infectious disease risks


  • Use of gloves
  • Proper disinfection or disposal of contaminated material
  • Frequent hand washing
  • No recapping immediate disposal of contaminated needles
  • Special caution for pregnant women and no contact with patients exudative or weeping skin lesions
• Measures to reduce Ionizing Radiation Exposure


  • Using proper barriers
  • Maximize the distance from the source of radiation
  • Limiting total exposure time during procedure