We all know that anesthetic gas exposure has risks. Short-term effects of an acute waste anesthetic gas exposure may include a headache, fatigue, and nausea. Longer-term, however, the risks are even more severe. Inhalant anesthetics have been associated with neurologic changes, liver and kidney damage, reproductive disorders, hematopoietic issues, and even neoplasia. Waste anesthetic gas exposure may also pose a miscarriage risk in pregnant women, although this has not been definitively determined.
In order to minimize these risks, it’s important for everyone on the hospital team to work to limit waste anesthetic gas exposure.
Your employer is responsible for providing a functional anesthetic machine with an appropriate active or passive scavenging system, but you and your coworkers must also take precautions to keep yourselves and your coworkers safe.
1. Perform machine checks at the start of each day and before each procedure
At the beginning of each day, a thorough anesthetic machine check should be performed. First, inspect the machine to ensure that all tubing is correctly connected and nothing is visibly wrong with the machine. Next, perform a leak test. Leak testing methods can vary, depending on the breathing circuit and the anesthetic machine. In general, you will temporarily close the pop-off valve while occluding the patient end of the circuit with your thumb or palm. Use the flowmeter or oxygen flush valve to increase the pressure within the system to 30 cm H20, then turn the oxygen flow off. Check to see if the pressure remains constant for at least 15 seconds. If the pressure rapidly begins to fall, the machine may have a leak.
In addition to a morning inspection and leak test, a brief visual inspection of the anesthetic machine should be performed before every procedure. Be sure that the reservoir bag has been switched over from the last patient, all tubes and hoses have been reconnected, and the scavenger is properly connected. These brief inspections can reduce the likelihood of waste anesthetic gas exposure.
2. Ensure that regular machine maintenance is performed
While scheduling anesthetic machine maintenance is likely the responsibility of your practice manager, you can help them stay on top of it. Most anesthetic machines have stickers indicating the date of the last service and the date that the next service is due. Check these stickers periodically and let your practice manager know if machine maintenance is overdue. Additionally, if you notice that the anesthesia machine is not functioning properly, request a service call as soon as possible.
3. Use the right tube size and inflate cuffs appropriately
While we don’t want to use an excessively large tube or overinflate a cuff, a good fit helps reduce waste anesthetic gas exposure by preventing leakage around the tube. Check the cuff prior to intubation, to ensure that it will hold air. After the patient is intubated, check the cuff by having a coworker close the pop-off valve and squeeze the reservoir bag, giving the patient a breath. Place your ear by the patient’s mouth and listen carefully for leaks, which are typically heard as a hissing sound.
4. Occlude the Y-piece if the patient is disconnected from the circuit during surgery
When you roll your dental patient over to address the other side of the mouth, you probably don’t bother to turn off the anesthesia machine… and that’s okay! Instead, occlude the Y-piece with your thumb or palm. This ensures that gas goes back to the scavenger, instead of being released to the room for you and your coworkers to inhale.
5. Leave patients on oxygen for five minutes after anesthesia
Don’t start disconnecting the patient as soon as you turn off the anesthetic gas. Instead, leave the patient connected to oxygen for five minutes. Not only will this help support your patient during recovery, it also will ensure that exhaled anesthetic gases end up in the scavenger instead of in your surgery suite.
Take Waste Anesthetic Gas Exposure Seriously
Working as a veterinarian, it’s almost inevitable that you will receive some degree of waste anesthetic gas exposure. However, your actions at work can go a long way towards reducing your exposure and the effects of this exposure. Work to set a good example for your vet techs and vet assistants, emphasizing that employee safety should be taken just as seriously as patient safety.