HAZARDS OF ANAESTHESIA
G.K.KUMAR
DEFENITON
DANGER/RISK ANESTHESIOLOGISTS PATIENTS
HAZARDS FOR ANASTHESIOLOGISTS Fire & explosions Electrical accidents Pollutions by anesthetic agents Radiations Infections Incompatibilities / allergies Stress Chemical dependence
OR
HAZARDS FOR ANASTHESIOLOGISTS PHYSICAL -ELECTRICAL -ENVIRONMENTAL -INFECTIVE -ALLERGY PSYCOLOGICAL -STRESS -DEPENDENCY
Electrical accidents
Unsafe electrical configurations Types-macro shock -micro shock -loss of power supply to
gadgets Safe practices
Electrical accidents Macro shock-Large voltage
current-Causes
tissue damages burns explosions
1ma perception
5ma harmless
10-20maMuscular contraction
50-100ma Pain, fainting
100-2500ma VF
>6000ma Resp.arrest
Micro shock-Direct application of very small voltages to the heart thro’ electrodes
Allowable leakage thro’ electrodes-10µA
>50µA-VF occurs
Electrical accidents
Electrical accidents - Safe
practices
1. Proper grounded equipments(3pin)2. Don’t connect the pt to the OR grounding
sources3. Electro cautery: large grounding pads, to be
kept well away from electrodes & PM4. Use bipolar5. Reset the pace maker to regular
mode(asynchronised)6. Keep ready pharmacological pacing-
Isoprenaline7. Good maintenance of equipments
Pollution by anesthetic agents
Risks Recommendations Remedies
Pollution by anesthetic agents
Risks- Real? Or Mystiques? -abortions -congenital abnormalities -malignancies (liver) -behavioral problems(N2O)
Pollution by anesthetic agents
Recommendations Upper limits N2O 25ppm
Halogenated agents
2ppm
Halogenated agents with N2O
0.5ppm
Pollution by anesthetic agents
Remedies Scavenging systems Closed circuits Anti spill devices Avoid agents
Radiation hazards
Risks Recommendations Remedies
Radiation hazards
Risks Ionizing radiation-X’ray, radioactive
isotopes Formation of free radicals, ionizing
molecules Damage/destruction of cells,
Ch anomalies, malignancies.
Radiation hazards
Risks Non-Ionizing radiation –laser
Disruption of electrons from one orbit to others, but with in cells
Tissue damage Laser plums formation (contain viable
bacteria,HPV DNA,HIVproviral DNA)
Radiation hazards
Recommendations Max. allowable exposure/yr<5Rem during pregnancy-
500mRem 0ne X’ray-25 mRem Natural exposure cosmic rays-
40mRem
Radiation hazards
Remedies for ionizing radiation Scattered rays inv. Proportional to
(distance)2 from the source Best way of protection-physical
separation (6 ft = 9 in concrete = 2.5 mm lead) Protective lead aprons (o.25-o.5mm)
Radiation hazards
Remedies for non-ionizing radiation Radiation intensity not decreased to
distance in an average OR. Proper gaggles Laser plum to be removed by
effective scavenging systems removes particles ≥o.1µm (filters ≥0.5µm).
Infections
Physical spread-HSV,CMV Blood borne-HIV,HBV,HCV Air borne-Mtb
Infections Blood borne diseases thro’ Needle stick
injuries- HIV:0.3%, HBV:3%, HCV30% 32% had at least 1 NSI in the preceding 12M.
(only half of them took treatment). More risk with hollow-core & large bore NSI more in non dominated hands NSI more during disposal of contaminated
needles. Anesthesiologists have risk for occupational
infection during 30years of exposure-0.045-4.5%
Infections-HIV Health care workers contribute 5%
of total cases 4% of emergency department pts
are unidentified cases. Pts considered infective if both
screening (ELISHA) & confirmatory (western blot, indirect fluorescent ab) tests are positive.
Infections-HIV
54 reported cases of occupationally acquired HIV(1998).
88% of them had H/O NSI ? Quantity of inoculums- ( a case
report :100-200µml of blood thro”i.v. produced HIV).
Risk for the pts- 6 cases reported.
Infections-HBV Non immunized health care workers
higher risks 17.8% 0f seropositive among
anesthesiologist 30% became positive after 11 years of
exposure Disinfectants & gloves are not
completely protective- viruses viable for >14 days in needles, gloves, &surfaces.
Infections-HCV
No immunization available No specific treatment available Advice: serologic monitoring for
HCV & LFT 3-6 monthly.
Infections
Management of occupational infections.SAFE PRACTICE1. Protective equipments2. Washing methods3. Disposal methods
Infections -CDC recommendations Universal precautions-1980
-considering as all pts, blood & body fluids are infective.
Isolation precautions-1996
-2 tier recommendations1. Standard precautions -to be followed
for handling all pts as UP.2. Transmission based precautions -for
handling pts known to be / suspected of being risks.
Infections -CDC recommendations
Transmission based precautions Based on specific the properties of specific
pathogens Airborne precautions [measles,varicella,Tb] -to
prevent from small particles<5µm by specific filters air handling devices.-HEPA, Negative pr environment
Droplet precautions [HI-type b, mycoplasma, streptococcal pharyngitis, rubella]-to prevent from large particles>5µm, keep distance>1m
Contact precautions [HAV, HSV, viral conjunctivitis]
Incompatibilities / Allergies
Latex allergy Type iv/ type I Risk groups :
1. Atopics,2. Spina bifida,3. Urogenital abnormalities ,4. HCW, 5. Rubber factory workers.
Latex allergy Managements
1. Identification of risk groups2. Use latex free objects-latex free
environment 3. Tests:RAST[radio-allergo-sorbent test] SPT Sr.histamine Urinary histamine Sr.IgE Sr.compliments Sr.tryptase
Tests for anaphylaxis
Screening tests
Latex allergyManagements-drug regimens Preoperative protocol:
1. Dipenhydramine -1mg/kg,po/iv,q 6hr at 13,7,1hr before surgery
2. Prednisolone -1mg/kg,po/iv,q 6hr at 13,7,1hr before surgery or hydro cortisone 4g/kg
3. Ranitidine - 2mg/kg po, 1mg/kg iv,q 12hr at 13,1hr before surgery
Postop protocol -drugs to be repeated for 12hrs
Stress Inevitable, universal phenomenon
to which no one is immune Job related stress are unavoidable
but may be controlled 2 types-Unavoidable & Avoidable Unavoidable-professional stress Avoidable-sleep related
Stress
Unavoidable Stress Professional Stress Co-worker relationships Work load Litigations Peer review Professional dissatisfaction Administrative responsibilities
Stress
Avoidable Stress Sleep related-altered sleep
pattern, sleep deprivation Coincide with natural sleep
peaks[2-7a.m] Identification of sleep disturbances Regulations of working hours
Chemical dependenceSelf administration of drugs & suicide rates are
high among anesthesiologist. Addiction :compulsive continued use of drugs
in spite of adverse, a chronic, relapsing condition resulting from long term effects of drugs on brain, due to molecular, structural, cellular, & functional changes.
Dependence: physical / psychological inability to control drug use
Abuse :use of drugs in detrimental way but not to the point of addiction. a pre addiction level, can easily quit. a voluntary act.
Chemical dependence
Causes Stress Availabilities Curiosity for experimentation Drug potency Others-genetic predisposition
Chemical dependence
Management Identification Intervention Referral Rehabilitation
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