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Anestezistlerin Mesleki Riskleri, I, Bölüm: Teratojenite

Yıl 1992, Cilt: 45 Sayı: 1, 85 - 100, 31.03.1992

Çiğdem Tezcan

Öz

Ameliyathane atmosferi, anestezi aygıtlarının kaçak valvlerin- den, vaporizatörlerin kilitleme mekanizmalarının kapatılmamasından ve hatta hastaların ekspiryum havalarından çıkan anestezik gazlar ile sürekli olarak kontamine olur. Bu atmosferde çalışan personel ise kronik olarak bu gazlara maruz kalır, Bu kirli ortamda çalışmanın olası tehlikeleri hakkındaki endişeler, ilk kez 1967 de Waisman'ın ça- uşmasının yayınlanması sonucu tetiklenmiş ve o zamandan bu yana da yaklaşık 25 yıldır, kronik maruz kalmanın sağlık üzerindeki etki- lerini araştırmaya yönelik pekçok makale yayınlanmıştır. Bu çalış- maların çoğu fötotoksik, teratojenik, mutajenik ve karsinojenik tehli- keler üzerinde dururken, diğer bazıları hepatik ve renal hastalıklar, psikomotor performansta, bozulma, ilaç alışkanlığı ve süisid üzerinde yoğunlaştırılmıştır. Bu seçimlerde kısmen anestezik gazların trase düzeylerinin ölçülebilmesini mümkün kılan yöntem ve aygıtların ge- Jiştirilmesinin, kısmen anestezik gazların metabolizması sonucu tok- sik metabolitlerin açığa çıktığının saptanabilmesinin ve kısmen de karsinojenik, mutajenik ve teratojenik potansiyellerin araştırılabilmesinin rolü vardır. Bu makaleler topluca gözden geçirildiğinde atık anestetik gazlara kronik olarak maruz kalmanın sağlığı gerçekten tehdit ettiğine dair direkt kanıtlara hâlâ rastlanmamaktadır. Buna karşın indirekt bazı kanıtların mevcudiyeti kontaminasyonu âazalt- maya ilişkin çabaların hâlâ sürdürülmesine yol açmaktadır.

Anahtar Kelimeler

ANESTEZİSTLERİN MESLEKİ RİSKLERİ I BÖLÜM : TERATOJENİTE

Kaynakça

  • 1.American Society of Anesthesiologists Ad Hoc Committee : Occupational diseâse among operating room personel, Anesthesiology 41 : 321-340, 1974.
  • 2.Axelsson G Rylander R ; Exposure to anesthetic gases and spontaneou$s abortion. Response bias in postal guestionnaire study. Int. J, Epidemiol. 11 : 250-256,
  • 1982. 3.Baden JM Rice SA : Metabolism and toxicity of inhaled anesthetics. In ; Miller RD (ed). Anesthesia. New York, Churchill Livingstone, pp. 701-744, 1986,
  • 4.Brendel K Duhamel RC Shepard TH ; Embryotoxic drugs. Biol. Rossa. Pregn. 8 : 1-54, 1985.
  • 5.Burning JE Hennekens CH Mayrent SL Rosner B Greenberg ER Colton T : Health experiences of operaiing roon personel, Anesthesiology 62 : 325-330, 1985.
  • 6.Bussard DA Stoelting RK Peterson C Ishag M : Fetal changes in hamsters anesthetized with nitrous oxide and halothane, Anesthesiology 41 : 275-278,
  • 7.Chalon J Tang CK Ramanathan 5 : Exposure to halothane and enflurane aftects learning function of murine progeny. Anesth. Analg. 60 : 794-797, 1981.
  • 8.Coate WB Kaap RW Lewis TR : Chronic exposure to low concentration of halothane-nitrous oxide. Aneşthesiology 50 : 310-318, 1979.
  • 9.Cohen EN Belville JW Brown BW : Anesthesla, pregnancy and miscarriage A study of operating room nurses and anesthetists. Anesthesiology 35 : 343-347, 16071.
  • 10.Cohen EN Brown BW Bruce DL Cascerbi HE Corbet TH Jones TW Whitcher CE : A survey of anesthetic health hazards among dentisis. J, Am. Dent. Assoc. 90 : 1291-1296, 1975.
  • 11.Cohen EN Brown BW WuML Whitcher CE Brodsky JB Gift HC Greenfield W Jones TW Driscoll EJ « Occupational disease in dentistry and chronic eXposure to trace anesthetic gases. J. Am. Dent. Assoc. 101 : 21-31, 1980. 12.Corbett TH Cornell ARC Endres JL Lielding K : Birth defects among children of nurse-anesthetist. Aneşthesiology 41 : 341-344, 1974.
  • 13.Ericson A Kallen B : Survey ol infants born in 1973 or 1975 to Swedish women working in operating rooms during their pregnancies. Anest. Analg, 58 : 302-305, 1979.
  • 14.Ferstanding LL : Trace concentration of anesthetic gases :A eritical review of their disease potential .Anesth. Analg. 57 : 328-345, 1978.
  • 15.Fink BR Cullen BF ;: Anesthetic pollution : What is happening to us. Anesthesiology 45 : 79-83, 1976.
  • 16.Friedman JM : Teratogen update : Anesthetic agents. Teratology 37 : 69-77, 1988.
  • 17. Gandolphy AJ Hubbard AK Nunn JF : Hepatic and renal toxicity of inhelational anaesthetics : Metabolic effects of nitrous oxide. In : Nunn JE, Utting JE, Brown
  • 18.BR (eds). General Anaesthesia. London, Butterwords, pp. 86-95, 1989.
  • 18..Harrington JM ; Editorial. The health of anaesihetists. Anaesthesia 42 : 131-132, 1978.
  • 19.Hemminki K Kyyroneu P Lindbohni MR : Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs and other potential hazafds in hospitals, based on registered information of outcome. J. Epidemiol. Community Health 39 : 141-147, 1985. 20.Kennedy GL Smith SH Keplinger ML Calandra J€C : Reproductive and teratogenie studies with halothane. Toxicol. App. Pharmacol. 85 : 467-474, 1976.
  • 21.Knili-Jones RP Rodrigues LV Moir DD Spence AA : Anaesihetic practice and pregnancy. Lancet 1 : 1326-1328, 1972.
  • 22.Knill Jones RP Newman BJ Spence AA : Anaesthetiç practice and pregnancy. Controlled survey of male anaesthetist in tne United Kingdom, Lancet 2: 307 - 809, 1975.
  • 23.Lansdown ABG Pope WDB Halsey MJ Bateman PE ; Analysis oi fetal development in rats following maternal exposure to subanesthetic conceniration of halothane. Teratology 13 : 299-304, 1976.
  • 24.Lauwers R Siddons M Misson CB Bouckaert A Lechat MF De Temmerman P: Anaesthetic health hazards among Belgian nurses and physicianş, In, Arch. Occup. Environ. Health, 48 : 195-203, 1981.
  • 25.Layzer RB : Myeloneuropaty after prolonged exposure to nitrous oxide. Lancet 2:339-349, 1978.
  • 26.Mazze RI Wilson Al Rice SA Baden JM : Reproduction and fetal development .in mice uhronicaliy exposed to nitrouş oxide, Teratology 26 : 11-16, 1982.
  • 27.Mazze RI Wilson A! Rice SA Baden JM : Reproduction and fetal development in rats exposed to nitrous oxide. Teratology 30 : 259-265, 1984,
  • 28.Mazze RI Wilson Al Rice SA Baden JM : Fetal development in mice exposed to isoflurane. Teratology 32 : 339-345, 1985.
  • 29.Mazze RI Fujinaga M Rice SA Harris SB Baden JM : Reproductive and teraflogenic effects of nitrous oxide, halothane, isoflurane and enflurane in SpragueDawley rats. Anesthesiology 64 : 339-344, 1986.
  • 30.Pharoah POD Alberman E Doyle P : Outcome of pregnancy among women in anagesthetic practice, Lancet 1 : 34-36, 1977,
  • 31.Pope WDB Halsey MJ Lansdown ABG Simmonds A Bateman PE : Fetotoxicity in rats following chronic exposure to halothane, nitrous oxide, or methoxyflurane. Anesthesiology 48 ; 11-16, 1978,
  • 32.Rosenberg P Kirves A : Miscariages among operating theatre staff. Acta. Anaeşthesiol. Scand. (Suppl) 53 ; 37-42, 1973.
  • 33.Rosenberg PH Vanttinen H : Occupational hazards to reproduction and health in anaesthetists and pediatricians, Acta. Anaest, Scand. 22 : 202-207, 1978.
  • 34.Royston B Nunn JF Weinbren K Royston DB : Rate of inactivation of methionine synthase by nitrouş oxide in man. Anesthesiology 68 : 213-216, 1988.
  • 35.Scacel PO Hewlett AM Lewis JD Lumb M Nunn JF Chanarin 1: Studies on the haemopoetic toxicity of nitrous oxide in man, Br. J. Haematol, 53 : 189-200, 1983.
  • 36.Smith RF Bowman RE Kaiz J Behavioral effects of exposure to halothane durring early developmeni in the rat. : Sensitive period during pregnancy. Anesthesiology 49 : 319-323, 1978.
  • 37.Spence AA Cohen EN Brown BW Enili-Jone$ AP Himmelberger DU : Occupational hazards for operating romm-based physicians. Analysis of data from ihe United States and the United Kingdom. JAMA 236 : 955-959, 1977.
  • 38.Spence AA Knil-Jones RP : Is there a health hazard in anesthetic practice, Br. J. Anaest. 50 : 713-719, 1978.
  • 39.Spence AA Wall RA Nunn JF : Environmenta Isafety of anaesthetist. In : Nunn JF, Utting JE, Brown BR (gds). General Anaesthesia, London, Butterworths, 1989,
  • 40.Tannenbaum TN Goldber RJ : Exposure to anesthetic gases and reproductive outcome. A review of epidemiologic literature. J. Occup. Med. 42 : 659-668, 1885.
  • 41.Tomlin PJ : Health problems of anaesthetists and their families in the West Midlands. Br. Med. J.1: 779-784, 1979.
  • 42.Visira E Cleaton-Jones P Austin JC Moyes DG Dhaw R : Effects of low conceniration of nitrous oxide on ret fetuses, Anesth, Analg. 59 : 175-77, 198 0. 43.Wessey MP : Epidemiological studies of the occupational hazards of anaesthesia-a review, Anaesthesia 33 : 430-438. 1978.
  • 44.Wessey MP Nunn JF : Occupational hazard of anaesthesia. Br, Med. J, 281 ; 696 - 698, 1980.
  • 45.Wharton RS Mazze RI Baden JM Hiti BA Dooley JR : Fertility, reproduction and postnatal survival in mice chronically exposed to enflurane. Anesthesiology 48 ; 167-174, 1978,
  • 46.Wharton RS Wilson Al Mazze RI Baden JM Rice SA ; Fetal morphology in mice exposed to halothane. Anesthesiology 49 : 532-537, 1970.
  • 47.Wharton RS Sievenpipar TS Mazze Rl : Developmental toxicity of metoxyilurane in mice. Anest, Analg. 59 : 339-345, 1985.
  • 48.Wharton RS Mazze RI Wilson AI : Reproduction and fetal development in mice chronically exposed to halothane. Anesthesiology 54 : 505-510, 1981.

OCCUPATIONAL RISKS OF ANESTHESISTS, PART I: TERATOGENICITY

Yıl 1992, Cilt: 45 Sayı: 1, 85 - 100, 31.03.1992

Çiğdem Tezcan

Öz

The operating room atmosphere is constantly contaminated with anesthetic gases from leaking valves on anesthesia devices, from vaporizer locking mechanisms that have not been closed, and even from patients' expiratory air. Personnel working in this atmosphere are chronically exposed to these gases. Concerns about the potential hazards of working in this contaminated environment were first triggered by the publication of Waisman's study in 1967, and since then, in the nearly 25 years since, many articles have been published investigating the health effects of chronic exposure. Most of these studies have focused on fetotoxic, teratogenic, mutagenic, and carcinogenic hazards, while others have focused on hepatic and renal disease, psychomotor performance impairment, drug addiction, and suicidality. These choices have been partly due to the development of methods and devices that enable the measurement of trace levels of anesthetic gases, partly to the detection of toxic metabolites released as a result of the metabolism of anesthetic gases, and partly to the investigation of carcinogenic, mutagenic, and teratogenic potentials. When these articles are reviewed collectively, direct evidence that chronic exposure to waste anesthetic gases poses a real threat to health is still lacking. However, the existence of some indirect evidence continues to lead to efforts to reduce contamination.

Anahtar Kelimeler

anesthesia trace levels of anesthetic gases contamination

Kaynakça

  • 1.American Society of Anesthesiologists Ad Hoc Committee : Occupational diseâse among operating room personel, Anesthesiology 41 : 321-340, 1974.
  • 2.Axelsson G Rylander R ; Exposure to anesthetic gases and spontaneou$s abortion. Response bias in postal guestionnaire study. Int. J, Epidemiol. 11 : 250-256,
  • 1982. 3.Baden JM Rice SA : Metabolism and toxicity of inhaled anesthetics. In ; Miller RD (ed). Anesthesia. New York, Churchill Livingstone, pp. 701-744, 1986,
  • 4.Brendel K Duhamel RC Shepard TH ; Embryotoxic drugs. Biol. Rossa. Pregn. 8 : 1-54, 1985.
  • 5.Burning JE Hennekens CH Mayrent SL Rosner B Greenberg ER Colton T : Health experiences of operaiing roon personel, Anesthesiology 62 : 325-330, 1985.
  • 6.Bussard DA Stoelting RK Peterson C Ishag M : Fetal changes in hamsters anesthetized with nitrous oxide and halothane, Anesthesiology 41 : 275-278,
  • 7.Chalon J Tang CK Ramanathan 5 : Exposure to halothane and enflurane aftects learning function of murine progeny. Anesth. Analg. 60 : 794-797, 1981.
  • 8.Coate WB Kaap RW Lewis TR : Chronic exposure to low concentration of halothane-nitrous oxide. Aneşthesiology 50 : 310-318, 1979.
  • 9.Cohen EN Belville JW Brown BW : Anesthesla, pregnancy and miscarriage A study of operating room nurses and anesthetists. Anesthesiology 35 : 343-347, 16071.
  • 10.Cohen EN Brown BW Bruce DL Cascerbi HE Corbet TH Jones TW Whitcher CE : A survey of anesthetic health hazards among dentisis. J, Am. Dent. Assoc. 90 : 1291-1296, 1975.
  • 11.Cohen EN Brown BW WuML Whitcher CE Brodsky JB Gift HC Greenfield W Jones TW Driscoll EJ « Occupational disease in dentistry and chronic eXposure to trace anesthetic gases. J. Am. Dent. Assoc. 101 : 21-31, 1980. 12.Corbett TH Cornell ARC Endres JL Lielding K : Birth defects among children of nurse-anesthetist. Aneşthesiology 41 : 341-344, 1974.
  • 13.Ericson A Kallen B : Survey ol infants born in 1973 or 1975 to Swedish women working in operating rooms during their pregnancies. Anest. Analg, 58 : 302-305, 1979.
  • 14.Ferstanding LL : Trace concentration of anesthetic gases :A eritical review of their disease potential .Anesth. Analg. 57 : 328-345, 1978.
  • 15.Fink BR Cullen BF ;: Anesthetic pollution : What is happening to us. Anesthesiology 45 : 79-83, 1976.
  • 16.Friedman JM : Teratogen update : Anesthetic agents. Teratology 37 : 69-77, 1988.
  • 17. Gandolphy AJ Hubbard AK Nunn JF : Hepatic and renal toxicity of inhelational anaesthetics : Metabolic effects of nitrous oxide. In : Nunn JE, Utting JE, Brown
  • 18.BR (eds). General Anaesthesia. London, Butterwords, pp. 86-95, 1989.
  • 18..Harrington JM ; Editorial. The health of anaesihetists. Anaesthesia 42 : 131-132, 1978.
  • 19.Hemminki K Kyyroneu P Lindbohni MR : Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs and other potential hazafds in hospitals, based on registered information of outcome. J. Epidemiol. Community Health 39 : 141-147, 1985. 20.Kennedy GL Smith SH Keplinger ML Calandra J€C : Reproductive and teratogenie studies with halothane. Toxicol. App. Pharmacol. 85 : 467-474, 1976.
  • 21.Knili-Jones RP Rodrigues LV Moir DD Spence AA : Anaesihetic practice and pregnancy. Lancet 1 : 1326-1328, 1972.
  • 22.Knill Jones RP Newman BJ Spence AA : Anaesthetiç practice and pregnancy. Controlled survey of male anaesthetist in tne United Kingdom, Lancet 2: 307 - 809, 1975.
  • 23.Lansdown ABG Pope WDB Halsey MJ Bateman PE ; Analysis oi fetal development in rats following maternal exposure to subanesthetic conceniration of halothane. Teratology 13 : 299-304, 1976.
  • 24.Lauwers R Siddons M Misson CB Bouckaert A Lechat MF De Temmerman P: Anaesthetic health hazards among Belgian nurses and physicianş, In, Arch. Occup. Environ. Health, 48 : 195-203, 1981.
  • 25.Layzer RB : Myeloneuropaty after prolonged exposure to nitrous oxide. Lancet 2:339-349, 1978.
  • 26.Mazze RI Wilson Al Rice SA Baden JM : Reproduction and fetal development .in mice uhronicaliy exposed to nitrouş oxide, Teratology 26 : 11-16, 1982.
  • 27.Mazze RI Wilson A! Rice SA Baden JM : Reproduction and fetal development in rats exposed to nitrous oxide. Teratology 30 : 259-265, 1984,
  • 28.Mazze RI Wilson Al Rice SA Baden JM : Fetal development in mice exposed to isoflurane. Teratology 32 : 339-345, 1985.
  • 29.Mazze RI Fujinaga M Rice SA Harris SB Baden JM : Reproductive and teraflogenic effects of nitrous oxide, halothane, isoflurane and enflurane in SpragueDawley rats. Anesthesiology 64 : 339-344, 1986.
  • 30.Pharoah POD Alberman E Doyle P : Outcome of pregnancy among women in anagesthetic practice, Lancet 1 : 34-36, 1977,
  • 31.Pope WDB Halsey MJ Lansdown ABG Simmonds A Bateman PE : Fetotoxicity in rats following chronic exposure to halothane, nitrous oxide, or methoxyflurane. Anesthesiology 48 ; 11-16, 1978,
  • 32.Rosenberg P Kirves A : Miscariages among operating theatre staff. Acta. Anaeşthesiol. Scand. (Suppl) 53 ; 37-42, 1973.
  • 33.Rosenberg PH Vanttinen H : Occupational hazards to reproduction and health in anaesthetists and pediatricians, Acta. Anaest, Scand. 22 : 202-207, 1978.
  • 34.Royston B Nunn JF Weinbren K Royston DB : Rate of inactivation of methionine synthase by nitrouş oxide in man. Anesthesiology 68 : 213-216, 1988.
  • 35.Scacel PO Hewlett AM Lewis JD Lumb M Nunn JF Chanarin 1: Studies on the haemopoetic toxicity of nitrous oxide in man, Br. J. Haematol, 53 : 189-200, 1983.
  • 36.Smith RF Bowman RE Kaiz J Behavioral effects of exposure to halothane durring early developmeni in the rat. : Sensitive period during pregnancy. Anesthesiology 49 : 319-323, 1978.
  • 37.Spence AA Cohen EN Brown BW Enili-Jone$ AP Himmelberger DU : Occupational hazards for operating romm-based physicians. Analysis of data from ihe United States and the United Kingdom. JAMA 236 : 955-959, 1977.
  • 38.Spence AA Knil-Jones RP : Is there a health hazard in anesthetic practice, Br. J. Anaest. 50 : 713-719, 1978.
  • 39.Spence AA Wall RA Nunn JF : Environmenta Isafety of anaesthetist. In : Nunn JF, Utting JE, Brown BR (gds). General Anaesthesia, London, Butterworths, 1989,
  • 40.Tannenbaum TN Goldber RJ : Exposure to anesthetic gases and reproductive outcome. A review of epidemiologic literature. J. Occup. Med. 42 : 659-668, 1885.
  • 41.Tomlin PJ : Health problems of anaesthetists and their families in the West Midlands. Br. Med. J.1: 779-784, 1979.
  • 42.Visira E Cleaton-Jones P Austin JC Moyes DG Dhaw R : Effects of low conceniration of nitrous oxide on ret fetuses, Anesth, Analg. 59 : 175-77, 198 0. 43.Wessey MP : Epidemiological studies of the occupational hazards of anaesthesia-a review, Anaesthesia 33 : 430-438. 1978.
  • 44.Wessey MP Nunn JF : Occupational hazard of anaesthesia. Br, Med. J, 281 ; 696 - 698, 1980.
  • 45.Wharton RS Mazze RI Baden JM Hiti BA Dooley JR : Fertility, reproduction and postnatal survival in mice chronically exposed to enflurane. Anesthesiology 48 ; 167-174, 1978,
  • 46.Wharton RS Wilson Al Mazze RI Baden JM Rice SA ; Fetal morphology in mice exposed to halothane. Anesthesiology 49 : 532-537, 1970.
  • 47.Wharton RS Sievenpipar TS Mazze Rl : Developmental toxicity of metoxyilurane in mice. Anest, Analg. 59 : 339-345, 1985.
  • 48.Wharton RS Mazze RI Wilson AI : Reproduction and fetal development in mice chronically exposed to halothane. Anesthesiology 54 : 505-510, 1981.
Toplam 46 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Anesteziyoloji
Bölüm Makaleler
Yazarlar

Çiğdem Tezcan

Yayımlanma Tarihi 31 Mart 1992
Yayımlandığı Sayı Yıl 1992 Cilt: 45 Sayı: 1

Kaynak Göster

APA Tezcan, Ç. (1992). Anestezistlerin Mesleki Riskleri, I, Bölüm: Teratojenite. Ankara Üniversitesi Tıp Fakültesi Mecmuası, 45(1), 85-100.
AMA Tezcan Ç. Anestezistlerin Mesleki Riskleri, I, Bölüm: Teratojenite. Ankara Üniversitesi Tıp Fakültesi Mecmuası. Mart 1992;45(1):85-100.
Chicago Tezcan, Çiğdem. “Anestezistlerin Mesleki Riskleri, I, Bölüm: Teratojenite”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 45, sy. 1 (Mart 1992): 85-100.
EndNote Tezcan Ç (01 Mart 1992) Anestezistlerin Mesleki Riskleri, I, Bölüm: Teratojenite. Ankara Üniversitesi Tıp Fakültesi Mecmuası 45 1 85–100.
IEEE Ç. Tezcan, “Anestezistlerin Mesleki Riskleri, I, Bölüm: Teratojenite”, Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 45, sy. 1, ss. 85–100, 1992.
ISNAD Tezcan, Çiğdem. “Anestezistlerin Mesleki Riskleri, I, Bölüm: Teratojenite”. Ankara Üniversitesi Tıp Fakültesi Mecmuası 45/1 (Mart 1992), 85-100.
JAMA Tezcan Ç. Anestezistlerin Mesleki Riskleri, I, Bölüm: Teratojenite. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 1992;45:85–100.
MLA Tezcan, Çiğdem. “Anestezistlerin Mesleki Riskleri, I, Bölüm: Teratojenite”. Ankara Üniversitesi Tıp Fakültesi Mecmuası, c. 45, sy. 1, 1992, ss. 85-100.
Vancouver Tezcan Ç. Anestezistlerin Mesleki Riskleri, I, Bölüm: Teratojenite. Ankara Üniversitesi Tıp Fakültesi Mecmuası. 1992;45(1):85-100.
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