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Tuesday, March 01, 2011
Beware of what you can’t see-your vision may get worse!
Occupational hazards have posed very real threats to anesthesiologists since the start of our clinical practice. (interesting links: Vessey & Nunn, Alexander et al, NIOSH, ASA refresher course and Patterson et al. Substance abuse, suicide, environmental pollution by trace anesthetic gases and exposure to radiation are some, but not all, of the culprits. Radiation exposure is a major concern and has been well attended to so that risk is minimized; however, has risk been fully addressed?

As I care for patients in the OR, radiology suite and cardiac catheterization laboratory, it’s obvious how careful we all are to cover our thorax and neck (thyroid) with protective lead aprons. Upon closer inspection, I also notice that in the radiology and cardiology venues, the radiologists and cardiac interventionalists don protective leaded eyeglasses (in both the front-view and side guard lenses) and stand behind lead shields strategically located, for example, hanging from the ceiling, allowing the practitioner protected space behind the shield. Why do our radiology and cardiology colleagues take these extra measures of protection and we don’t; what information are they privy to that anesthesiologists are not or further, which risks are they heeding that anesthesiologists apparently are not aware of?

Radiation exposure to the human eye is known to cause cataracts. Radiation damage to the eye may be more important than the carcinogenic or teratogenic effects of occupational radiation exposure; this fact alone mandates employing better safety protocols. (reference) The March issue of ANESTHESIOLOGY includes compelling data from a study demonstrating that anesthesiologists have a major health risk to contend with when it comes to radiation exposure to the eyes. In this investigation, radiation exposure to the face of anesthesiologists and radiologists was measured during neuroradiology angiographic and interventional procedures. During interventional radiation procedures, the anesthesiologist's face was exposed to more than six times the radiation than for non-interventional angiographic procedures and averaged more than three times the exposure of the radiologist. A given anesthesiologist’s exposure was directly related to the anesthesia patient care (frequency of pharmacologic interventions, i.e., intravenous boluses and infusion changes performed during the procedure) they provided. How often they provided benefit to the patient was directly correlated with increasing amounts of risk to the anesthesiologist.

Radiation exposure is a hospital systems issue that depends upon the somewhat unavoidable demands of the physical layout of the radiation suite and interdependent locations of the radiology equipment, position of the patient and their airway and location of the anesthesiologist, anesthesia machine and specific equipment such as the intravenous injection ports and infusion pumps. The amount and direction of the scatter radiation determines how much ocular damage potential there is to the anesthesiologist. While surely not intentional, the typical layout of fluoroscopy equipment directs radiation scatter away from the radiologist and toward the anesthesiologist. During neuroradiology procedures, the need to manage the anesthetic medications and patient’s airway increasingly brings the anesthesiologist in closer proximity to the patient and therefore into the path of dangerous radiation scatter.

In your respective clinical practice settings, what is the percentage of your radiology and cardiology peers who wear protective eyewear? What is the comparable percentage for the anesthesiologists and CRNAs caring for the same patients? Is there a need for a new guideline for anesthesia practice that calls for eye protection? Tell us how you currently handle this issue and what you might change based on this important study published in ANESTHESIOLOGY.

Posted by Alan Jay Schwartz, M.D.,MSEd
Alan Jay Schwartz
About the Author

J. Lance Lichtor, M.D
J. Lance Lichtor, M.D. is a professor of anesthesiology and pediatrics at The University of Massachusetts Medical School. He is the web editor and an associate editor for Anesthesiology.

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