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Comparison of 3 Methods to Assess Occupational Sevoflurane Exposure in Abdominal Surgeons

A Single-Center Observational Pilot Study

Herzog-Niescery, Jennifer MD*; Seipp, Hans-Martin PhD; Bellgardt, Martin MD*; Herzog, Torsten PhD; Belyaev, Orlin PhD; Uhl, Waldemar PhD; Gude, Philipp MD*; Weber, Thomas P. PhD*; Vogelsang, Heike MD*

doi: 10.1213/ANE.0000000000004301
Anesthetic Clinical Pharmacology: PDF Only

BACKGROUND: Studies demonstrated that operating room personnel are exposed to anesthetic gases such as sevoflurane (SEVO). Measuring the gas burden is essential to assess the exposure objectively. Air pollution measurements and the biological monitoring of urinary SEVO and its metabolite hexafluoroisopropanol (HFIP) are possible approaches. Calculating the mass of inhaled SEVO is an alternative, but its predictive power has not been evaluated. We investigated the SEVO burdens of abdominal surgeons and hypothesized that inhaled mass calculations would be better suited than pollution measurements in their breathing zones (25 cm around nose and mouth) to estimate urinary SEVO and HFIP concentrations. The effects of potentially influencing factors were considered.

METHODS: SEVO pollution was continuously measured by photoacoustic gas monitoring. Urinary SEVO and HFIP samples, which were collected before and after surgery, were analyzed by a blinded environmental toxicologist using the headspace gas chromatography-mass spectrometry method. The mass of inhaled SEVO was calculated according to the formula mVA = cVA·V·t·ρ VA aer. (mVA: inhaled mass; cVA: volume concentration; V: respiratory minute volume; t: exposure time; and ρ VA aer.: gaseous density of SEVO). A linear multilevel mixed model was used for data analysis and comparisons of the different approaches.

RESULTS: Eight surgeons performed 22 pancreatic resections. Mean (standard deviation [SD]) SEVO pollution was 0.32 ppm (0.09 ppm). Urinary SEVO concentrations were below the detection limit in all samples, whereas HFIP was detectable in 82% of the preoperative samples in a mean (SD) concentration of 8.53 µg·L−1 (15.53 µg·L−1; median: 2.11 µg·L1, interquartile range [IQR]: 4.58 µg·L−1) and in all postoperative samples (25.42 µg·L−1 [21.39 µg·L−1]). The mean (SD) inhaled SEVO mass was 5.67 mg (2.55 mg). The postoperative HFIP concentrations correlated linearly to the SEVO concentrations in the surgeons’ breathing zones (β = 216.89; P < .001) and to the calculated masses of inhaled SEVO (β = 4.17; P = .018). The surgeon’s body mass index (BMI), age, and the frequency of surgeries within the last 24 hours before study entry did not influence the relation between HFIP concentration and air pollution or inhaled mass, respectively.

CONCLUSIONS: The biological SEVO burden, expressed as urinary HFIP concentration, can be estimated by monitoring SEVO pollution in the personnel’s individual breathing zone. Urinary SEVO was not an appropriate biomarker in this setting.

From the *Department of Anesthesiology, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany

Department of Life Science Engineering, University of Applied Sciences, Giessen, Germany

Department of Surgery, Ruhr-University Bochum, St Josef Hospital, Bochum, Germany.

Accepted for publication May 16, 2019.

Funding: Departmental.

The authors declare no conflicts of interest.

Reprints will not be available from the authors.

Address correspondence to Jennifer Herzog-Niescery, MD, Department of Anesthesiology, Ruhr-University Bochum, St Josef-Hospital Bochum, Gudrunstraße 56, D-44791 Bochum, Germany. Address e-mail to

© 2019 International Anesthesia Research Society
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