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Occupational exposure to nitrous oxide during procedural pain control in children: a comparison of different inhalation techniques and scavenging systems
Author(s) -
Messeri Andrea,
Amore Elena,
Dugheri Stefano,
Bonari Alessandro,
Pompilio Ilenia,
Arcangeli Giulio,
Rizzo Giuliana
Publication year - 2016
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/pan.12966
Subject(s) - medicine , nitrous oxide , scavenging , inhalation , anesthesia , inhalation exposure , pain control , biochemistry , chemistry , antioxidant
Summary Background Nitrous oxide (N 2 O 50% in oxygen) is commonly used for painful procedures in children. Potential negative health effects associated with chronic workplace exposure limit its use. Safe occupational N 2 O exposure concentrations are below 25 ppm environmental concentration as a time‐weighted average ( TWA ) and below 200 ppm as a short‐time exposure level ( STEL ) of 15 min. Aim The aim was to assess occupational exposure of staff during nitrous oxide administration to children using different inhalation delivery devices and scavenging systems. Methods Staff nitrous oxide exposure during use of a double face mask ( DFM ) with or without a demand valve ( DV ) was compared with a conventional single face mask ( FM ). We also compared exposure using the hospital central scavenging system with a portable evacuation system. N 2 O concentrations, representing exposure values, were monitored within proximity to staff. Urine N 2 O concentration was measured in staff administering the N 2 O at the end of the procedural session. Results The mean and median values of TWA and STEL within the working area were lower than recommended values in the DFM (10.8, 11.6 ppm for TWA ; 13.9, 11.0 ppm for STEL ) and DFM ‐ DV groups (2.3, 2.8 ppm for TWA ; 4.4, 3.5 ppm for STEL ) using the portable evacuation system. The N 2 O urine exposure in DFM ‐ DV group was lower than DFM group: a mean difference of 9.56 ppm (95% CI 2.65–16.46). Staff N 2 O urinary concentrations were within safe biological limits in both the DFM and DFM ‐ DV groups. High exposure concentrations to N 2 O were recorded in all FM and FM ‐ DV environmental and biological samples. Conclusions The DFM system, with or without a DV , connected to a portable evacuation system during N 2 O administration to children for painful procedures kept N 2 O levels within the local environment below recommended limits.