Occupational Exposure to Inhalation Anesthetics in Operating Room and Adverse Health Outcomes: A Systematic Review
Main Article Content
Keywords
Volatile anaesthetics; Operating room; Exposure; Adverse health effects; Systematic review
Abstract
Summary: Volatile anesthetics (VA) are essential agents for inducing and maintaining unconsciousness during specific surgical procedures, but they pose several health risks for exposed workers. The aim of the systematic review was to assess the effects of long-term VA occupational exposure in operating rooms. The review was conducted in accordance with the PRISMA Statement, and the search was conducted in PubMed, Scopus, and Web of Science to identify articles published between January 1, 1994, and December 31, 2024, that reported data from observational, quasi-experimental, and experimental studies. The protocol was registered in PROSPERO (ID: CRD42024500838). The quality of the studies was assessed using the standard Newcastle-Ottawa Scale versions for cohort and case–control studies, and an adapted version for cross-sectional studies. A total of 65 studies were included. Adverse effects were categorized into four groups: reproductive and Adverse pregnancy or offspring outcomes, neurotoxic alterations, laboratory parameter changes, and cyto- and genotoxicity. Overall, no significant associations were found between VA exposure and reproductive or pregnancy outcomes. One study reported neurological alterations (prolonged reaction times). Additionally, some studies have documented impairments in immune function and minor alterations in renal and hepatic function parameters. Finally, several studies indicated an increased risk of genotoxicity and oxidative stress. Given this evidence, protective measures and health surveillance for exposed workers remain crucial preventive measures.
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3. CDC. Criteria for a Recommended Standard – Occupational Exposure to Waste Anesthetic Gases and Vapors. Available online: https://www.cdc.gov/niosh/docs/77-140/default.html (Last Accessed on 20/02/2025).
4. Chandrasekhar M, Rekhadevi PV, Sailaja N, et al. Evaluation of Genetic Damage in Operating Room Personnel Exposed to Anaesthetic Gases. Mutagenesis. 2006; 21 (4), 249–254. Doi: https://doi.org/10.1093/mutage/gel029
5. Chang WP, Kau CW, Hseu SS. Exposure of Anesthesiologists to Nitrous Oxide during Pediatric Anesthesia. Ind Health. 1997; 35(1), 112–118. Doi: https://doi.org/10.2486/indhealth.35.112
6. Casale T, Caciari T, Rosati MV, et al. Anesthetic gases and occupationally exposed workers. Environ Toxicol Phar. 2014; 37(1), 267-274. Doi: https://doi.org/10.1016/j.etap.2013.12.003
7. Nilsson R, Björdal C, Andersson M, et al. Health risks and occupational exposure to volatile anaesthetics--a re-view with a systematic approach. J Clin Nurs. 2005; 14(2), 173-186. Doi: 10.1111/j.1365-2702.2004. 01032.x
8. Sahin SH, Cinar SO, Paksoy I, et al. Comparison between Low Flow Sevoflurane Anesthesia and Total Intrave-nous Anesthesia during Intermediate-Duration Surgery: Effects on Renal and Hepatic Toxicity. Hippokratia. 2011; 15(1), 69–74.
9. Hoerauf K, Harth M, Wild K, Hobbhahn J. Occupational Exposure to Desflurane and Isoflurane during Cardio-pulmonary Bypass: Is the Gas Outlet of the Membrane Oxygenator an Operating Theatre Pollution Hazard? Br J Anaesth. 1997; 78(4), 378–380. Doi: https://doi.org/10.1093/bja/78.4.378
10. Szyfter K, Szulc R, Mikstacki A, et al. Genotoxicity of inhalation anaesthetics: DNA lesions generated by sevoflu-rane in vitro and in vivo. J Appl Genet. 2004; 45(3), 369-374.
11. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting sys-tematic reviews. Br Med J. 2021; 372, 71. Doi: 10.1136/bmj.n71
12. Wells GA, Shea B, O’Connell D, et al. The Newcastle-Ottawa Scale (NOS) for Assessing the Quality of Nonran-domised Studies in Meta-Analyses. 2021. Available online: http://www.ohri.ca/programs/clinical_epidemiology/oxford.asp (Last Accessed on 20/02/2025).
13. Bargellini A, Rovesti S, Barbieri A, et al. Effects of chronic exposure to anaesthetic gases on some immune pa-rameters. Sci Total Environ. 2001; 270(1-3), 149-156. Doi: 10.1016/s0048-9697(00)00778-6
14. Isolani L, Fiorentini C, Violante FS, Raffi GB. Short-term neurobehavioural effects in anaesthetists with low ex-posure to nitrous oxide. Arh Hig Rada Toksiko. 1999; 50(4), 381-388.
15. Lucchini R, Belotti L, Cassitto MG, et al. Neurobehavioral Functions in Operating Theatre Personnel: A Multi-center Study. Med Lav. 1997; 88(5), 396–405.
16. Lucchini R, Placidi D, Toffoletto F, Alessio L. Neurotoxicity in Operating Room Personnel Working with Gaseous and Nongaseous Anesthesia. Int Arch Occup Environ Health. 1996;68(3),188–192. Doi: https://doi.org/10.1007/BF00381630
17. Lucchini R, Toffoletto F, Camerino D, et al. Neurobehavioral Functions in Operating Theatre Personnel Exposed to Anesthetic Gases. Med Lav. 1995; 86 (1), 27–33.
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24-02-2026
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Caronna A, Vitale K, Ciccariello L, et al. Occupational Exposure to Inhalation Anesthetics in Operating Room and Adverse Health Outcomes: A Systematic Review. Med Lav. 2026;117(1):17428. doi:10.23749/mdl.2026.17428
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Author Biography
Matteo Vitali, Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
Professore Associato di Igiene
Dipartimento di Sanità Pubblica e Malattie Infettive
How to Cite
1.
Caronna A, Vitale K, Ciccariello L, et al. Occupational Exposure to Inhalation Anesthetics in Operating Room and Adverse Health Outcomes: A Systematic Review. Med Lav. 2026;117(1):17428. doi:10.23749/mdl.2026.17428
