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HAZARDS OF ANAESTHESIA

HAZARDS OF ANAESTHESIA. G.K.KUMAR. DEFENITON. DANGER/RISK ANESTHESIOLOGISTS PATIENTS. HAZARDS FOR ANASTHESIOLOGISTS. Fire & explosions Electrical accidents Pollutions by anesthetic agents Radiations Infections Incompatibilities / allergies Stress Chemical dependence. OR.

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HAZARDS OF ANAESTHESIA

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  1. HAZARDS OF ANAESTHESIA G.K.KUMAR

  2. DEFENITON • DANGER/RISK • ANESTHESIOLOGISTS • PATIENTS

  3. HAZARDS FOR ANASTHESIOLOGISTS • Fire & explosions • Electrical accidents • Pollutions by anesthetic agents • Radiations • Infections • Incompatibilities / allergies • Stress • Chemical dependence OR

  4. HAZARDS FOR ANASTHESIOLOGISTS • PHYSICAL -ELECTRICAL -ENVIRONMENTAL -INFECTIVE -ALLERGY • PSYCOLOGICAL -STRESS -DEPENDENCY

  5. Electrical accidents • Unsafe electrical configurations • Types-macro shock -micro shock -loss of power supply to gadgets • Safe practices

  6. Electrical accidents • Macro shock -Large voltage current -Causes tissue damages burns explosions

  7. Electrical accidents • Micro shock-Direct application of very small voltages to the heart thro’ electrodes • Allowable leakage thro’ electrodes-10µA • >50µA-VF occurs

  8. Electrical accidents - Safe practices • Proper grounded equipments(3pin) • Don’t connect the pt to the OR grounding sources • Electro cautery: large grounding pads, to be kept well away from electrodes & PM • Use bipolar • Reset the pace maker to regular mode(asynchronised) • Keep ready pharmacological pacing- Isoprenaline • Good maintenance of equipments

  9. Pollution by anesthetic agents • Risks • Recommendations • Remedies

  10. Pollution by anesthetic agents • Risks- Real? Or Mystiques? -abortions -congenital abnormalities -malignancies (liver) -behavioral problems(N2O)

  11. Pollution by anesthetic agents Recommendations • Upper limits

  12. Pollution by anesthetic agents Remedies • Scavenging systems • Closed circuits • Anti spill devices • Avoid agents

  13. Radiation hazards • Risks • Recommendations • Remedies

  14. Radiation hazards Risks • Ionizing radiation-X’ray, radioactive isotopes • Formation of free radicals, ionizing molecules • Damage/destruction of cells, Ch anomalies, malignancies.

  15. Radiation hazards Risks • Non-Ionizing radiation –laser • Disruption of electrons from one orbit to others, but with in cells • Tissue damage • Laser plums formation (contain viable bacteria,HPV DNA,HIVproviral DNA)

  16. Radiation hazards Recommendations • Max. allowable exposure/yr<5Rem during pregnancy-500mRem • 0ne X’ray-25 mRem • Natural exposure cosmic rays-40mRem

  17. Radiation hazards Remedies for ionizing radiation • Scattered rays inv. Proportional to (distance)2 from the source • Best way of protection-physical separation (6 ft = 9 in concrete = 2.5 mm lead) • Protective lead aprons (o.25-o.5mm)

  18. Radiation hazards Remedies for non-ionizing radiation • Radiation intensity not decreased to distance in an average OR. • Proper gaggles • Laser plum to be removed by effective scavenging systems removes particles ≥o.1µm (filters ≥0.5µm).

  19. Infections • Physical spread-HSV,CMV • Blood borne-HIV,HBV,HCV • Air borne-Mtb

  20. Infections • Blood borne diseases thro’ Needle stick injuries- HIV:0.3%, HBV:3%, HCV30% • 32% had at least 1 NSI in the preceding 12M.(only half of them took treatment). • More risk with hollow-core & large bore • NSI more in non dominated hands • NSI more during disposal of contaminated needles. • Anesthesiologists have risk for occupational infection during 30years of exposure-0.045-4.5%

  21. Infections-HIV • Health care workers contribute 5% of total cases • 4% of emergency department pts are unidentified cases. • Pts considered infective if both screening (ELISHA) & confirmatory (western blot, indirect fluorescent ab) tests are positive.

  22. Infections-HIV • 54 reported cases of occupationally acquired HIV(1998). • 88% of them had H/O NSI • ? Quantity of inoculums- ( a case report :100-200µml of blood thro”i.v. produced HIV). • Risk for the pts- 6 cases reported.

  23. Infections-HBV • Non immunized health care workers higher risks • 17.8% 0f seropositive among anesthesiologist • 30% became positive after 11 years of exposure • Disinfectants & gloves are not completely protective- viruses viable for >14 days in needles, gloves, &surfaces.

  24. Infections-HCV • No immunization available • No specific treatment available • Advice: serologic monitoring for HCV & LFT 3-6 monthly.

  25. Infections Management of occupational infections. SAFE PRACTICE • Protective equipments • Washing methods • Disposal methods

  26. Infections -CDC recommendations • Universal precautions-1980 -considering as all pts, blood & body fluids are infective. • Isolation precautions-1996 -2 tier recommendations • Standard precautions -to be followed for handling all pts as UP. • Transmission based precautions -for handling pts known to be / suspected of being risks.

  27. Infections -CDC recommendations Transmission based precautions • Based on specific the properties of specific pathogens • Airborne precautions [measles,varicella,Tb] -to prevent from small particles<5µm by specific filters air handling devices.-HEPA, Negative pr environment • Droplet precautions [HI-type b, mycoplasma, streptococcal pharyngitis, rubella]-to prevent from large particles>5µm, keep distance>1m • Contact precautions [HAV, HSV, viral conjunctivitis]

  28. Incompatibilities / Allergies Latex allergy • Type iv/ type I • Risk groups : • Atopics, • Spina bifida, • Urogenital abnormalities , • HCW, • Rubber factory workers.

  29. Latex allergy • Managements • Identification of risk groups • Use latex free objects-latex free environment • Tests:RAST[radio-allergo-sorbent test] SPT Sr.histamine Urinary histamine Sr.IgE Sr.compliments Sr.tryptase Screening tests Tests for anaphylaxis

  30. Latex allergy Managements-drug regimens • Preoperative protocol: • Dipenhydramine -1mg/kg,po/iv,q 6hr at 13,7,1hr before surgery • Prednisolone -1mg/kg,po/iv,q 6hr at 13,7,1hr before surgery or hydro cortisone 4g/kg • Ranitidine - 2mg/kg po, 1mg/kg iv,q 12hr at 13,1hr before surgery • Postop protocol -drugs to be repeated for 12hrs

  31. Stress • Inevitable, universal phenomenon to which no one is immune • Job related stress are unavoidable but may be controlled • 2 types-Unavoidable & Avoidable • Unavoidable-professional stress • Avoidable-sleep related

  32. Stress Unavoidable Stress • Professional Stress • Co-worker relationships • Work load • Litigations • Peer review • Professional dissatisfaction • Administrative responsibilities

  33. Stress Avoidable Stress • Sleep related-altered sleep pattern, sleep deprivation • Coincide with natural sleep peaks[2-7a.m] • Identification of sleep disturbances • Regulations of working hours

  34. Chemical dependence Self administration of drugs & suicide rates are high among anesthesiologist. • Addiction :compulsive continued use of drugs in spite of adverse, a chronic, relapsing condition resulting from long term effects of drugs on brain, due to molecular, structural, cellular, & functional changes. • Dependence: physical / psychological inability to control drug use • Abuse :use of drugs in detrimental way but not to the point of addiction. a pre addiction level, can easily quit. a voluntary act.

  35. Chemical dependence Causes • Stress • Availabilities • Curiosity for experimentation • Drug potency • Others-genetic predisposition

  36. Chemical dependence Management • Identification • Intervention • Referral • Rehabilitation

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