Risques professionnels liés à la pratique de l'anesthésie.
Ann Fr Anesth Reanim. 2008 Jan;27(1):63-73. Epub 2007 Dec 21.
Risques professionnels liés à la pratique de l’anesthésie.
Merat F, Merat S.
Ecole du Val-de-Grace, 1, place Alphonse-Laveran, 75230 Paris, France.
OBJECTIVE: To evaluate the occupational hazards related to the practice of anaesthesia and to give the preventing measures related to these risks. DATA SOURCES: The Medline data bank, the specialized reviews of Occupational medicine and the bank of data of the Regional Case Disease in « Ile-de-France » were consulted. The key words employed separately or in combination were: anaesthesia, occupational hazards, anaesthetic gas, stress, working conditions, burnout, addiction, occupational blood exposure, latex allergy, ionizing radiation, electrocution, explosion. STUDY SELECTION: General reviews and original articles were selected. We also selected isolated clinical cases and letters to editor according to their relevance compared with the existing literature. DATA EXTRACTION: After grouping the data according to the nature of the risk, the articles were analyzed for description, the analysis and the prevention of the risk. DATA SYNTHESIS: There are several occupational hazards related to the practice of anaesthesia. The toxicity of anaesthetic gases and particularly of nitrous oxide was highlighted at the beginning of their use. Most toxic gases were abandoned and the application of collective protection measures (system of evacuation of anaesthetic gas, ventilation of operating rooms, use of closed circuit for anaesthesia) made it possible to decrease considerably the risk related to inhalational anaesthesia. Occupational blood exposure also decreases thanks to a better observance of safety rules and the use of protected material. The risk of latex allergy has decreased considerably with the substitution of latex by other material. The risk related to the exposure to ionizing radiations is better controlled because very strict regulations have been implemented. The operating room environment involves risks of electrification, fire and explosion. New risks have been identified: drug-addiction and the painfulness of work or burnout. Their frequency is difficult to evaluate but they can have serious consequences for the patients and the anaesthetists. Their prevention relies on early tracking by the members of the team, the improvement of working conditions and a better professional recognition. CONCLUSION: Toxicity of anaesthetic gases, occupational blood exposure, exposure to ionizing radiations, latex allergy, electrification and the risk of explosion in the operating room are well identified professional risks of anaesthesia. Measures have been implemented to reduce their incidence. Two risks are increasingly recognized: drug-addiction and burnout. Early tracking, the improvement of working conditions and a better professional recognition are the best way to prevent them.