Controlling Exposures To Nitrous Oxide During Anesthetic Administration
Nitrous oxide or N2O is used as anesthetic agent in medical, dental and veterinary operatories. This gas is also used as a foaming agent for whipped cream, an oxidant for organic compounds, a nitrating agent for alkali metals and a component of certain rocket fuels.
According to DHHS NIOSH Publication No. 94-100, workers exposed to N2O may suffer harmful side effects.
It suggests taking the following steps to protect yourself from waste N2O in the workplace:
Beware that N2O may cause the following health effects:
- Decreases in mental performance, audiovisual ability and manual dexterity
- Adverse reproductive effects
Make sure that the following monitoring procedures are performed when the anesthetic equipment is installed and every three months thereafter:
- Leak testing of equipment
- Monitoring of air in the worker’s personal breathing zone
- Environmental (room air) monitoring
Prevent leakage from the anesthetic delivery system through proper maintenance and inspection of equipment. Eliminate or replace the following:
- Loose-fitting connections
- Loosely assembled or deformed slip joints and threaded connections
- Defective or worn seals, gaskets, breathing bags and hoses
Control waste N2O with a well designed scavenging system that includes the following:
- Security fitting masks
- Sufficient flow rates for the exhaust system
- Properly vented vacuum pumps
Make sure that the room ventilation is effectively removing waste N2O. If concentrations of N2O are above 25 ppm, take the following steps:
- Increase the airflow into the room
- Use supplemental local ventilation to capture N2O as the source
Work practices
Use the following practices to control N2O exposures:
Inspect the anesthetic delivery system and all connections before starting anesthetic gas administration. Make sure that breathing bags, hoses and clamps are in place before turning on the anesthetic machine.
Connect the scavenging mask properly to the gas delivery hose and the vacuum system.
Do not turn on the machine delivering N2O until the vacuum system scavenging unit is operating at the recommended flow rate of 45 L/min, and the scavenging mask is secured over the patient’s nose or face.
Fasten the mask according to the manufacturer’s instructions to prevent leaks around the mask during gas delivery.
Do not fill the breathing bag to capacity with N2O; an over-inflated bag can cause excessive leakage from the scavenging mask. The breathing bag should collapse and expand as the patient breathes. This bag activity shows that the proper amounts of N2O and air are being delivered to the patient.
Flush the system of N2O after surgery by administering oxygen to the patient through the anesthetic equipment for at least five minutes before disconnecting the gas delivery system.
Encourage patients to minimize talking and mouth-breathing during dental surgery. When mouth-breathing is apparent, avoid the patient’s breathing zone to the extent possible.
Source: NIOSH, USA.
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