Environmental hazards

Obstetric problems This is the most widely recognised environmental hazard of anaesthesia but individual opinions, as well as governmental and professional reactions, differ widely. Some feel that not enough is being done about the problem while others maintain either that there is no problem and that much research and finance has been misdirected, or that scavenging devices introduce an unacceptable hazard to the patient. In general many feel that this is a well worn subject about which there is considerable indifference and confusion amongst general operating room staff. The epidemiological data has been reviewed before (e.g. Vessey and Nunnl). New information includes the recent Swedish survey (Axelsson and Rylander 2) as well as the Finnish study of obstetrical hazards associated with other aspects of hospital work (Hemminki et al.3). The animal studies have two contributions to make to the solution of the problem. First, they provide evidence for a cause and effect relationship based on exposure to specific drugs. Second, where there is a satisfactory animal model, it may be possible to determine rational criteria for maximum "safe" levels of contamination. Good examples of the two objectives are provided respectively by the current studies with isoflurane (Mazze et al. 4) and nitrous oxide (Sharer et al.5). Non-obstetric risks The information on other health hazards is at the moment less than adequate to allow any firm conclusions. Most British anaesthetists are easily persuaded that disease of the lumbar spine is an occupational hazard associated with transferring patients in the operating room. However, there are serious limitations to the self-reporting of diseases. Various studies have implied that chronic exposure to anaesthetics is associated with a 1.6-1.7-fold increase in liver disease, and a 1.2-1.7-fold increase in kidney disease (Cohen et al. 6) while a morbidity study of British doctors revealed no unusual pattern among anaesthetists compared with other specialists except in increased number of deaths from cancer of the pancreas (Doll and Peto7). It may be relevant to many occupational groups to note that approximately 50 per cent of pancreatic cancers are thought to be attributable to coffee drinking, a relative risk of 2.7 associated with three or more cups daily (MacMahon et al.8). A more objective assessment of morbidity would be provided by a study of early retirement from medical practice but it appears that the information required is not easily available.