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George W. Williams - One of the best experts on this subject based on the ideXlab platform.

  • evaluation and control of waste Anesthetic Gas in the postanesthesia care unit within patient and caregiver breathing zones
    Proceedings (Baylor University. Medical Center), 2019
    Co-Authors: George W. Williams, Sam D. Gumbert, Evan G. Pivalizza, Tariq Syed, Tyrone Burnett, Omar L Mancillas, Leslie A Vargas, Carin A Hagberg
    Abstract:

    AbstractThis study (NCT02428413) evaluated waste Anesthetic Gas (WAG) in the postanesthesia care unit (PACU) and assessed the utility of the ISO-Gard® mask in reducing nursing exposure to WAG. We h...

  • Evaluation and control of waste Anesthetic Gas in the postanesthesia care unit within patient and caregiver breathing zones.
    Proceedings (Baylor University. Medical Center), 2018
    Co-Authors: George W. Williams, Sam D. Gumbert, Evan G. Pivalizza, Tariq Syed, Tyrone Burnett, Omar L Mancillas, Leslie A Vargas, Stephanie H Ahn, Chunyan Cai, Carin A Hagberg
    Abstract:

    This study (NCT02428413) evaluated waste Anesthetic Gas (WAG) in the postanesthesia care unit (PACU) and assessed the utility of the ISO-Gard® mask in reducing nursing exposure to WAG. We hypothesized that WAG levels in the patient's breathing zone upon recovery would exceed the recommended levels, leading to increased exposure of the PACU nurses, with use of the ISO-Gard mask limiting this exposure. A total of 125 adult patients were recruited to participate. Patients were randomized to receive the standard oxygen delivery mask or the ISO-Gard face mask postoperatively. Continuous particulate concentrations were measured using infrared spectrophotometers placed within the patients' and nurses' 6-inch breathing zone. Maximum WAG measurements were obtained every 30 seconds, and the duration of maximum WAG >2 ppm and its proportion relative to the total collection period were calculated. We observed a statistically significant difference in desflurane duration and proportion of maximum WAG >2 ppm in both patient and PACU nurse breathing zones. Therefore, patients and PACU nurses using routine care were exposed to WAG levels >2 ppm during the 1-hour postoperative period, and the ISO-Gard mask effectively reduced the amount of WAG detected in the immediate 1-hour postoperative recovery phase.

  • Clinical Study Evaluation of Waste Anesthetic Gas in the Postanesthesia Care Unit within the Patient Breathing Zone
    2016
    Co-Authors: Kenneth N Hiller, Stephanie F Tran, Chunyan Cai, Alfonso V. Altamirano, George W. Williams
    Abstract:

    License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Potential health hazards fromwaste Anesthetic Gases (WAGs) have been a concern since the introduction of inhalational Anesthetics into clinical practice. The potential to exceed recommended exposure levels (RELs) in the postanesthesia care unit (PACU) exists. The aim of this pilot study was to assess sevoflurane WAG levels while accounting for factors that affect inhalational Anesthetic elimination. In this pilot study, 20 adult day surgery patients were enrolled with anesthesia maintained with sevoflurane. Following extubation, exhaledWAG from the patient breathing zone wasmeasured 8 inches from the patient’s mouth in the PACU.Maximum sevofluraneWAG levels in the patient breathing zone exceededNational Institute forOccupational Safety andHealth (NIOSH)RELs for every 5-minute time interval measured during PACU Phase I. Observed WAGs in our study were explained by inhalational Anesthetic pharmacokinetics. Further analysis suggests that the rate of washout of sevoflurane was dependent on the duration of Anesthetic exposure. This study demonstrated that clinically relevant inhalational Anesthetic concentrations result in sevoflurane WAG levels that exceed current RELs. Evaluating peak and cumulative sevoflurane WAG levels in the breathing zone of PACU Phase I and Phase II providers is warranted to quantify the extent and duration of exposure. 1

  • evaluation of waste Anesthetic Gas in the postanesthesia care unit within the patient breathing zone
    Anesthesiology Research and Practice, 2015
    Co-Authors: Kenneth N Hiller, Alfonso Altamirano, Stephanie F Tran, George W. Williams
    Abstract:

    Potential health hazards from waste Anesthetic Gases (WAGs) have been a concern since the introduction of inhalational Anesthetics into clinical practice. The potential to exceed recommended exposure levels (RELs) in the postanesthesia care unit (PACU) exists. The aim of this pilot study was to assess sevoflurane WAG levels while accounting for factors that affect inhalational Anesthetic elimination. In this pilot study, 20 adult day surgery patients were enrolled with anesthesia maintained with sevoflurane. Following extubation, exhaled WAG from the patient breathing zone was measured 8 inches from the patient's mouth in the PACU. Maximum sevoflurane WAG levels in the patient breathing zone exceeded National Institute for Occupational Safety and Health (NIOSH) RELs for every 5-minute time interval measured during PACU Phase I. Observed WAGs in our study were explained by inhalational Anesthetic pharmacokinetics. Further analysis suggests that the rate of washout of sevoflurane was dependent on the duration of Anesthetic exposure. This study demonstrated that clinically relevant inhalational Anesthetic concentrations result in sevoflurane WAG levels that exceed current RELs. Evaluating peak and cumulative sevoflurane WAG levels in the breathing zone of PACU Phase I and Phase II providers is warranted to quantify the extent and duration of exposure.

Maria M Zestos - One of the best experts on this subject based on the ideXlab platform.

  • does exposure to inhalation anesthesia Gases change the ratio of x bearing sperms and y bearing sperms a worth exploring project into an uncharted domain
    Medical Hypotheses, 2016
    Co-Authors: Deepak Gupta, George Mckelvey, Edward Kaminski, Maria M Zestos
    Abstract:

    According to recent surveys performed in United States and India, anesthesia care providers were observed to have sired female offspring in a higher proportion than male offspring as their firstborn progeny; however, the reasons for the skew are not clear. Our hypothesis is that the underlying biological evidence may be elucidated by unraveling differences (if any) between the concentrations of X-bearing sperms and Y-bearing sperms in the semen samples obtained from males exposed to varied levels of Anesthetics in their lifetimes. Therefore, the objectives of the envisaged study would be to conduct a three-stage investigative study on in-vitro human semen samples to determine (a) X-bearing sperms and Y-bearing sperms concentrations' ratio in male pediatric anesthesia care providers' semen samples, (b) changes in X-bearing sperms and Y-bearing sperms concentrations' ratios between the pre-rotation and post-rotation semen samples of male medical student volunteers/observers, and (c) changes in X-bearing sperms and Y-bearing sperms concentrations' ratios between the pre-operative and post-operative day-3 semen samples of male patients presenting for outpatient procedures under inhalational anesthesia. The expected outcomes would be (a) linear and positive correlation of the Anesthetic Gas usage (exposure) with increased X-bearing sperms/Y-bearing sperms ratio in post-anesthesia day 3 sample as compared to the baseline preoperative sample, (b) linear and positive correlation of the Anesthetic Gas usage (exposure) with increased X-bearing sperms/Y-bearing sperms ratio in post-rotation sample as compared to the baseline sample, and (c) observation of high X-bearing sperms/Y-bearing sperms ratio in the pediatric anesthesia care providers. In summary, effects (if any) of occupational or personal exposure to inhalational Anesthetic Gases on the X-bearing sperms and Y-bearing sperms ratio is a worthy project wherein lots of questions that have arisen over decades could find the path to their definitive answers, based on envisaged laboratory investigations into this uncharted domain.

  • propofol decreases waste Anesthetic Gas exposure during pediatric bronchoscopy
    Laryngoscope, 2004
    Co-Authors: Maria M Zestos, Debashish Bhattacharya, Sankar Rajan, Sharon Kemper, Michael Haupert
    Abstract:

    Objective: This study compared the Anesthetic Gas exposure and operating conditions during insufflation anesthesia with halothane-alone versus halothane-propofol in children undergoing direct laryngobronchoscopy. Study Design: Forty-six children were enrolled in this randomized prospective study, with institutional review board approval and informed consent. Methods: All children were anesthetized by halothane mask induction and anesthesia was maintained using spontaneous ventilation with insufflation. No muscle relaxants or opioids were used. In the halothane group, halothane was titrated as needed. In the propofol group, halothane was decreased to 1% inspired concentration and the propofol was titrated as needed to maintain spontaneous ventilation and a still patient. Trace Anesthetic Gases, hemodynamic stability, and operating conditions were measured. Results: The groups were similar in age, weight, and bronchoscopy time. There was significantly less Gas exposure in the propofol group (25 ± 33 parts per million) versus the halothane group (66 ± 97 ppm; P <.02). There was a trend toward earlier emergence in the halothane group (33 ± 13 minutes) versus the propofol group (41 ± 17 minutes). Postoperative stridor was common, occurring in 30% of children. Conclusions: Insufflation anesthesia with spontaneous respiration provides excellent surgical conditions for laryngobronchoscopy. The addition of propofol resulted in fewer airway complications (P = .047). Although the addition of propofol significantly decreased Anesthetic Gas exposure in the operating room, both techniques resulted in operating room pollution that exceeded the maximum levels of 2 ppm per hour recommended by the US National Institute for Occupational Safety and Health (NIOSH).

K Westphal - One of the best experts on this subject based on the ideXlab platform.

  • surgeon s occupational exposure to nitrous oxide and sevoflurane during pediatric surgery
    World Journal of Surgery, 2001
    Co-Authors: Christian Byhahn, K Heller, V Lischke, K Westphal
    Abstract:

    Health hazards from occupational exposure to trace concentrations of Anesthetic Gases cannot be definitively excluded. The aim of the study was to determine the surgeon’s occupational exposure to nitrous oxide and sevoflurane during pediatric surgical procedures. Twenty young children (age 10 years) underwent elective abdominal surgery under general inhalational anesthesia. The operating room was equipped with modern air conditioning and waste Anesthetic Gas scavenger. Levels of both nitrous oxide and sevoflurane were determined in the breathing zone of the surgeon and the anesthesiologist during the operative procedures by means of a direct-reading photoacoustic infrared spectrometer. Both the surgeon and the anesthesiologist were exposed to low concentrations of the inhalational agents used. Exposure to sevoflurane and nitrous oxide was clearly higher during surgery in young children than during operative procedures in teenagers. Nonetheless, the concentrations of these agents were well below the threshold limits of 25 ppm for nitrous oxide and 2 ppm for sevoflurane recommended by the National Institute of Occupational Safety and Health. General anesthesia results in operating room air pollution with inhalational Anesthetics. Under modern air conditioning, personnel’s occupational exposure is low, and inhalational anesthesia is safe from the standpoint of modern workplace laws and health care regulations. Nonetheless, all efforts must be taken to maintain occupational exposure at this low level.

Pinakin Gujjar - One of the best experts on this subject based on the ideXlab platform.

  • comparison of endotracheal tube cuff pressure changes using air versus nitrous oxide in Anesthetic Gases during laparoscopic abdominal surgeries
    Revista Brasileira De Anestesiologia, 2018
    Co-Authors: Shweta Sarjerao Mogal, Lipika Baliarsing, Raylene Dias, Pinakin Gujjar
    Abstract:

    Abstract Background and objectives The purpose of this study was to compare the endotracheal tube cuff pressure changes during laparoscopic surgeries using air versus nitrous-oxide in Anesthetic Gas mixture; and to observe the incidences of postoperative sore throat, hoarseness and dysphagia. Methods Total 100 patients scheduled for elective laparoscopic abdominal surgery were allocated into two groups. Group A (n = 50) received air while Group N (n = 50) received nitrous-oxide in Anesthetic Gas mixture. After endotracheal intubation, cuff was inflated with air to achieve sealing pressure. Cuff pressure at baseline (sealing pressure), 30 min, 60 min and 90 min was recorded with a manometer. Incidence of sore throat, hoarseness and dysphagia was noted at the time of discharge from post-anesthesia care unit and 24 h after extubation. Results Cuff pressure increased from baseline in both the groups. The increase in cuff pressure in Group N was greater than that in Group A at all time points studied (p  Conclusion Use of nitrous-oxide during laparoscopy increases cuff pressure resulting in increased incidence of postoperative sore throat. Cuff pressure should be monitored routinely during laparoscopy with nitrous-oxide anesthesia.

  • Comparison of endotracheal tube cuff pressure changes using air versus nitrous oxide in Anesthetic Gases during laparoscopic abdominal surgeries
    Elsevier, 2018
    Co-Authors: Shweta Sarjerao Mogal, Lipika Baliarsing, Raylene Dias, Pinakin Gujjar
    Abstract:

    Background and objectives: The purpose of this study was to compare the endotracheal tube cuff pressure changes during laparoscopic surgeries using air versus nitrous-oxide in Anesthetic Gas mixture; and to observe the incidences of postoperative sore throat, hoarseness and dysphagia. Methods: Total 100 patients scheduled for elective laparoscopic abdominal surgery were allocated into two groups. Group A (n = 50) received air while Group N (n = 50) received nitrous-oxide in Anesthetic Gas mixture. After endotracheal intubation, cuff was inflated with air to achieve sealing pressure. Cuff pressure at baseline (sealing pressure), 30 min, 60 min and 90 min was recorded with a manometer. Incidence of sore throat, hoarseness and dysphagia was noted at the time of discharge from post-anesthesia care unit and 24 h after extubation. Results: Cuff pressure increased from baseline in both the groups. The increase in cuff pressure in Group N was greater than that in Group A at all time points studied (p 

Michael S Avidan - One of the best experts on this subject based on the ideXlab platform.

  • association of perioperative risk factors and cumulative duration of low bispectral index with intermediate term mortality after cardiac surgery in the b unaware trial
    Anesthesiology, 2010
    Co-Authors: Miklos D Kertai, Lini Zhang, Beth A Burnside, Kevin J Finkel, Ben J A Palanca, Nirvik Pal, Nan Lin, Sylvia A Searleman, Michael S Avidan
    Abstract:

    Background: Current data suggest that mortality after noncardiac surgery may be associated with persistent hypotension and the cumulative duration of low processed electroencephalogram-based bispectral index (BIS). This study assessed the relationships among cumulative duration of low BIS (BIS 45), intermediate-term mortality, and Anesthetic dose after cardiac surgery. Methods: The authors studied 460 patients (mean age, 63.0 13.1 yr; 287 men) who underwent cardiac surgery between September 2005 and October 2006 at Washington University Medical Center, St Louis, Missouri. By using multivariable Cox regression analysis, perioperative factors were evaluated for their potential association with intermediate-term all-cause mortality. Results: A total of 82 patients (17.8%) died during a median follow-up of 3 yr (interquartile range, 2.7–3.3 yr). Comparing patients who died with those who survived, there was no statistically significant difference in the relationship between end-tidal Anesthetic Gas concentrations during the Anesthetic maintenance phase and the BIS. Cumulative duration of low BIS was independently associated with intermediate-term mortality. The 1.29 adjusted hazard ratio (95% CI, 1.12–1.49) for intermediate-term mortality with cumulative duration of low BIS translated into a 29% increased risk of death for every cumulative hour spent with a BIS less than 45. The final multivariable Cox regression model showed a good discriminative ability (c-index of 0.78). Conclusions: This study found an association between cumulative duration of low BIS and mortality in the setting of cardiac surgery. Notably, this association was independent of both volatile Anesthetic concentration and duration of anesthesia, suggesting that intermediate-term mortality after cardiac surgery was not causally related to excessive Anesthetic dose.

  • protocol for the bag recall clinical trial a prospective multi center randomized controlled trial to determine whether a bispectral index guided protocol is superior to an anesthesia Gas guided protocol in reducing intraoperative awareness with expli
    BMC Anesthesiology, 2009
    Co-Authors: Michael S Avidan, Ben J A Palanca, David B Glick, Eric Jacobsohn, Alex Villafranca, Michael D Oconnor, George A Mashour
    Abstract:

    Awareness with explicit recall of intra-operative events is a rare and distressing complication that may lead to severe psychological symptoms. Candidate depth of anesthesia monitors have been developed, partly with the aim of preventing this complication. Despite conflicting results from clinical trials and the lack of incisive validation, such monitors have enjoyed widespread clinical adoption, in particular the bispectral index. The American Society of Anesthesiologists has called for adequately powered and rigorously designed clinical trials to determine whether the use of such monitors decreases the incidence of awareness in various settings. The aim of this study is to determine with increased precision whether incorporating the bispectral index into a structured general anesthesia protocol decreases the incidence of awareness with explicit recall among a subset of surgical patients at increased risk for awareness and scheduled to receive an inhalation Gas-based general Anesthetic. BAG-RECALL is a multi-center, randomized, controlled clinical trial, in which 6,000 patients are being assigned to bispectral index-guided anesthesia (target range, 40 to 60) or end-tidal Anesthetic Gas-guided anesthesia (target range, 0.7 to 1.3 age-adjusted minimum alveolar concentration). Postoperatively, patients are being assessed for explicit recall at two intervals (0 to 72 hours, and 30 days after extubation). The primary outcome of the trial is awareness with explicit recall. Secondary outcomes include postoperative mortality, psychological symptoms, intensive care and hospital length of stay, average Anesthetic Gas administration, postoperative pain and nausea and vomiting, duration of stay in the recovery area, intra-operative dreaming, and postoperative delirium. This trial has been designed to complement two other clinical trials: B-Unaware and MACS (ClinicalTrials.gov numbers, NCT00281489 and NCT00689091). With the large patient numbers and complementary rigorous designs, it is envisaged that pre-specified meta-analyses will address some of the outstanding controversies and questions relating to processed electroencephalography monitoring. ClinicalTrials.gov Identifier: NCT00682825

  • anesthesia awareness and the bispectral index
    The New England Journal of Medicine, 2008
    Co-Authors: Michael S Avidan, Lini Zhang, Beth A Burnside, Kevin J Finkel, Adam C Searleman, Jacqueline A Selvidge, Leif Saager, Michelle S Turner, Srikar Rao, Michael M Bottros
    Abstract:

    Background Awareness during anesthesia is a serious complication with potential long-term psychological consequences. Use of the bispectral index (BIS), developed from a processed electroencephalogram, has been reported to decrease the incidence of anesthesia awareness when the BIS value is maintained below 60. In this trial, we sought to determine whether a BIS-based protocol is better than a protocol based on a measurement of end-tidal Anesthetic Gas (ETAG) for decreasing anesthesia awareness in patients at high risk for this complication. Methods We randomly assigned 2000 patients to BIS-guided anesthesia (target BIS range, 40 to 60) or ETAG-guided anesthesia (target ETAG range, 0.7 to 1.3 minimum alveolar concentration [MAC]). Postoperatively, patients were assessed for anesthesia awareness at three intervals (0 to 24 hours, 24 to 72 hours, and 30 days after extubation). Results We assessed 967 and 974 patients from the BIS and ETAG groups, respectively. Two cases of definite anesthesia awareness occurred in each group (absolute difference, 0%; 95% confidence interval [CI], −0.56 to 0.57%). The BIS value was greater than 60 in one case of definite anesthesia awareness, and the ETAG concentrations were less than 0.7 MAC in three cases. For all patients, the mean (±SD) time-averaged ETAG concentration was 0.81±0.25 MAC in the BIS group and 0.82±0.23 MAC in the ETAG group (P = 0.10; 95% CI for the difference between the BIS and ETAG groups, −0.04 to 0.01 MAC). Conclusions We did not reproduce the results of previous studies that reported a lower incidence of anesthesia awareness with BIS monitoring, and the use of the BIS protocol was not associated with reduced administration of volatile Anesthetic Gases. Anesthesia awareness occurred even when BIS values and ETAG concentrations were within the target ranges. Our findings do not support routine BIS monitoring as part of standard practice. (ClinicalTrials.gov number, NCT00281489.)