scholarly journals Nitrous Oxide Occupational Exposure in Conscious Sedation Procedures in Endoscopic Ambulatories: A Pilot Retrospective Observational Study in an Italian Hospital

2021 ◽  
Author(s):  
Ivan Borrelli ◽  
Roberta Pastorino ◽  
Rodolfo Buccico ◽  
Paolo Emilio Santoro ◽  
Umberto Moscato
Keyword(s):  
Nitrous Oxide ◽  
Observational Study ◽  
Threshold Value ◽  
Operating Rooms ◽  
Environmental Research ◽  
Urinary Concentration ◽  
Environmental Testing ◽  
Professional Exposure ◽  
Security Device ◽  
Outpatient Settings

Abstract Background: Nitrous oxide is widely used to induce sedation; however, its use outside of operating rooms – such as in ambulatory rooms – is not properly controlled by norms. In the lack of supervision, there is a chance of workplace exposures for the operators engaged in the outpatient use of nitrous oxide. The aim of this research is to assess nitrous oxide exposure in gastroenterology outpatient settings. Methods: We performed an observational study with a first step marked by nitrous oxide environmental testing in a gastroenterology outpatient care where colonoscopies were practiced; environmental research was supported by biological monitoring with urinary N2O analysis in exposed operators. The research was conducted in the absence and then in the presence of a collective security device (Niki mask). Results: The study was rolled out in 10 sessions of day shift procedures, totaling 4105 samples. The average nitrous oxide concentration in the environment was 27.58 (SD 1.76) and 449.59 (SD 35.29), respectively with and without Niki Mask; the distribution of gases in the environment under investigation was not homogeneous (Anova test p.001). Biological testing revealed a substantial rise in urinary concentration of 8.97 (p.001) between the start and the end of the shift, and the use of the Niki mask was effective (p=.003). Conclusions: The exposure levels reported in environmental sampling exceed the limits of 50 ppm (the value set for operating rooms in Italy) as well as the value of 25 ppm (NIOSH threshold value), indicating a significant issue in the outpatient use of nitrous oxide. It is evident that technical measures are needed to contain the occupational risk from Nitrous oxide exposure outside of operating rooms, and that even the basic use of Niki masks would not be sufficient to minimize professional exposure and protect workers; for the exposure results detected in this research, it is also plain that exposures must be subject to health surveillance.

Predictive value of thyroxine for prognosis in pediatric septic shock: a prospective observational study

2020 ◽  
Vol 33 (5) ◽  
pp. 653-659
Author(s):  
Jia Song ◽  
Yun Cui ◽  
Chunxia Wang ◽  
Jiaying Dou ◽  
Huijie Miao ◽  
...  
Keyword(s):  
Septic Shock ◽  
Thyroid Hormone ◽  
Observational Study ◽  
Hospital Mortality ◽  
Predictive Value ◽  
Prospective Observational Study ◽  
Threshold Value ◽  
Nonthyroidal Illness ◽  
Hormone Levels ◽  
Thyroid Hormone Levels

AbstractBackgroundThyroid hormone plays an important role in the adaptation of metabolic function to critically ill. The relationship between thyroid hormone levels and the outcomes of septic shock is still unclear. The aim of this study was to assess the predictive value of thyroid hormone for prognosis in pediatric septic shock.MethodsWe performed a prospective observational study in a pediatric intensive care unit (PICU). Patients with septic shock were enrolled from August 2017 to July 2019. Clinical and laboratory indexes were collected, and thyroid hormone levels were measured on PICU admission.ResultsNinety-three patients who fulfilled the inclusion criteria were enrolled in this study. The incidence of nonthyroidal illness syndrome (NTIS) was 87.09% (81/93) in patients with septic shock. Multivariate logistic regression analysis showed that T4 level was independently associated with in-hospital mortality in patients with septic shock (OR: 0.965, 95% CI: 0.937–0.993, p = 0.017). The area under receiver operating characteristic (ROC) curve (AUC) for T4 was 0.762 (95% CI: 0.655–0.869). The cutoff threshold value of 58.71 nmol/L for T4 offered a sensitivity of 61.54% and a specificity of 85.07%, and patients with T4 < 58.71 nmol/L showed high mortality (60.0%). Moreover, T4 levels were negatively associated with the pediatric risk of mortality III scores (PRISM III), lactate (Lac) level in septic shock children.ConclusionsNonthyroidal illness syndrome is common in pediatric septic shock. T4 is an independent predictor for in-hospital mortality, and patients with T4 < 58.71 nmol/L on PICU admission could be with a risk of hospital mortality.

Is the Surgical Safety Checklist successfully conducted? An observational study of social interactions in the operating rooms of a tertiary hospital

2013 ◽  
Vol 22 (8) ◽  
pp. 639-646 ◽  
Author(s):  
Stéphane Cullati ◽  
Sophie Le Du ◽  
Anne-Claire Raë ◽  
Martine Micallef ◽  
Ebrahim Khabiri ◽  
...  
Keyword(s):  
Observational Study ◽  
Social Interactions ◽  
Tertiary Hospital ◽  
Operating Rooms ◽  
Surgical Safety Checklist ◽  
Surgical Safety

Monitoring of Nitrous Oxide in Operating Rooms: Identification of Sources and Estimation of Occupational Exposure

1990 ◽  
Vol 32 (11) ◽  
pp. 1112-1116 ◽  
Author(s):  
Paul J.A. Borm ◽  
IJmert Kant ◽  
Guido Houben ◽  
Marjo van Rijssen-Moll ◽  
Peter T. Henderson
Keyword(s):  
Nitrous Oxide ◽  
Occupational Exposure ◽  
Operating Rooms

scholarly journals IASI nitrous oxide (N<sub>2</sub>O) retrievals: validation and application to transport studies at daily time scales

2018 ◽  
Author(s):  
Yannick Kangah ◽  
Philippe Ricaud ◽  
Jean-Luc Attié ◽  
Naoko Saitoh ◽  
Jérôme Vidot ◽  
...  
Keyword(s):  
Nitrous Oxide ◽  
Long Range ◽  
Summer Monsoon ◽  
Asian Summer Monsoon ◽  
Daily Basis ◽  
Environmental Research ◽  
Long Range Transport ◽  
Absorption Bands ◽  
Range Transport ◽  
The Impact

Abstract. The aim of this paper is to present a method to retrieve nitrous oxide (N2O) vertical profiles from the Infrared Atmospheric Sounding Interferometer (IASI) onboard the MetOp platform. We retrieved N2O profiles using IASI clear sky radiances in 2 spectral bands: B1 and B2 centered at ∼ 1280 cm−1 and ∼ 2220 cm−1, respectively. Both retrievals in B1 and B2 (hereafter referred to as N2O_B1 and N2O_B2, respectively) are sensitive to the mid-to-upper troposphere with a maximum of sensitivity at around 309 hPa. The degrees of freedom for N2O_B1 and N2O_B2 are 1.38 and 0.93, respectively. We validated the retrievals using the High-performance Instrumented Airborne Platform for Environmental Research Pole-to-Pole Observations (HIPPO). The comparisons between HIPPO and the two retrieved datasets show relatively low standard deviation errors around 1.5 % (∼ 4.8 ppbv) and 1.0 % (∼ 3.2 ppbv) for N2O_B1 and N2O_B2, respectively. However, the impact of H2O contamination on N2O_B1 due to its strong absorption bands in B1 significantly degrades the quality of the retrievals in tropical regions. We analysed the scientific consistency of the retrievals at 309 hPa with a focus on the long-range transport of N2O especially during the Asian summer monsoon. Over the mid-latitude regions, both variations of N2O_B1 and N2O_B2 at 309 hPa are influenced by the stratospheric N2O-depleted air because of the relative coarse shape of the averaging kernel. The analysis of N2O_B2 using results from backtrajectories exhibits the capacity of these retrievals to capture long-range transport of air masses from Asia to northern Africa via the summer monsoon anticyclone on a daily basis. Thus, N2O_B1 and N2O_B2 offer an unprecedented possibility to study global upper tropospheric N2O on a daily basis.

scholarly journals Nitrous Oxide Exposure of Health Care Personnel in the Operating Rooms and Intensive Care Units in Hospitals in Macedonia

2017 ◽  
Vol 5 (6) ◽  
pp. 790-793 ◽  
Author(s):  
Biljana Eftimova ◽  
Dejan Mirakovski ◽  
Marija Sholjakova ◽  
Marija Hadzi-Nikolova
Keyword(s):  
Nitrous Oxide ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Personal Exposure ◽  
Operating Rooms ◽  
Work Practices ◽  
Breathing Zone ◽  
Data Logging ◽  
Safe Work ◽  
High Workload

AIM: To determine average personal exposure to nitrous oxide for anaesthesiologists and nurses working in operating rooms (ORs) and intensive care units (ICU) in Clinical Hospital in Shtip, ENT University Clinic in Skopje and General Hospital in Kochani.METHODS: To determine TWA exposure nitrous oxide concentration was continuously measured over 8 hours shift within breathing zone of the subjects involved, using the handheld electrochemical instrument with data logging option. Results obtained were statistically processed.RESULTS: Highest TWA exposures (well above RELs) were found for nurses and anaesthesiologists in ORs in CH – Shtip, because of high workload in substandard conditions. TWA exposures in CH – Kochani were found to be significantly lower although in substandard conditions, mostly due to lower workload. TWA exposures found in ORs in ENT UC – Skopje is within RELs due to good work practices and proper ORs equipment.CONCLUSIONS: Study indicated significant exposure of personal working in substandard ORs in CH – Shtip. Applying proper work practices and maintain control equipment (general ventilation and scavenging systems) in operation, could provide for safe work environment.

Translation, cultural refinement, content re-validation & application of OTAS and METEOR instruments in Turkish operating rooms: An observational study

2020 ◽  
Vol 19 ◽  
pp. 100104
Author(s):  
Ebru Önler ◽  
Louise Hull ◽  
Stephanie Russ ◽  
Nick Sevdalis ◽  
Tülin Yıldız ◽  
...  
Keyword(s):  
Observational Study ◽  
Operating Rooms

Causes of Nitrous Oxide Contamination in Operating Rooms 

1999 ◽  
Vol 90 (3) ◽  
pp. 693-696 ◽  
Author(s):  
Yuichi Kanmura ◽  
Junya Sakai ◽  
Heiji Yoshinaka ◽  
Kazusada Shirao
Keyword(s):  
Nitrous Oxide ◽  
Ambient Air ◽  
Operating Rooms ◽  
University Hospital ◽  
High Concentration ◽  
Anesthetic Agents ◽  
Infrared Spectrophotometer ◽  
High Concentrations ◽  
Almost All ◽  
Oxide Contamination

Background To reduce the ambient concentration of waste anesthetic agents, exhaust gas scavenging systems are standard in almost all operating rooms. The incidence of contamination and the factors that may increase the concentrations of ambient anesthetic gases have not been evaluated fully during routine circumstances, however. Methods Concentrations of nitrous oxide (N2O) in ambient air were monitored automatically in 10 operating rooms in Kagoshima University Hospital from January to March 1997. Ambient air was sampled automatically from each operating room, and the concentrations of N2O were analyzed every 22 min by an infrared spectrophotometer. The output of the N2O analyzer was integrated electronically regarding time, and data were displayed on a monitor in the administrative office for anesthesia supervisors. A concentration of N2O &gt; 50 parts per million was regarded as abnormally high and was displayed with an alarm signal. The cause of the high concentration of N2O was then sought. Results During the 3-month investigation, N2O was used in 402 cases. Abnormally high concentrations of N2O were detected at some time during 104 (25.9%) of those cases. The causes were mask ventilation (42 cases, 40.4% of detected cases), unconnected scavenging systems (20 cases, 19.2%), leak around uncuffed pediatric endotracheal tube (13 cases, 12.5%), equipment leakage (12 cases, 11.5%), and others (17 cases, 16.4%). Conclusions N2O contamination was common during routine circumstances in our operating rooms. An unconnected scavenging system led to the highest concentrations of N2O recorded. Proper use of scavenging systems is necessary if contamination by anesthetic gas is to be limited.

scholarly journals Hospitalization in fibromyalgia: a cohort-level observational study of in-patient procedures, costs and geographical variation in England

Rheumatology ◽  
2019 ◽  
Vol 59 (8) ◽  
pp. 2074-2084
Author(s):  
Anushka Soni ◽  
Stephanie Santos-Paulo ◽  
Andrew Segerdahl ◽  
M Kassim Javaid ◽  
Rafael Pinedo-Villanueva ◽  
...  
Keyword(s):  
National Health Service ◽  
Health Service ◽  
Observational Study ◽  
National Health ◽  
Inpatient Care ◽  
Geographical Variation ◽  
Diagnostic Code ◽  
Weak Evidence ◽  
Therapeutic Procedures ◽  
Outpatient Settings

Abstract Objectives Fibromyalgia is a complex, debilitating, multifactorial condition that can be difficult to manage. Recommended treatments are usually delivered in outpatient settings; evidence suggests that significant inpatient care occurs. We describe the scale and cost of inpatient care with a primary diagnostic code of fibromyalgia within the English National Health Service. Methods We conducted a cohort-level observational study of all patients admitted to hospital due to a diagnosis of fibromyalgia, between 1 April 2014 and 31 March 2018 inclusive, in the National Health Service in England. We used data from Hospital Episode Statistics Admitted Patient Care to study: the age and sex of patients admitted, number and costs of admissions, length of stay, procedures undertaken, class and type of admission, and distribution of admissions across clinical commissioning groups. Results A total of 24 295 inpatient admissions, costing £20 220 576, occurred during the 4-year study period. Most patients were women (89%) with peak age of admission of between 45 and 55 years. Most admissions were elective (92%). A number of invasive therapeutic procedures took place, including a continuous i.v. infusion (35%). There was marked geographical variation in the prevalence and cost of inpatient fibromyalgia care delivered across the country, even after accounting for clinical commissioning group size. Conclusions Many patients are admitted for treatment of their fibromyalgia and given invasive procedures for which there is weak evidence, with significant variation in practice and cost across the country. This highlights the need to identify areas of resource use that can be rationalized and diverted to provide more effective, evidence-based treatment.

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