Enfluran. Dokumentacja proponowanych dopuszczalnych wielkości narażenia zawodowego

• Autorzy: Kupczewska-Dobecka Małgorzata , Dobecki Marek

Identyfikatory

DOI

10.54215/PiMOSP/3.115.2023

Warianty tytułu

EN

Enflurane. Documentation of proposed values of occupational exposure limits (OELs)

• Języki publikacji: PL

Abstrakty

PL

Enfluran jest fluorowanym anestetykiem wziewnym. Dane dotyczące działania enfluranu uzyskano głównie od osób poddawanych narkozie. Minimalne stężenie enfl uranu w pęcherzykach płucnych w trakcie znieczulania, wyrażone jako procent atmosfery MAC (Minimal Anesthetic Concentration), wynosi dla osób dorosłych ok. 1,68% obj. U pacjentów obserwowano przypadki złośliwej hipertermii, niedociśnienie, depresję ośrodka oddechowego i niedotlenienie, zaburzenia rytmu serca oraz leukocytozę. Stwierdzano przypadki łagodnego i umiarkowanego uszkodzenia wątroby. Oszacowany próg obniżenia sprawności psychomotorycznej u ochotników narażonych na enfl uran z powietrzem wynosi 5% wartości MAC. Badania epidemiologiczne dotyczące narażenia zawodowego wzbudziły podejrzenie o wpływ mieszanin gazów znieczulających na częstość poronień, rozwój płodu, poród przedwczesny i wady wrodzone u dzieci, jednak w żadnym z tych badań nie określono szczegółowo rodzaju i stężenia stosowanych gazów znieczulających. W badaniu rakotwórczości i mutagenności dla enfluranu uzyskano wyniki ujemne. Badania na zwierzętach obejmowały głównie narażenie na stężenia subanestetyczne enfl uranu. W większości doświadczeń nie znaleziono dowodów na zaburzenia płodności lub uszkodzenia płodu przez enfluran u zwierząt. Skutkiem krytycznym działania enfl ranu u ludzi jest wpływ na ośrodkowy układ nerwowy, manifestujący się pogorszeniem sprawności psychomotorycznej. Do wyliczenia wartości NDS enfluranu wykorzystano wyniki badań na zwierzętach. Za wartość NOAEC dla działania układowego enfluranu przyjęto stężenie 153,2 mg/m³ (20 ppm), wyznaczone u szczurów (samców) narażanych na enfluran 8 h/dzień, 5 dni/tydzień łącznie przez 99 dni. Zaproponowano wartość NDS dla enfluranu na poziomie 38 mg/m³ (5 ppm). Zakres tematyczny artykułu obejmuje zagadnienia zdrowia oraz bezpieczeństwa i higieny środowiska pracy będące przedmiotem badań z zakresu nauk o zdrowiu i inżynierii środowiska.

EN

Enflurane is a fluorinated inhalation anesthetic. Data on the effects of enflurane have mainly been obtained from people undergoing anesthesia. The minimum concentration of enflurane in the alveoli during anesthesia, expressed as a percentage of the MAC (Minimal Anesthetic Concentration) atmosphere, is approx. 1.68 vol.% for adults. Cases of malignant hyperthermia, hypotension, respiratory depression and hypoxia, arrhythmias and leukocytosis have been observed in patients. Cases of mild and moderate liver injury have been reported. The expert estimate of the reduction in psychomotor performance in volunteers exposed to air enflurane is 5% of the MAC value. Occupational exposure epidemiology studies have raised concerns about the effects of anesthetic gas mixtures on miscarriage rate, fetal development, preterm labor and birth defects in children, but none of these studies specifically determined the type and concentration of anesthetic gases used. A carcinogenicity and mutagenicity study with enflurane was negative. Animal studies mainly involved exposure to subanesthetic concentrations of enflurane. In most experiments, no evidence of impaired fertility or damage to the fetus by enflurane in animals was found. A critical effect of enflurane in humans is its effect on the central nervous system, manifested by deterioration of psychomotor performance. Animal studies were used to calculate the OEL value for enflurane. The concentration of 153.2 mg/m³ (20 ppm) was assumed as the NOAEC value for the systemic effect of enflurane. MAC value for enflurane was proposed at the level of 38 mg/m³ (5 ppm). This article discusses the problems of occupational safety and health, which are covered by health sciences and environmental engineering.

Słowa kluczowe

PL

enfluran; narażenie zawodowe; NDS; gazy anestetyczne; działanie toksyczne; nauki o zdrowiu; inżynieria środowiska

EN

enflurane; occupational exposure; OEL; anesthetic gases; toxicity; health sciences; environmental engineering

• Wydawca: Centralny Instytut Ochrony Pracy - Państwowy Instytut Badawczy
• Czasopismo: Podstawy i Metody Oceny Środowiska Pracy
• Rocznik: 2023
• Tom: Nr 1 (115)
• Strony: 45--89
• Opis fizyczny: Bibliogr. 202 poz., tab.

Twórcy

autor

Kupczewska-Dobecka Małgorzata

• Instytut Medycyny Pracy im. prof. dr. med. Jerzego Nofera 91-348 Łódź, ul. św. Teresy od Dzieciątka Jezus 8 POLAND

• https://orcid.org/0000-0001-9633-9428

autor

Dobecki Marek

• Instytut Medycyny Pracy im. prof. dr. med. Jerzego Nofera 91-348 Łódź, ul. św. Teresy od Dzieciątka Jezus 8 POLAND

• https://orcid.org/0000-0002-8083-5686

Bibliografia

• 1. AbbVie (2014). Karta charakterystyki. North Chicago, Illinois.
• 2. ACGIH, American Conference of Governmental Industrial Hygienists (2001). 7th Edition of chemical substances documentation of threshold limit value documentation. Enflurane [on CD]. Cincinnati, Ohio 2018.
• 3. ACGIH, American Conference of Governmental Industrial Hygienists (2021). TLVs and BEIs: based on the documentation of the threshold limit values for chemical substances and physical agents & biological exposure indices. Cincinnati, Ohio.
• 4. Alfa-Aesar (2020). Karta charakterystyki, www.alfa.com/en/ content/msds/USA/L16725.pdf [data dostępu: 27.10.2022].
• 5. Allan M.W.B. (1984). Convulsions after enflurane. Anaesthesia 39, 605–606.
• 6. Apollo Scientific (2011). Karta charakterystyki, www.apolloscientific.co.uk/downloads/msds/PC2040_msds.pdf [data dostępu: 27.10.2022].
• 7. Aun A.G., Souza K.M., Guedes J.L. i in. (2021). Hepatotoxic and neuroendocrine effects in physicians occupationally exposed to most modern halogenated anesthetics and nitrous oxide. Environ. Toxicol. Pharmacol. 81, 103515. DOI: 10.1016/j.etap.2020.103515
• 8. Baden J.M., Kelley M., Wharton R.S. i in. (1977). Mutagenicity of halogenated ether anesthetics. Anesthesiology 46, 346–350.
• 9. Baden J.M., Egbert B., Rice S.A. (1980a). Enflurane has no effect on haemopoiesis in mice. Br. J. Anaesth. 52, 471–474.
• 10. Baden J.M., Rice S.A., Wharton R.S. i in. (1980b). Metabolic and toxicologic studies with enflurane in Swiss/ICR-mice. J. Environ. Pathol. Toxicol. 4, 293–303.
• 11. Baden J.M., Kelley M., Cheung A. i in. (1980c). Lack of mutagens in urines of operating room personnel. Anesthesiology 53, 195–198.
• 12. Baden J.M., Egbert B., Mazze R.I. (1982). Carcinogen bioassay of enflurane in mice. Anesthesiology 56, 9–13.
• 13. Baden J.M., Kundomal Y.R. (1987). Mutagenicity of the combination of a volatile anaesthetic and nitrous oxide. Br. J. Anaesth. 59, 772–775.
• 14. Bakhshaei M.H., Bahrami A., Mirzakhani A. i in. (2017). Exposure assessment, biological monitoring, and liver function tests of operating room personnel exposed to halothane in Hamedan hospitals, West of Iran. J. Res. Health Sci. 17, e00397.
• 15. Ball C., Westhorpe R.N. (2007). Enflurane. Anaesth. Intensive Care 35(3), 325.
• 16. Barash P., Cullen B.F., Stoelting R.K. i in. (2013). Clinical anesthesia. 7th ed. Philadelphia: Wolters Kluwer.
• 17. Barker J.P., Abdelatti M.O. (1997). Anaesthetic pollution: potential sources, their identification and control. Anaesthesia 52, 1077–1083.
• 18. Barr G.A., Cousins M.J., Mazze R.I. i in. (1974). A comparison of the renal effects and metabolism of enflurane and methoxyflurane in Fischer 344 rats. J. Pharmacol. Exp. Ther. 188, 257–264.
• 19. Bassell G.M., Cullen B.F., Fairchild M.D. i in. (1982). Electroencephalographic and behavioural effects of enflurane and halothane anaesthesia in the cat. Br. J. Anaesth. 54, 659–663.
• 20. Bentin S., Collins G.I., Adam N. (1978a). Decision-making behavior during inhalation of subanaesthetic concentrations of enflurane. Br. J. Anaesth. 50,1173–1178.
• 21. Bentin S., Collins G.I., Adam N. (1978b). Effects of low concentrations of enflurane on probability learning. Br. J. Anaesth. 50, 1179–1183.
• 22. Bielnicka B., Majka J. (1994). Halotan. Dokumentacja proponowanej wartości dopuszcalnego poziomu narażenia zawodowego. Biuletyn Międzyresortowej Komisji do spraw aktualizacji wykazu najwyższych dopuszczalnych stężeń i natężeń czynników szkodliwych dla zdrowia w środowisku pracy 10, 5–45.
• 23. Black G.W. (1979). Enflurane. Br. J. Anaesth. 51, 627.
• 24. Black G.W., Johnston H.M.L., Scott M.G. (1977). Clinical impressions of enflurane. Br. J. Anaesth. 49, 875–880.
• 25. Boop W.C. Jr, Knight R. (1978). Enflurane anesthesia and changes of intracranial pressure. J. Neurosurg. 48, 228–231.
• 26. Bowdle T.A., Williams M. (2007). Therapeutic areas I: central nervous system, pain, metabolic syndrome, urology, gastrointestinal and cardiovascular. [W:] Comprehensive medicinal chemistry II, Vol. 6. Enfluran, 351–367. [Red.] J.B. Taylor, D.J. Triggle. Elsevier.
• 27. Bruce D.L., Bach M.J., Arbit J. (1974). Trace anesthetic effects on perceptual, cognitive and motor skills. Anesthesiology 40, 453–458.
• 28. Bruce D.L., Bach M.J. (1975). Psychological studies of human performance as affected by traces of enflurane and nitrous oxide. Anesthesiology 42, 194–205.
• 29. Bruce D.L., Bach M.J. (1976a). Effects of trace anaesthetic gases on behavioral performance of volunteers. Br. J. Anaesth. 48, 871–876.
• 30. Bruce D.L., Bach M.J. (1976b). Effects of trace concentrations of anesthetic gases on behavioral performance of operating room personnel. NIOSH Technical Information 76-169. U.S. Department of Health, Education, and Welfare, Public Health Service for Disease Control, National Institute for Occupational Safety and Health. Chicago, Illinois.
• 31. Burchiel K.J., Stockard J.J., Calverley R.K. i in. (1977). Relationship of pre- and postanesthetic EEG abnormalities to enflurane-induced seizure activity. Anesth. Analg. 56, 509–514.
• 32. Burke T.R. Jr, Martin J.L., George J.W. i in. (1980). Investigation of the mechanism of defluorination of enflurane in rat liver microsomes with specifically deuterated derivatives. Biochem. Pharmacol. 29, 1623–1626.
• 33. Burke T.R. Jr, Branchflower R.V., Lees D.E. i in. (1981). Mechanism of defluorination of enflurane: identification of an organic metabolite in rat and man. Drug. Metab. Dispos. 9, 19–24.
• 34. Byles P.H., Dobkin A.B., Ferguson J.H. i in. (1971a). Forane (compound 469): cross-over comparison with enflurane (Ethrane), halothane and methoxyflurane in dogs. Canad. Anaesth. Soc. J. 18, 376–386.
• 35. Byles P.H., Dobkin A.B., Jones D.B. (1971b). Foran (compound 469): 3. Comparative effects of prolonged anaesthesia on mature beagle dogs and young rhesus monkeys. Canad. Anaesth. Soc. 18, 397–407.
• 36. Calverley R.K., Smith N.T., Prys-Roberts C. i in. (1975). Cardiovascular effects of prolonged enflurane anesthesia in man. Abstracts of Scientific Papers, American Society of Anesthesiologists Annual Meeting, p. 57.
• 37. Calverley R.K., Smith N.T., Prys-Roberts C. i in. (1978). Cardiovascular effects of enflurane anesthesia during controlled ventilation in man. Anesth. Analg. 57, 619–628.
• 38. Carlsson P., Ekstrand J., Hallén B. (1985). Plasma fluoride and bromide concentrations during occupational exposure to enflurane or halothane. Acta Anaesthesiol. Scand. 29, 669–673.
• 39. Carpenter R.L., Eger E.I. 2nd, Johnson B.H. i in. (1986). The extent of metabolism of inhaled anesthetics in humans. Anesthesiology 65, 201–205.
• 40. Casale T., Caciari T., Rosati M.V. i in. (2014). Anesthetic gases and occupationally exposed workers. Environ. Toxicol. Pharmacol. 37(1), 267–274.
• 41. Chandrasekhar M., Rekhadevi P., Sailaja N. i in. (2006). Evaluation of genetic damage in operating room personnel exposed to anaesthetic gases. Mutagenesis 21(4), 249–254.
• 42. Chatrian G.E. (1975). American electroencephalographic society: Seattle, Washington, July 25–27, 1974. Electroen. Clin. Neuro. 38(5), 542–556.
• 43. Chase R.E., Holaday D.A., Fiserova-Bergerova V. i in. (1971). The biotransformation of Ethrane in man. Anesthesiology 35, 262–267.
• 44. Chalon J., Tang C.-K., Ramanathan S. i in. (1981). Exposure to halothane and enflurane affects learning function of murine progeny. Anesth. Analg. 60, 794–797.
• 45. Clark G.C., Kesterson J.W., Coombs D.W. i in. (1979). Comparative effects of repeated and prolonged inhalation exposure of beagle dogs and cynomolgus monkeys to anaesthetic and subanaesthetic concentrations of enflurane and halothane. Acta Anaesth. Scand. Suppl. 71, 1–11.
• 46. Cook T.L., Smith M., Starkweather J.A. i in. (1976). Behavioral effects of trace and low dose nitrous oxide and halothane exposures in volunteers. Abstracts from Annual Meeting of ASA.
• 47. Cook T.L., Smith M., Starkweather J.A. i in. (1977). Effect of subanesthetic enflurane and halothane on human behavior. Abstracts from Annual Meeting of ASA [cyt. za: Smith i in. 1978].
• 48. Cook T.L., Smith M., Winter P.M. i in. (1978). Effect of subanesthetic concentration of enflurane and halothane on human behavior. Anesth. Analg. 57, 434–440 [cyt. za: DFG 2019].
• 49. Corall I.M., Knights K., Strunin L. (1977). Enflurane (Ethrane) anaesthesia in man: metabolism and effects on biochemical and haematological variables. Br. J. Anaesth. 49, 881–885.
• 50. Corbett T.H., Cornell R.G., Endres J.L. i in. (1974). Birth defects among children of nurse-anesthetists. Anesthesiology 41, 341–344.
• 51. Cousins M.J., Mazze R.I. (1973). Methoxyflurane nephrotoxicity: a study of dose response in man. JAMA 225, 1611–1616.
• 52. Cote C.J., Lerman J., Anderson B.J. (2013). A practice of anesthesia for infants and children. 5th ed. Elsevier Health Sciences.
• 53. Dale O., Nielsen K., Westgaard G. i in. (1983). Drug metabolizing enzymes in the rat after inhalation of halothane and enflurane: different pattern of response in liver, kidney and lung and possible implications for toxicity. Br. J. Anaesth. 55, 1217–1224.
• 54. Dascalaki E.G., Lagoudi A., Balarasa C.A. i in. (2008). Air quality in hospital operating rooms. Build. Environ. 43, 1945–1952.
• 55. DECOS, Dutch Expert Committee on Occupational Standards (1998). Enflurane, isoflurane and cyclopropane: healthbased recommended occupational exposure limits. Health Council of the Netherlands, Den Haag.
• 56. Dekkers S., van Benthem J., Piersma A.H. i in. (2008). [The burden of disease of the effects of chemical exposure in the workplace on human reproduction: best professional judgement]. [W:] RIVM rapport 320017001. RIVM, Bilthoven, Nederland.
• 57. Delgado-Herrera L., Ostroff R.D., Rogers S.A. (2001). Sevoflurane: approaching the ideal inhalational anesthetic: a pharmacologic, pharmacoeconomic, and clinical review. CNS Drug Rev. 7, 48–120.
• 58. Deng J., Lei C., Chen Y. i in. (2014). Neuroprotective gases: fantasy or reality for clinical use? Prog. Neurobiol. 115, 210–245.
• 59. De Zotti R., Negro C., Gobbato F. (1983). Results of hepatic and hemopoietic controls in hospital personnel exposed to waste anesthetic gases. Int. Arch. Occup. Environ. Health 52, 33–41.
• 60. DFG, Deutsche Forschungsgemeinschaft (2019). MAK‐ und BAT‐Werte‐Liste 2019: Ständige Senatskommission zur Prüfung gesundheitsschädlicher Arbeitsstoffe. Mitteilung 55. Wiley‐VCH Verlag.
• 61. Dobkin A.B., Kim D., Choi J.K. i in. (1973). Blood serum fluoride levels with enflurane (Ethrane) and isoflurane (Forane) anaesthesia during and following major abdominal surgery. Can. Anaesth. Soc. J. 20, 494–498.
• 62. Doi M., Ikeda K. (1993). Airway irritation produced by volatile anaesthetics during brief inhalation: comparison of halothane, enflurane, isoflurane and sevoflurane. Can. J. Anaesth. 40, 122–126.
• 63. Duncan P.G., Pope W.D.B., Cohen M.M. i in. (1986). Fetal risk of anesthesia and surgery during pregnancy. Anesthesiology 64, 790–794.
• 64. Eger E.I. 2nd, Calverly R.K., Smith N.T. (1976). Changes in blood chemistries following prolonged enflurane anesthesia. Anesth. Analg. 55, 547–549.
• 65. Eger E.I. 2nd, White A.E., Brown C.L. i in. (1978). A test of the carcinogenicity of enflurane, isoflurane, halothane, methoxyflurane, and nitrous oxide in mice. Anesth. Analg. 57, 678–694.
• 66. Eger E.I. 2nd, Smuckler E.A., Ferrell L.D. i in. (1986). Is enflurane hepatotoxic? Anesth. Analg. 65, 21–23.
• 67. Engelhard K., Werner C., Reeker W. (1999). Desflurane and isoflurane improve neurological outcome after incomplete cerebral ischaemia in rats. Br. J. Anaesth 83, 415–421.
• 68. Erickson A., Källén B. (1979). Survey of infants born in 1973 or 1975 to Swedish women working in operating rooms during their pregnancies. Anesth. Analg. 58, 302–305.
• 69. Eskinder H., Rusch N.J., Supan F.D. i in. (1991). The effects of volatile anesthetics on L- and T-type calcium channel currents in canine cardiac Purkinje cells. Anesthesiology 74(5), 919–926.
• 70. Fahy L.T. (1987). Delayed convulsions after day case anaesthesia with enflurane. Anaesthesia 42, 1327–1328.
• 71. Fang Z., Ionescu P., Chortkoff B.S. i in. (1997). Anesthetic potencies of n-alkanols: results of additivity and solubility studies suggest a mechanism of action similar to that for conventional inhaled anesthetics. Anesth. Analg. 84, 1042–1048.
• 72. Flemming D.C., Fitzpatrick J., Fariello R.G. i in. (1980). Diagnostic activation of epileptogenic foci by enflurane. Anesthesiology 52, 431–433.
• 73. GESTIS (2021). GESTIS International Limit Values, Enflurane, https://limitvalue.ifa.dguv.de/WebForm_ueliste2.aspx [data dostępu: 27.10.2022].
• 74. Gong D. (1998). Rat strain minimally influences anesthetic and convulsant requirements of inhaled compounds in rats. Anesth. Analg. 87, 963–966.
• 75. Goucke C.R., Hackett L.P., Barrett P.H. (2007). Blood concentrations of enflurane before, during and after hypothermic cardiopulmonary bypass. J. Cardiothorac. Vasc. Anesth. 21(2), 218–223.
• 76. Grant I.S. (1986). Delayed convulsions following enflurane anaesthesia. Anaesthesia 41, 1024–1025.
• 77. Grasshoff C., Antkowiak B. (2006). Effects of isoflurane and enflurane on GABAA and glycine receptors contribute equally to depressant actions on spinal ventral horn neurones in rats. Br. J. Anaesth. 97(5), 687–694.
• 78. Green C.J., Monk S.J., Knight J.F. i in. (1982). Chronic exposure of rats to enflurane 200 p.p.m.: no evidence of toxicity or teratogenicity. Br. J. Anaesth. 54, 1097–1104.
• 79. Guirguis S.S., Pelmear P.L., Roy M.L. i in. (1990). Health effects associated with exposure to anaesthetic gases in Ontario hospital personnel. Br. J. Ind. Med. 47, 490–497.
• 80. Halsey M.J., Green C.J., Monk S.J. i in. (1981). Maternal and paternal chronic exposure to enflurane and halothane: fetal and histological changes in the rat. Br. J. Anaesth. 53, 203–215.
• 81. Haworth R.A., Goknur A.B. (1995). Inhibition of sodium/calcium exchange and calcium channels of heart cells by volatile anesthestics. Anesthesiology 82(5), 1255–1265.
• 82. Health Council of the Netherlands (2002). Enflurane: evaluation of the effects on reproduction, recommendation for classification. Committee for Compounds toxic to reproduction, a Committee of the Health Council of the Netherlands to the Minister and State Secretary of Social Affairs and Employment. No. 2002/12OSH, The Hague, 6 September 2002.
• 83. Heavner J.E., Amory D.W. (1981). Lidocaine and pentylenetetrazol seizure thresholds in cats are not reduced after enflurane anesthesia. Anesthesiology 54, 403–408.
• 84. Hemminki K., Kyrönen P., Lindbohm M.L. (1985). Spontaneous abortions and malformations in the offspring of nurses exposed to anaesthetic gases, cytostatic drugs, and other potential hazards in hospitals, based on registered information of outcome. J. Epidemiol. Community Health 39, 141–147.
• 85. Hikasa Y., Ohe N., Ogasawara S. (1997). Cardiopulmonary effects of sevoflurane in cats: comparison with isoflurane, halothane, and enflurane. Res. Vet. Sci. 63, 205–210.
• 86. Hitt B.A., Mazze R.I., Beppu W.J. i in. (1977). Enflurane metabolism in rats and man. J. Pharmacol. Exp. Ther. 203, 193–202.
• 87. Hoerauf K., Mayer T., Hobbhahn J. (1996). [Occupational exposure to enflurane and laughing gas in operating rooms]. Zentralbl. Hyg. Umweltmed. 198(3), 265–274.
• 88. Hoerauf K.H., Hartmann T., Zavrski A. i in. (1999). Occcupational exposure to sevoflurane during sedation of adult patients. Int. Arch. Occup. Environ. Health 72, 174–177.
• 89. Horan B.F., Prys-Roberts C., Hamilton W.K. i in. (1977). Haemodynamic responses to enflurane anaesthesia and hypovolaemia in the dog, and their modification by propranolol. Br. J. Anaesth. 49, 1189–1197.
• 90. Huse von K., Köhler H. (1974). Kreislaufveränderungen in Ēthrane-narkose bei neurochirurgischen Patienten. [W:] Proceedings of the First European Symposium on Modern Anaesthetic Agents, Hamburg, November, 9th and 10th 1973. [Red.] P. Lawin, R. Beer. Berlin: Springer-Verlag.
• 91. Hussey A.J., Aldridge L.M., Paul D. (1988). Plasma glutathione S-transferase concentration as a measure of hepatocellular integrity following a single general anaesthetic with halothane, enflurane or isoflurane. Br. J. Anaesth. 60, 130–135.
• 92. Husum B., Wulf H.C., Niebuhr E. (1981). Sister chromatid exchanges in lymphocytes after anaesthesia with halothane or enflurane. Acta Anaesthesiol. Scand. 25, 97–98.
• 93. Husum B., Wulf H.C., Niebuhr E. (1985). Monitoring of sister chromatid exchanges in lymphocytes of nurse-anesthetists. Anesthesiology 62, 475–479.
• 94. Imbriani M., Ghittori S., Pezzagno G. i in. (1994). Biological monitoring of occupational exposure to enflurane (ethrane) in operating room personnel. Arch. Environ. Health 49(2), 135–140.
• 95. Jacob B., Heller C., Daldrup T. i in. (1989). Fatal accidental enflurane intoxication. J. Forensic Sci. 34(6), 1408–1412.
• 96. Jafari A., Jafari F., Mohebbi I. (2020). Effects of occupational exposure to trace levels of halogenated anesthetics on the liver, kidney, and oxidative stress parameters in operating room personel. Toxin Rev. 39(3), 242–251.
• 97. Jakubowski M. (2007). Dezfluran. Dokumentacja dopuszczalnych wielkości narażenia zawodowego. Podst. Metod. Ocen. Srod. Pr. 2(52), 65–82.
• 98. Jastak J.T., Greenfield W. (1977). Trace contamination of anesthetic gases: a brief review. J. Am. Dent. Assoc. 95, 758–762.
• 99. Jenkins J., Milne A.C. (1984). Convulsive reaction following enflurane anaesthesia. Anaesthesia 39, 44–45.
• 100. Johnson J.A., Buchan R.M., Reif J.S. (1987). Effect of waste anesthetic gas and vapor exposure on reproductive outcome in veterinary personnel. Am. Ind. Hyg. Ass. J. 48, 62–66.
• 101. Jones M.V., Brooks P.A., Harrison N.L. (1992). Enhancement of gamma-aminobutyric acid-activated Cl- currents in cultured rat hippocampal neurones by three volatile anaesthetics. J. Physiol. 449, 279–293.
• 102. Julien R.M., Kavan E.M. (1972). Electrographic studies of a new volatile anesthetic agent: enflurane (Ethrane). J. Pharmacol. Exp. Ther. 183, 393–403.
• 103. Klan P.H., Herden H.-N., Lawin P. (1975). Vergleichende gaschromatographische Untersuchungender Exspirationsluft von Patienten nach Narkosen mit Enflurane, Halothane und Methoxyfluran. Prakt. Anaesth. 10, 356–360.
• 104. Klide A.M. (1976). Cardiopulmonary effects of enflurane and isoflurane in dogs. Am. J. Vet. Res. 37, 127–131.
• 105. Khankhanian P., Himmelstein D. (2016). Prediction in epilepsy. Repethio: Repurposing drugs on hetnet [project]. Thinklab, https://think-lab.github.io/d/224/ [data dostępu: 27.10.2022].
• 106. Knill R.L., Manninen P.H., Clement J.L. (1979). Ventilation and chemoreflexes during enflurane sedation and anaesthesia in man. Can. Anaesth. Soc. J. 26, 353–360.
• 107. Knill-Jones R.P., Rodrigues L.V., Moir D.D. i in. (1972). Anaesthetic practice and pregnancy: controlled survey of women anaesthetists in the United Kingdom. Lancet 1, 1326–1328.
• 108. Knill-Jones R.P., Newman B.J., Spence A.A. (1975). Anaesthetic practice and pregnancy: controlled survey of male anesthetists in the United Kingdom. Lancet 2, 807–809.
• 109. Krasowski M.D., Harrison N.L. (2000). The actions of ether, alcohol and alkane general anaesthetics on GABAA and glycine receptors and the effects of TM2 and TM3 mutations. Br. J. Pharmacol. 129(4), 731–743.
• 110. Kruczek M., Albin M.S., Wolf S. i in. (1980). Postoperative seizure activity following enflurane anesthesia. Anesthesiology 53, 175–176.
• 111. Kucharska M., Wesołowski W. (2014). Ocena narażenia zawodowego personelu medycznego na anestetyki wziewne w Polsce. Med. Pr. 65(1), 43–54.
• 112. Kugel G., Letelier C., Atallah M. i in. (1986). Chronic low level nitrous oxide exposure and infertility. J. Dent. Res. 68, 313.
• 113. Kugel G., Norris L.H., Zive M.A. (1989). Nitrous oxide and occupational exposure: it’s time to stop laughing. Anesth. Prog. 36, 252–257.
• 114. Kundomal Y.R., Baden J.M. (1985). Mutagenicity of inhaled anesthetics in Drosophila melanogaster. Anesthesiology 62, 305–309.
• 115. Kupczewska-Dobecka M. (2007). Sewofluran. Dokumentacja dopuszczalnych wielkości narażenia zawodowego. Podst. Metod. Ocen. Srod. Pr. 3(53), 101–129.
• 116. Kurata J., Adachi T., Nakao S. i in. (1996). Sevoflurane, enflurane and isoflurane have no persistent postanaesthetic effects on the central nervous system in cats. Br. J. Anaesth. 76, 721–725.
• 117. Laisalmi M., Soikkeli A., Kokki H. i in. (2003). Fluoride metabolism in smokers and non-smokers following enflurane anaesthesia. Br. J. Anaesth. 91(6), 800–804.
• 118. Lamberti L., Bigatti P., Ardito G. i in. (1989). Chromosome analysis in operating room personnel. Mutagenesis 4, 95–97.
• 119. Land P.C., Owen E.L., Linde H.W. (1981). Morphologic changes in mouse spermatozoa after exposure to inhalational anesthetics during early spermatogenesis. Anesthesiology 54, 53–56.
• 120. Lauwerys R., Siddons M., Misson C.B. i in. (1981). Anaesthetic health hazards among Belgian nurses and physicians. Int. Arch. Occup. Environ. Health 48, 195–203.
• 121. Lebowitz M.H., Blitt C.D., Walts L.F. (1970). Depression of twitch response to stimulation of the ulnar nerve during ethrane anesthesia in man. Anesthesiology 33, 52–57.
• 122. Lebowitz M.H., Blitt C.D., Dillon J.B. (1972). Enflurane-induced central nervous system excitation and its relation to carbon dioxide tension. Anesth. Analg. 51, 355–363.
• 123. Lee K.S., Park S.S. (1980). Effect of halothane, enflurane and nitrous oxide on tracheal ciliary activity in vitro. Anesth. Analg. 59, 426–430.
• 124. Lew E.A. (1979). Mortality experience among anesthesiologists, 1954-1976. Anesthesiology 51, 195–199.
• 125. Lin L.H., Chen L., Zirrolli J.A. i in. (1992). General anesthetics potentiate gamma-aminobutyric acid actions on gamma-aminobutyric acidA receptors expressed by Xenopus oocytes: lack of involvement of intracellular calcium. J. Pharmacol. Exp. Ther. 263(2), 569–578.
• 126. Linde H.W., Lamb V.E., Quimby C.W. i in. (1970). The search for better anesthetic agents: clinical investigation of ethrane. Anesthesiology 32, 555–559.
• 127. Lingenfelter R.W. (1981). Fatal misuse of enflurane. Anesthesiology 55, 603.
• 128. Lowry C.J., Fielden B.P. (1976). Bronchospasm associated with enflurane exposure: three case reports. Anaesth. Intensive Care 4, 254–258.
• 129. Lucchini R., Toffoletto F., Camerino D. i in. (1995). Neurobehavioral functions in operating theatre personnel exposed to anesthetic gases. Med. Lav. 86, 27–33.
• 130. Lucchini R., Placidi D., Toffoletto F. i in. (1996). Neurotoxicity in operating room personnel working with gaseous and nongaseous anesthesia. Int. Arch. Occup. Environ. Health 68, 188–192.
• 131. Lucchini R., Belotti L., Cassitto M.G. i in. (1997). Neurobehavioral functions in operating theatre personnel: a multicenter study. Med. Lav. 88(5), 396–405.
• 132. MAK (2002). MAK Value Documentation, 1998. Enflurane. The MAK-Collection for occupational health and safety. Documentations and methods, Vol. 9, 51–68. Wiley Online Library. https://onlinelibrary.wiley.com/doi/ epdf/10.1002/3527600418.mb1383816e0009 [data dostępu: 27.10.2022].
• 133. Mapleson W.W. (1996). Effect of age on MAC in humans: a meta-analysis. Brit. J. Anaesth. 76, 179–185.
• 134. Material Safety Data Sheet (1992a). Material Safety Data Sheet: Ethrane. Anaquest, Liberty Corner, New Jersey.
• 135. Material Safety Data Sheet (1992b). Material Safety Data Sheet: Forane. Anaquest, Liberty Corner, New Jersey.
• 136. Matte T.D., Mulinare J., Erickson J.D. (1993). Case-control study of congenital defects and parental employment in health care. Am. J. Ind. Med. 24, 11–23.
• 137. Mazze R.I., Calverley R.K., Smith N.T. (1977). Inorganic fluoride nephrotoxicity: prolonged enflurane and halothane anesthesia in volunteers. Anesthesiology 46, 265–271.
• 138. Mazze R.I., Fujinaga M., Rice S. (1986). Reproductive and teratogenic effects of nitrous oxide, halothane, isoflurane and enflurane in Sprague-Dawley rats. Anesthesiology 64, 339–344.
• 139. McCammon C., Daniels W., Lee S. (1997). Health hazard evaluation report: HETA-97-0062-2662, New Alaska Native Medical Center, Anchorage, Alaska. NIOSH, Cincinnati, Ohio.
• 140. McGregor D.G. (2000). Occupational exposure to trace concentrations of waste anesthetic gases. Mayo Clin. Proc. 75(3), 273–277.
• 141. Merin R.G., Kumazawa T., Luka N.L. (1976). Enflurane depresses myocardial function, perfusion and metabolism in the dog. Anesthesiology 45, 501–507.
• 142. Miller M.S., Gandolfi A.J. (1979). A rapid, sensitive method for quantifying enflurane in whole blood. Anesthesiology 51, 542–544.
• 143. Modica P.A., Tempelhoff R., White P.F. (1990). Pro- and anticonvulsant effects of anesthetics (Part I). Anesth. Analg. 70(3), 303–315.
• 144. Molina Aragonés J.M., Ayora Ayora A., Barbara Ribalta A. i in. (2016). Occupational exposure to volatile anaesthetics: a systematic review. Occup. Med. (Lond.) 66, 202–207.
• 145. Moss E., Dearden N.M., McDowall D.G. (1983). Effects of 2% enflurane on intracranial pressure and cerebral perfusion pressure. Br. J. Anaesth. 55, 1083–1088.
• 146. Munson E.S., Embro W.J. (1977). Enflurane, isoflurane, and halothane and isolated human uterine muscle. Anesthesiology 46(1), 11–14.
• 147. Neigh J.L., Garman J.K., Harp J.R. (1971). The electroencephalographic pattern during anesthesia with ethrane: effects of depth of anesthesia, PaCO2, and nitrous oxide. Anesthesiology 35(5), 482–487.
• 148. Neurochemistry of consciousness: neurotransmitters in mind (2002). [Red.] E.K. Perry, H. Ashton, A.H. Young. John Benjamins Publishing.
• 149. Nicoll J.V.M. (1986). Status epilepticus following enflurane anaesthesia. Anaesthesia 41, 927–930.
• 150. NIOSH, National Institute of Occupational Safety and Health (1977). Criteria for a recommended standard occupational exposure to waste anesthetic gases and vapors. DHHS (NIOSH) publication number 77-140.
• 151. NIOSH, National Institute of Occupational Safety and Health (1994). RTECS (Registry of toxic effects of chemical substances). Databank. Cincinnati, Ohio.
• 152. NIOSH, National Institute of Occupational Safety and Health (2019). CDC – NIOSH Pocket guide to chemical hazards. Enflurane, https://www.cdc.gov/niosh/npg/npgd0253.html [data dostępu: 27.10.2022].
• 153. Occupational disease among operating room personnel: a national study. Report of an Ad Hoc Committee on the Effect of Trace Anesthetics on the Health of Operating Room Personnel, American Society of Anesthesiologists (1974). [No authors listed] Anesthesiology 41, 321–340.
• 154. Ogawa T., Shingu K., Shibata M. i in. (1992). The divergent actions of volatile anaesthetics on background neuronal activity and reactive capability in the central nervous system in cats. Can. J. Anaesth. 39, 862–872.
• 155. Osawa M., Shingu K., Murakawa M. i in. (1994). Effects of sevoflurane on central nervous system electrical activity in cats. Anesth. Analg. 79, 52–57.
• 156. Oyama T., Taniguchi K., Ishihara H. i in. (1979). Effects of enflurane anaesthesia and surgery on endocrine function in man. Br. J. Anaesth. 51, 141–148.
• 157. Pałaszkiewicz P. (2009). Analiza ryzyka skażenia anestetykami wziewnymi środowiska sal operacyjnych w Polsce. Badanie ankietowe [rozprawa na stopień doktora nauk medycznych]. Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu. Katedra Anestezjologii i Intensywnej Terapii. Poznań. https:// www.wbc.poznan.pl/dlibra/show-content/publication/edition/118740?id=118740 [data dostępu: 27.10.2022].
• 158. Parke T.J, Jago R.H. (1992). Focal seizure following enflurane. Anaesthesia 47, 79–80.
• 159. Pasquini R., Monarca S., Scassellati Sforzolini G. i in. (1989). Thioethers, mutagens, and D-glucaric acid in urine of operating room personnel exposed to anesthetics. Teratog. Carcinog. Mutagen. 9, 359–368.
• 160. Peters M.A., Hudson P.M. (1982). Postnatal development and behavior in offspring of enflurane exposed pregnant rats. Arch. Int. Pharmacodyn. Ther. 256, 134–144.
• 161. Pharoah P.O.D., Alberman E., Doyle P. i in. (1977). Outcome of pregnancy among women in anaesthetic practice. Lancet 1, 34–36.
• 162. Plummer J.L., Beckwith A.L.J., Bastin F.N. i in. (1982). Free radical formation in vivo and hepatotoxicty due to anesthesia with halothane. Anesthesiology 57, 160–166.
• 163. Pope W.D.B., Persaud T.V.N. (1978). Foetal growth retardation in the rat following chronic exposure to the inhalation anaesthetic enflurane. Experientia 34, 1332–1333.
• 164. Raphael J.H., Selwyn D.A., Mottram S.D. i in. (1996). Effects of 3 MAC of halothane, enflurane and isoflurane on cilia beat frequency of human nasal epithelium in vitro. Br. J. Anaesth. 76, 116–121.
• 165. Robbiano L., Mereto E., Migliazzi Morando A. i in. (1998). Increased frequency of micronucleated kidney cells in rats exposed to halogenated anaesthetics. Mutat. Res. 413(1), 1–6.
• 166. Rocha T.L., Dias-Junior C.A., Possomato-Vieira J.S. i in. (2015). Sevoflurane induces DNA damage whereas isoflurane leads to higher antioxidative status in anesthetized rats. Biomed. Res. Int. 264971. DOI: 10.1155/2015/264971
• 167. Rosenberg P.H., Väntinnen H. (1978). Occupational hazards to reproduction and health in anaesthetists and paediatricians. Acta Anaesthesiol. Scand. 22, 202–207.
• 168. Rozporządzenie Parlamentu Europejskiego i Rady (WE) nr 1272/2008 z dnia 16 grudnia 2008 r. w sprawie klasyfikacji, oznakowania i pakowania substancji i mieszanin, zmieniające i uchylające dyrektywy 67/548/EWG i 1999/45/WE oraz zmieniające rozporządzenie (WE) nr 1907/2006. Dz. Urz. UE L 353 z 31.12.2008.
• 169. Rozporządzenie Ministra Rodziny, Pracy i Polityki Społecznej z dnia 12 czerwca 2018 r. w sprawie najwyższych dopuszczalnych stężeń i natężeń czynników szkodliwych dla zdrowia w środowisku pracy. DzU 2018, poz. 1286 ze zm.
• 170. RxList information on medications (2016). WebMD Consumer Network: The Internet drug index [cited 2016 Mar 1]. Ethrane (Enflurane) uses, dosage, side effects, interactions, warning, https://www.rxlist.com/ethrane-drug.htm#precautions [data dostępu: 27.10.2022]. 171. Safari S., Motavaf M., Siamdoust S.A.S. i in. (2014). Hepatotoxicity of halogenated inhalational anesthetics. Iran. Red Crescent Med. J. 16, e20153. DOI: 10.5812/ircmj.20153 172. Saito N., Urakawa M., Ito R. (1974). [Influence of enflurane on fetus and growth after birth in mice and rats]. Oyo Yakuri 8, 1269–1276 (Japanese).
• 173. Sakai T., Takaori M. (1978). Biodegradation of halothane, enflurane and methoxyflurane. Br. J. Anaesth. 50(8), 785–791.
• 174. Sakai T., Takaori M.,Yoshida H. (1992). Metabolism of enflurane in dogs. Drug Metab. Dispos. 20(1), 127–129.
• 175. Scrascia E., Magalini S.I., Beccia F. (1973). Considerazioni e valutazioni sull’impiego clinico dell’enflurano. Acta Anesth. Ital. 24, 159.
• 176. Sigma-Aldrich (2018). Karta charakterystyki, https://www. sigmaaldrich.com/PL/pl/sds/usp/1235809 [data dostępu: 27.10.2022].
• 177. Sleigh J.W., Vizuete J.A., Voss L. i in. (2009). The electrocortical effects of enflurane: experiment and theory. Anesth. Analg. 109, 1253–1262.
• 178. Smith G., Shirley A.W. (1978). A review of the effects of trace concentrations of anaesthetics on performance. Br. J. Anaesth. 50, 701–712.
• 179. Soćko R., Kupczewska-Dobecka M. (2007). Izofluran. Dokumentacja dopuszczalnych wielkości narażenia zawodowego. Podst. Metod. Ocen. Srod. Pr. 2(52), 83–100.
• 180. Starek A. (2005). Tlenek diazotu. Dokumentacja proponowanych wartości dopuszczalnych wielkości narażenia zawodowego. Podst. Metod. Ocen. Srod. Pr. 3(45), 135–152.
• 181. Stefani S.J., Hughes S.C., Shnider S.M. i in. (1982). Neonatal neurobehavioral effects of inhalation analgesia for vaginal delivery. Anesthesiology 56, 351–355.
• 182. Steffey E.P., Howland D. Jr (1978). Potency of enflurane in dogs: comparison with halothane and isoflurane. Am. J. Vet. Res. 39, 573–577.
• 183. Stevens W.C., Eger E.I., White A. i in. (1977). Comparative toxicities of enflurane, fluroxene and nitrous oxide at subanaesthetic concentrations in laboratory animals. Canad. Anaesth. Soc. J. 24, 475–478.
• 184. Strout C.D., Nahrwold M.L., Taylor M.D. i in. (1977). Effects of subanesthetic concentrations of enflurane on rat pregnancy and early development. Environ. Health Perspect. 21, 211–214.
• 185. Strum D.P., Eger E.I. 2nd, Unadkat J.D. i in. (1991). Age affects the pharmacokinetics of inhaled anesthetics in humans. Anesth. Analg. 73, 310–318.
• 186. SWA, Safe Work Australia (2019). Recommendation and basis for workplace exposure standard: enflurane, https://engage. swa.gov.au/wes-review-release-8/widgets/268374/documents [data dostępu: 27.10.2022].
• 187. Sylvester G.C., Khoury M.J., Lu X. i in. (1994). First-trimester anesthesia exposure and the risk of central nervous system defects: a population-based case-control study. Am. J. Public Health 84, 1757–1760.
• 188. Szulc R., Nestorowicz A., Sobczyński P. i in. (2004). Anestetyki wziewne w atmosferze sal operacyjnych. Badania w dwóch makroregionach Polski [Operating room air pollution by waste anaesthetic agents and vapours: a survey of hospitals in two regions of Poland]. Anest. Inten. Terap. 2, 113–118.
• 189. Tankó B., Molnár L., Fülesdi B. i in. (2014). Occupational hazards of halogenated volatile anesthetics and their prevention: review of the literature. J. Anesth. Clin. Res. 5(7). DOI: 10.4172/2155-6148.1000426
• 190. Tannenbaum T.N., Goldberg R.J. (1985). Exposure to anesthetic gases and reproductive outcome: a review of the epidemiologic literature. J. Occup. Med. 27, 659–668.
• 191. Thoustrup Saber A., Sørig Hougaard K. (2009). The Nordic Expert Group for Criteria Documentation of Health Risks from Chemicals. 141. Isoflurane, sevoflurane and desflurane. NR 43(9).
• 192. Torri G., Damia G., Fabiani M.L. i in. (1972). Uptake and elimination of enflurane in man: a comparative study between enflurane and halothane. Brit. J. Anaesth. 44, 789–794.
• 193. Un L.-H., Chen L.L., Harris R.A. (1993). Enflurane inhibits NMDA, AMPA, and kainate-induced currents in Xenopus oocytes expressing mouse and human brain mRNA. FASEB J. 7(3), 479–485.
• 194. Van Dyke R.A. (1982). Hepatic centrilobular necrosis in rats after exposure to halothane, enflurane, or isoflurane. Anesth. Analg. 61(10), 812–819.
• 195. van Luijk J.A.K.R, Popa M., Swinkels J. i in. (2019). Establishing a health-based recommended occupational exposure limit for nitrous oxide using experimental animal data: a systematic review protocol. Environ. Res. 178, 108711. DOI: 10.1016/j. envres.2019.108711
• 196. Wakamori M., Ikemoto Y., Akaike N. (1991). Effects of two volatile anesthetics and a volatile convulsant on the excitatory and inhibitory amino acid responses in dissociated CNS neurons of the rat. J. Neurophysiol. 66(6), 2014–2021.
• 197. Wharton R.S., Mazze R.I., Wilson A.I. (1981). Reproduction and fetal development in mice chronically exposed to enflurane. Anesthesiology 54, 505–510.
• 198. Wise-Faberowski L., Osorio-Lujan S. (2013). Acute and sustained isoflurane neuroprotection: the effect of culture age and duration of oxygen and glucose deprivation. Brain Inj. 27, 444–453.
• 199. Wyrobek A.J., Brodsky J., Gordon L. i in. (1981). Sperm studies in anesthesiologists. Anesthesiology 55, 527–532.
• 200. Yazji N.S., Seed R.F. (1984). Convulsive reaction following enflurane anaesthesia. Anaesthesia 39, 1249.
• 201. Zhang B., Wei X., Cui X. i in. (2008). Desflurane affords greater protection than halothane in the function of mitochondria against forebrain ischemia reperfusion injury in rats. Anesth. Analg. 106, 1242–1249.
• 202. Zhu Y., Xiao X., Li G. i in. (2017). Isoflurane anesthesia induces liver injury by regulating the expression of insulin-like growth factor 1. Exp. Ther. Med. 13(4), 1608–1613.

Uwagi

Opracowanie rekordu ze środków MEiN, umowa nr SONP/SP/546092/2022 w ramach programu "Społeczna odpowiedzialność nauki" - moduł: Popularyzacja nauki i promocja sportu (2022-2023).