This past summer I interned at Montefiore Medical Center, and although I was not an intern in the surgery department, I was able to go watch a procedure from inside the operating room (OR). People always talk about the dangers of the individual undergoing surgery, but I began to wonder if there were dangers associated with being the surgeon. Many surgeons and other medical staff who spend time daily in an OR might not be aware of the genotoxic effects that environment can have long term.
General anesthesia is used in the operating room to make the patient both unconscious and unable to feel pain during medical procedures. General anesthesia is commonly produced by a combination of intravenous drugs which is then given to the patient in a gaseous form. Anesthetics contain many gases which, when inhaled over a long period of time — for example by those who work in an OR — can lead to genotoxic effects. The genotoxic effects of anesthetics have been shown to include the formation of micronuclei, excessive amounts of sister chromatid exchange, and chromosomal aberrations. These forms of genetic damage can lead to cancer in somatic cells and can lead to problems in fertility or in the next generation of gametic cells. It has been shown that exposure to anesthetic gases has a significant genotoxic effect, not related to age or gender, but rather only to the duration of exposure. Those occupationally exposed to anesthetic gases should take precautions when possible and monitor their levels of chemical intake.
Retrospective studies have indicated that those occupationally exposed to anesthetic gases may have increased risks of spontaneous abortion, congenital malformations in offspring, and cancer. Induction of changes in the DNA in the chromosomes can lead to mutations, which can in turn cause carcinogenicity. By examining sister chromatid exchanges (SCEs) during cell replication, the extent to which mutations have occurred can be analyzed. Frequencies of SCE were measured in lymphocyte cultures of 27 non-smokers working in the operating room and 27 non-smoking controls. After exposure, it was found that sister chromatid exchange frequency was increased significantly. This study concluded that exposure to even trace concentrations of waste anesthetic gases on a daily basis, may cause genetic damage comparable with smoking 11-20 cigarettes per day.
Although spontaneous abortion and decreased fertility rates have been seen associated with individuals exposed occupationally to anesthetic gases, no correlation has been determined. In one study the question of whether fertility or childbearing problems are more common among surgeons than the general public. They did so by evaluating female surgeons in every field to conclude whether any fertility or childbearing issues exist across the board. Of women surgeons, 32% reported fertility difficulty and 84% of those women had a fertility work- up. This is in comparison to only 10.9% of women in the general US population having reported difficulties in the area of fertility. It was also found that surgeons had 1.4 biological children which is less than the nation’s average. This study concluded that female surgeons have first pregnancies later in life, fewer children, and report more issues with infertility, but exact rates could not be concluded.
Another source of genetic damage among those who work in an operating room is from pesticides, which are in most cleaning products used to sterilize the OR. Genetic damage due to pesticides is seen in those who experience high exposure levels due to intensive use or misuse of the products. The damage was also found to be highly dose-dependent, and the highest rates of genetic damage were seen among those who had low exposure to these chemicals over a long period of time, for example surgeon or other OR personnel who work in an environment where these chemicals are used daily.
All of the studies mentioned above lead to the conclusion that there are genotoxic and carcinogenic effects from occupational exposure to anesthetic gases in an OR, as well as other chemicals used daily in the OR. Those undergoing surgery should not be concerned about these risks, for their exposure is not over a long enough period of time to cause significant damage. To reduce genetic damage in those occupationally exposed to anesthetic gases a chemical reader should be used in the operating room to maintain knowledge of the extent OR personnel are exposed to various chemical gases. In addition, those occupationally exposed should take proper precautions and get periodic tests to ensure their exposure rate is not too high. Those who desire to become surgeons should be aware that in the United States, many of these adverse effects seen from waste anesthetic gases are controlled more in the US than in other countries, and therefore are not as great a concern.