POLLUTION AND SCAVENGING
64. Pollution and
scavenging
Delivery of anaesthesia may result in atmospheric contamination by anaesthetic gases such as nitrous oxide and
volatile agents. In 1996 the Health and Safety Executive Agency placed constraints on the maximum allowable
concentration of such substances within the theatre setting. In order to comply, scavenging of expired anaesthetic
gases became mandatory.
What are the adverse effects of
N2O and volatile agents?
What methods are available to
reduce pollution in theatre?
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There are adverse effects to both the environment and staff (and patients).
Environment:
> Volatile agents and N2O are both known to damage the ozone layer.
> N2O is also a ‘greenhouse’ gas contributing towards global warming.
> N2O sustains combustion and therefore in the presence of lasers or
grease it can become a fire hazard.
Staff (adverse effects are primarily related to the use of N2O):
> Bone marrow toxicity and peripheral neuropathy: N2O inhibits
the enzyme methionine synthase, which is involved in the synthesis
of methionine (required for myelin formation) and tetrahydrofolate
(required for DNA synthesis). It also oxidises the cobalt atom in vitamin
B12 rendering it non-functional (vitamin B12 is a cofactor for methionine
synthase). The result is megaloblastic changes in bone marrow, bone
marrow suppression, megaloblastic anaemia, impaired spinal cord
myelination (subacute combined degeneration of the cord) and peripheral
neuropathy.
> Teratogenicity: Exact mechanism is unclear but is likely to be multi-
factorial and involve impaired DNA synthesis, which can manifest as
neural tube defects.
> Spontaneous miscarriage: There were reports suggesting an increased
incidence of miscarriages in dental practice nurses working with N2O.
Although these reports got a lot of publicity there is still no good level of
evidence to support this observation.
> Substance abuse.
> Air conditioning with rapid rate of air change (15 times per hour)
> Circle system
> Low gas flows
> Avoid using N2O, use O2 with air mix instead
> Scavenging systems
> Monitoring inspired and expired N2O and volatile agent concentration and
adjusting concentration to required clinical effect
> Monitoring theatre pollution levels
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 02 PHYSICS
How can anaesthetic gases be
scavenged?
What are the problems with
passive scavenging?
What are the components of an
active scavenging system?
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> Checking for leaks during daily anaesthetic machine check
> Capping breathing circuits when not in use (there is always a small leak)
> Vaporisers should be filled carefully to ensure no spillage
> Total intravenous anaesthesia technique
> Regional anaesthesia technique
> Rotate staff
> Regular servicing of anaesthetic machinery, gas supply, scavenging
systems and ventilation
> Training and education of staff to be aware of potential hazards and how
to minimise them
Scavenging may be classified into active and passive systems.
Passive scavenging
> Requires no external power.
> Gas movement to the exterior is due to the pressure generated by the
patient during expiration.
> This is an example of a ventile system (i.e. wind is used to entrain waste
gases).
> Passive scavenging simply employs the use of wide-bore tubing to
channel expired gases to the exterior and therefore it is not as effective as
active methods.
> Excess positive or sub-atmospheric pressures may be caused by wind or
air movement at the outlet.
> The outlets are above roof level to prevent re-entry of scavenged gas into
the building; however, the weight of denser gases such as N2O may exert
a back-pressure into the patient’s breathing system.
Active scavenging
> Utilises an external power source such as vacuum pumps to generate a
negative pressure, which propels gases to the external atmosphere.
COLLECTING SYSTEM [collection of expired gases from
breathing system or ventilator]
↓
TRANSFER SYSTEM [wide-bore 30 mm tubing]
↓
RECEIVING SYSTEM [reservoir with visual flow indicator]
↓
DISPOSAL SYSTEM [air pump or fan generates a vacuum]
↓
EXTERIOR
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What are the disadvantages of
the active system?
What is the recommended number Despite scavenging, there will always be a quantity of gas that escapes
of air changes per hour in theatre? into the theatre environment, and therefore the theatre needs adequate
ventilation. Theatre ventilation should ensure 15 air changes per hour.
What is COSHH?
What are the maximum
recommended anaesthetic
pollutant levels?
POLLUTION AND SCAVENGING
> Gas from the expiratory valve of the breathing circuit or from the ventilator
is collected and channelled via wide-bore, 30 mm diameter transfer tubing
to the receiving system.
> The receiving system is usually an open-ended cylinder forming a
reservoir for the collection of gases. The cylinder must be open-ended
as a safety precaution, ensuring that the patient’s airway cannot be
subjected to excess positive or negative pressure.
> The receiving system also has a flow indicator. Scavenging flow rate is in
the order of 80 L/min, which ensures removal of all expired gases.
> Gases in the reservoir are vented to the exterior atmosphere via a
disposal system. The disposal system is either an air pump or a fan. It
operates within a pressure of −0.5 to +5 cm H2O.
> Excessive positive pressure may lead to barotrauma.
> Excessive negative pressure can deflate the reservoir bag of the breathing
system and lead to rebreathing.
The Health and Safety Executive Agency is a government agency with the
role of preventing death, injury and ill health in Britain’s workplaces. COSHH –
Control of Substances Hazardous to Health – sets safe maximum exposure
limits to chemicals and other hazardous substances.
These levels are based on an 8-hour TWA (time-weighted average).
Halothane 10 ppm
Enflurane 50 ppm
Isoflurane 50 ppm
Nitrous oxide 100 ppm
Sevoflurane 20 ppm (recommended limit by Abbot Laboratories)
Desflurane No data provided

Are there any areas of the hospital > It may be difficult to achieve acceptable pollution levels in post-
in which long-term exposure limits anaesthesia care units – patients waking from anaesthesia with direct
may be difficult to achieve? expiration into the environment of volatiles and possibly N2O.
> Paediatric theatres – because of the use of non-closed breathing systems
and high gas flows, e.g. Ayre’s T-piece.

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