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研究生:王守堅
研究生(外文):Shou-Chien Wang
論文名稱:醫療院所常見麻醉廢氣採樣分析技術初探
論文名稱(外文):A Preliminary Study of Sampling and Analysis for Common Waste Anesthetic Gases in Medical Unit
指導教授:陳叡瑜陳叡瑜引用關係
指導教授(外文):Ruey-Yu Chen
學位類別:碩士
校院名稱:臺北醫學大學
系所名稱:公共衛生學系
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2005
畢業學年度:93
語文別:中文
論文頁數:95
中文關鍵詞:笑氣麻醉廢氣採樣分析方法
外文關鍵詞:laughing gasnitrous oxidewaste anesthetic gasessampling and analytical method
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醫療院所醫護人員在使用麻醉氣體為病患進行手術時,常暴露於病患呼出或管線洩漏之麻醉廢氣,其中以笑氣最為嚴重。研究指出,暴露笑氣可能會造成醫護人員生殖系統之危害,引發自發性流產、早產、新生兒低出生體重以及不孕等問題,並可能會減緩心智活動之能力,實有必要對醫療院所麻醉用笑氣定期進行環境監測。
我國尚未建立笑氣測定之採樣分析方法,而目前常見之笑氣測量技術主要以紅外線光儀直接分析空氣,或使用分子篩5A吸附管採樣,經脫附後以氣相層析儀搭配電子捕捉偵測器(GC-ECD)或紅外光儀分析。方法皆有其限制或不便。
本研究以採樣袋收集笑氣樣本,送回實驗室利用氣相層析質譜儀(GC- MS)進行笑氣濃度分析,驗證方法之準確性與精確性。實驗結果發現使用此方法確能同時偵測笑氣及Desflurane、Sevoflurane和Isoflurane三種揮發性麻醉劑,具良好之定性及定量能力。採樣後在冷藏之環境下可以儲存七天,而使用內標法則可增加分析的穩定性及準確度。本研究方法值得做為笑氣分析方法選擇之參考。
Nitrous oxide is used as a surgical inhalation anesthetic. Health care professionals worked in operating rooms or recovery rooms are potentially exposed to nitrous oxide from various components of the anesthesia delivery system or the exhaled gases of patients. The possible effects of nitrous oxide exposure included spontaneous abortion, premature delivery, low birth weight, involuntary infertility, as well as the decrement in audiovisual performance. It is important to evaluate the potential risks of excess exposure to waste anesthetic gases and to implement the appropriate controls to minimize these risks.
We do not yet have a certified standard method for nitrous oxide sampling and analysis. Current best recommended method for nitrous oxide measurement is infrared spectrophotometer. The molecular sieve 5A sampling tube was also used to collect nitrous oxide. After sampling, molecular sieve 5A tube are desorbed and then analyzed by gas chromatography or infrared spectrophotometer. However, the uptake rate of nitrous oxide on molecular sieve 5A tube varied with the absorbed mass. The sampling rate was non-liner and the variance was too large to satisfy. Moreover, infrared spectrophotometer is easily interfered with carbon dioxide, and its minimum sampling volume is limited by the cell volume of spectrophotometer when using air sampling bag instead of field direct reading.
In this study, we try to establish a new method of nitrous oxide measurement. Air will be sampled with sampling bag and then determine the concentration using gas chromatography with mass detector. The accuracy and precision of the new method will be verified. For the co-existing of nitrous oxide and volatile anesthetic gases in a field environment, we also attempt to analyze those co-existing anesthetic gases, Sevoflurane, Isoflurane and Desflurane. Finally, a suggested method for nitrous oxide air sampling and analysis will be drafted.
目 錄
中文摘要..............................................................................................................i
英文摘要.............................................................................................................ii
目錄....................................................................................................................iii
表目錄.................................................................................................................v
圖目錄................................................................................................................vi

第一章 緒論...................................................................................................... 1
第一節 研究動機 .........................................................................................1
第二節 研究目的與架構...............................................................................2
第三節 名詞解釋...........................................................................................4
第二章 文獻探討...............................................................................................5
第一節 麻醉的歷史.......................................................................................5
第二節 麻醉簡介...........................................................................................9
第三節 麻醉氣體之潛在性危害.................................................................20
第四節 容許暴露濃度與暴露現況.............................................................30
第五節 分析方法.........................................................................................34
第三章 材料與方法.........................................................................................37
 第一節 藥品、設備與儀器.........................................................................37
 第二節 氣體標準品配製.............................................................................40
第三節 層析管柱測試.................................................................................43
第四節 建立檢量線.....................................................................................47
第五節 偵測極限和量化極限.....................................................................49
第六節 儲存穩定性測試.............................................................................49
第七節 品質管制.........................................................................................50
第四章 結果與討論.........................................................................................52
 第一節 檢量線建立.....................................................................................52
第二節 偵測極限和量化極限.....................................................................69
第三節 儲存穩定性測試.............................................................................71
第四節 品質管制.........................................................................................73
第五節 實際應用之探討.............................................................................77
第六節 研究限制.........................................................................................78
第五章 結論與建議.........................................................................................79
第一節 結論.................................................................................................79
第二節 建議.................................................................................................81
第六章 參考文獻.............................................................................................82
1. Abbott Laboratories. Material safety data sheet. Abbott Park (IL): Abbott Laboratories, 1995.
2. Accorsi A, Barbieri A, Raffi GB, Violante FS, 2001; “Biomonitoring of exposure to nitrous oxide, sevoflurane, isoflurane and halothane by automated GC/MS headspace urinalysis”, Int Arch Occup Environ Health 74:541–548.
3. Accorsi A, Valenti S, Barbieri A, Raffi GB, Violante FS, 2003; “Proposal for single and mixture biological exposure limits for sevoflurane and nitrous oxide at low occupational exposure levels”, Int Arch Occup Environ Health 76:139-136.
4. Accorsi A, Valent S, et al. Enflurane as an internal standard in monitoring halogenated volatile anesthetics by headspace gas chromatography-mass spectrometry. Journal of Chromatography A 985(2003) 259-264
5. Accorsi A, Morrone B, et al. High-speed capillary gas chromatography for determination of inhalation anesthetics. Journal of Chromatography A 1071 (2005) 81-84.
6. ACGIH, 1991; “Documentation of the threshold limit values and biological exposure indices. 6th ed. Cincinnati, OH: American Conference of Governmental Industrial Hygienists.
7. ACGIH Worldwide, 2001; “American Conference of Governmental Industrial Hygienists, 2000 TLVs and BEIs.” ACGIH, Cincinnati, USA.
8. Anton GL Burm. Occupational hazards of inhalational anaesthetics. Best Practice & Research Clinical Anaesthesiology 2003; 17(1): 147-161.
9. Baden JR & Simmon VF. Mutagenic effects of inhalational anesthetics. Mutation Research 1980; 75:169-189.
10. Baden JM, Kundomal YR, Luttropp ME et al. Carcinogen bioassay of nitrous oxide in mice. Anesthesiology 1986; 64: 747-750.
11. Baden JM & Rice SA. Metabolism and toxicity. In Miller MD (ed.) Anesthesia, 4th edn. New York: Churchill Livingstone, 1994; 157-183.
12. Belfarge S, Ahlgren J, Axelson S. Halothane hepatitis in an anaesthetist. Lancet 1966; II: 1466
13. Boland, F.K.; “The first anesthetic—Story of Crawford Long”, Athens, Ga., The University of Georgia Press, 1950.
14.Brody GL, Sweets RB. Halothane anesthesia as a possible cause of massive hepatic necrosis. Anesthesiology 1963; 24: 29-37
15. Bruce DL, Eide KA, Linde HW, Eckenhoff JE. Causes of death among a anesthesiologists: a 20-year survey. Anesthesiology. 1968; 29(3):565-9.
16. Bruce DL, Bach MJ & Arbit J. Trace anesthetic effects on perceptual, cognitive and motor skills. Anesthesiology 1974; 40:453-458.
17. Bruce DL & Bach MJ. Psychological studies of human performance as affected by traces of enflurane and nitrous oxide. Anesthesiology 1975; 42: 194-196.
18. Bruce DL, Eide KA, Smith NJ, Seltzer F, Dykes MH. Characteristics of the American Society of Anesthesiologists' membership, 1967-1971. Anesthesiology. 1974; 41(1):67-70.
19. Bruce DL & Bach MJ. Effects of trace aneaesthetic gases on behavioural performance of volunteers. British Journal of Anaesthesia 1976; 48: 871-876.
20. Bunker JP, Blumenfeld CM. Liver necrosis after halothane anesthesia: cause or coincidence? N Engl J Med 1963; 268: 531-4
21. Buring JE, Hennekens CH & Mayrent SL et al. Health experiences of operating room personnel. Anesthesiology 1985; 62:325-330.
22. Byhahn C, Wilke HJ & Westphal K. Occupational Exposure to Volatile Anaesthetics: Epidemiology and Approaches to Reducing the Problem. CNS Drug 2001; 15(3): 197-215.
23. Chang WP, Kau CW, Hseu SS. Exposure of anesthesiologists to nitrous oxide during pediatric anesthesia. Ind Health. 1997; 35(1):112-8.
24. Chang WP, Kau C, Hseu S. Waste anesthetic nitrous oxide suspected to be f frequent contaminant in medical practices worldwide. Arch Environ Health. 1997; 52(2):149.
25. Coate WB, Ulland BM, Lewis TR. Chronic exposure to low concentrations of halothane-nitrous oxide: lack of carcinogenic effect in the rat. Anesthesiology. 1979; 50(4):306-9.
26. Cohen EN, Bellville JW, Brown BW Jr. Anesthesia, pregnancy, and miscarriage: a study of operating room nurses and anesthetists. Anesthesiology. 1971; 35(4):343-7.
27. Cohen EN, Gift HC, Brown BW, Greenfield W, Wu ML, Jones TW, Whitcher CE, Driscoll EJ, Brodsky JB. Occupational disease in dentistry and chronic exposure to trace anesthetic gases. J Am Dent Assoc. 1980; 101(1):21-31.
28. Cook TL, Smith M, Starkweather JA et al. Behavioral effects of trace and subanesthetic halothane and nitrous oxide in man. Anesthesiology 1978; 49: 419-424.
29. Corbett TH, Cornell RG, Endres JL & Millard RI. Effects of low concentrations of nitrous oxide on rat pregnancy. Anesthesiology 1973; 39: 299-301.
30. Corbett TH, Cornell RG, Lieding K, Endres JL. Incidence of cancer among Michigan nurse-anesthetists. Anesthesiology. 1973; 38(3):260-3.
31. Cox, P.C. and Brown, R.H., 1984; “A Personal Sampling Method for the Determination of Nitrous Oxide Exposure,” Am. Ind. Hyg. Assoc. J. 45(5):345-350.
32. Davies DA. The operating room: an unhealthy environment? In Davis DA (ed.) Historical Vignettes of Modern Anesthesia, 2. Oxford; Blankwell Scientific Publications, 1968; 42-45.
33. De Zotti R, Negro C, Gobbato F. Results of hepatic and hemopoietic controls in hospital personnel exposed to waste anesthetic gases. Int Arch Occup Environ Health. 1983; 52(1):33-41.
34. Dinn JJ, Weir DG, McCann S, Reed B, Wilson P, Scott JM. Methyl group deficiency in nerve tissue: a hypothesis to explain the lesion of subacute combined degeneration. Ir J Med Sci. 1980; 149(1):1-4.
35. Doll R, Peto R. Mortality among doctors in different occupations. Br Med J. 1977; 1(6074):1433-6.
36. Eger II EI, Smuckler EA, Ferrell LD, et al. Is enflurane hepatotoxic? Anesth Analg 1986; 65: 21-30.
37. Eger EI 2nd, White AE, Brown CL, Biava CG, Corbett TH, Stevens WC. A test of the carcinogenicity of enflurane, isoflurane, halothane, methoxyflurane, and nitrous oxide in mice. Anesth Analg. 1978; 57(6):678-94
38. Ericson A, Kallen B. Survey of infants born in 1973 or 1975 to Swedish women working in operating rooms during their pregnancies. Anesth Analg. 1979; 58(4):302-5.
39. Ferstandig LL. Trace concentrations of anesthetic gases: a critical review of their disease potential. Anesthesia & Analgesia 1978; 57: 328-345.
40. Frankhuizen JL, Vlek CAJ, Burm AGL & Rejger V. Failure to replicate negative effects of trace aneaesthetics on mental performance. British Journal of Anaesthesia 1978; 50: 229-234.
41. Green CD, Eastwood DW. Effects of nitrous oxide inhalation on hemopoiesis in rats. Anesthesiology. 1963; 24:341-5.
42. Green CJ, Monk SJ, Knight JF et al. Chronic exposure of rats to enflurane 200ppm: no evidence of toxicity or teratogenicity. British Journal of Anaesthesia 1982; 54: 1097-1104.
43. Guirguis SS, Pelmear PL, Roy ML & Wong L. Health effects associated with exposure to anaesthetic gases in Ontario hospital personnel. British Journal of Industrial Medicine 1990; 47: 490-497.
44. Hardin RD et al.Testing of selected workplace chemicals for teratogenic potential. Scand. J. Work. Environ. Health 1981; 7(4):66.
45. Hoerauf KH, Hartmann T, Zavrski A, et al. Occupational exposure to sevoflurane during sedation of adult patients. Int Arch Occup Environ Health 1999; 72: 174-7
46. Hoerauf KH. Nitrous oxide: workplace concentrations/ ecology. Bailliere’s Clinical Anaesthesiology 2001; 15: 389-396.
47. Halsey MJ, Green CJ, Monk SJ et al. Maternal and paternal chronic exposure to enflurane and halothane: fetal and histological changes in the rat. British Journal of Anaesthesia 1981; 53; 203-215.
48. Halsey MJ. Occupational Exposure to Inhalational Anaesthetics. Abingdon: The Medicine Group, 1995.
49. Hathaway GJ, Proctor NH, Hughes JP, and Fischman ML, 1991; “Proctor and Hughes' chemical hazards of the workplace”, 3rd ed. New York, NY: Van Nostrand Reinhold.
50. Hessiches Landessozialgericht. Az L-3/U-1152/86 [in German]. Frankfurt am Main: Hessisches Lanessozialgericht, 1992
51. Junge CE. Air Chemistry and Radioactivity. Academic Press, New York, N.Y., 1963, pp81-84.
52. Jurgen Hahn. Improved Gas Chromatographic Method for Field Measurement of Nitrous Oxide in Air and Water Using a 5A Molecular Sieve Trap. Anal Chem., 44(11) 1972.
53. Klatskin G, KimbergDV. Recurrent hepatitis attributable to halothane sensitization in an anesthetist. N Engl J Med 1969; 280: 515-22
54. Knill-Jones RP, Rodrigues LV, Moir DD, Spence AA. Anaesthetic practice and pregnancy. Controlled survey of women anaesthetists in the United Kingdom. Lancet. 1972; 1(7764):1326-8.
55. Koblin DD, Watson JE, Deady JE, Stokstad EL, Eger EI 2nd. Inactivation of methionine synthetase by nitrous oxide in mice. Anesthesiology. 1981; 54(4):318-24.
56. Kristensson, J. and Widén, M., 1986; “Development and Evaluation of Diffusive Sampler for Measurements of Anesthetic Cases,” International Symposium held in Luxembourg, 22-26 Sep.
57. LaHue MD, Axelrod HD, Lodge JP. Measurement of Atmospheric Nitrous Oxide Using a Molecular Sieve 5A Tran and Gas Chromotagraphy. Anal Chem., 43(8) 1971
58. Lauwerys R, Siddons M, Misson CB et al. Anaesthetic health hazards among Belgian nurses and physicians. International Archives of Occupational and Environmental Health 1981; 48: 195-203.
59. Layzer RB. Myeloneuropathy after prolonged exposure to nitrous oxide. Lancet. 1978; 2(8102):1227-30.
60. Lew EA. Mortality experience among anesthesiologists, 1954-1976. Anesthesiology. 1979; 51(3):195-9.
61. Lindenbaum J, Leifer E. Hepatic necrosis associated with halothane anesthesia. N Engl J Med 1963; 268: 525-30
62. Mazze RI. Fertility, reproduction, and postnatal survival in mice chronically exposed to isoflurane. Anesthesiology 1951; 63: 663-667.
63. Mazze RI, Wilson AI, Rice SA & Baden JM, Reproduction and fetal development in mice chronically exposed to nitrous oxide. Teratology 1982; 26: 11-163.
64. Mazze RI, Rice SA, Wyrobek AJ et al. Germ cell studies in mice after prolonged exposure to nitrous oxide. Toxicology and applied pharmacology 1983; 67: 370-375.
65. Mazze RI, Wilson AI, Rice SA & Baden JM. Reproduction and fetal development in rats exposed to nitrous oxide. Teratology 1984; 30:259-265.
66. NIOSH, 1977; “Criteria for a recommended standard–occupational exposure to waste anesthetic gases and vapors.” DHEW (NIOSH) No. 77–140.
67. NIOSH, USA, 1994; “NIOSH Manual of Analytical Method”, 4th ed. Method 6600: Nitrous Oxide.
68. Nunn JF, Sharer N, Royston D, Watts RW, Purkiss P, Worth HG. Serum methionine and hepatic enzyme activity in anaesthetists exposed to nitrous oxide. Br J Anaesth. 1982; 54(6):593-7.
69. OSHA, 1994; “Computerized information system. Washington, DC: U.S. Department of Labor, Occupational Safety and Health Administration.”
http://www.osha.gov/dts/sltc/methods/inorganic/id166/id166.html
70. Pharoah PO, Alberman E, Doyle P, Chamberlain G. Outcome of pregnancy among women in anaesthetic practice. Lancet. 1977; 1(8001):34-6.
71. Pope WDB, Halsey MJ, Lansdown ABG & Bateman PE. Lack of teratogenic dangers with halothane. Acta Anaesthesiologica Belgica 1975; 26: 169-173.
72. Pope WD, Halsey MJ, Lansdown AB, Simmonds A, Bateman PE. Fetotoxicity in rats following chronic exposure to halothane, nitrous oxide, or methoxyflurane. Anesthesiology. 1978; 48(1):11-6.
73. Rejger V, Burm AGL & Spierdijk J. Working in operating rooms, an unhealthy existence? Acta Anaesthesiologica Belgica 1975; 26: 174-181.
74. Rice SA, Mazze RI, Baden JM. Effects of subchronic intermittent exposure to nitrous oxide in Swiss Webster mice. J Environ Pathol Toxicol Oncol. 1985; 6(2):271-81.
75. Sando MJ, Lawrence JR. Bone-marrow depression following treatment of tetanus with protracted nitrous-oxide anaesthesia. Lancet. 1958; 274:588.
76. Sharer NM, Nunn JF, Royston JP, Chanarin I. Effects of chronic exposure to nitrous oxide on methionine synthase activity. Br J Anaesth. 1983; 55(8):693-701.
77. Smith G & Shirley AW. Failure to demonstrate effect of trace concentrations of nitrous oxide and halothane on psychomotor performance. British Journal of anaesthesia 1977; 49: 65-70.
78. Stevens WC, Eger EI 2nd, White A, Biava CG, Gibbons RD, Shargel R. Comparative toxicities of enflurane, fluroxene and nitrous oxide at subanaesthetic concentrations in laboratory animals. Can Anaesth Soc J. 1977; 24(4):479-90.
79. Stoelting RK, Blitt CD, Cohen PJ, et al. Hepatic dysfunction after isoflurane anesthesia. Anesth Analg 1987; 66: 147-53
80. Venables H, Cherry N, Waldron HA et al. Effects of trace levels of nitrous oxide on psychomotor performance. Scandinavian Journal of Work, Environment and Health 1983; 9: 391-396.
81. Vessey MP. Epidemiological studies of the occupational hazards of aneaesthesia-a review. Anaesthesia 1978; 33: 430-438.
82. Vieira E, Cleaton-Jones P, Austin JC, Moyes DG, Shaw R. Effects of low concentrations of nitrous oxide on rat fetuses. Anesth Analg. 1980; 59(3):175-7.
83. Vieira E, Cleaton-Jones P & Moyes D. Effects of intermittent 0.5% nitrous oxide/air (v/v) on the fertility of male rats and the post-natal growth of their offspring. Anaesthesia 1983; 38: 319-323.
84. Vieira E, Cleaton-Jones P & Moyes D. Effects of low intermittent concentrations of nitrous oxide on the developing rat fetus. British Journal of Anaesthesia 1983; 55:67-69.
85. Wharton RS, Mazze RI & Wilson AI. Reproduction and fetal development in mice chronically exposed to enflurane. Anesthesiology 1981; 54: 505-510.
86. 行政院勞委會勞工安全衛生研究所,民國90 年;”醫療院所麻醉用笑氣測定技術評估”。
87. 行政院勞工委員會,勞工作業環境空氣中有害物採樣分析建議方法通則篇,民國84年12月。
88. 李潤海:中國醫藥學家史話。明文書局,1984。
89. 林志彬、金有豫:醫用藥理學。九州圖書文物有限公司。2002。
90. 林佳谷:醫學史與自然醫學。合記書局,2000。
91. 林松洲:應用藥理學。豪峰出版社,1999。
92. 高金華:臨床麻醉學。國立編譯館,1981。
93. 高崎真弓:圖解麻醉學,曾清楷譯。長年出版社,1995。
94. 陳永松:護理人員麻醉廢氣之環境偵測與生殖危害。國防醫學院公共衛生研究所碩士論文,2004。
95. 陳逸光:臨床藥理學(上冊)。環球書社,1980。
96. 陳勝崑:中國傳統醫學史。橘井文化事業股份有限公司,1992。
97. 張文亮:科學大師的求學、戀愛與理念。校園出版社,1996。
98. 張傳林:臨床麻醉手冊。九州圖書文物有限公司,1990。
99. 趙繼慶:麻醉學手冊。合記圖書出版社,1988。
100.蔡蓮貴譯:MGH臨床麻醉手冊。九州圖書文物有限公司,2001。
101.環境樣品採集及保存作業指引, 93年10月4日環署檢字第0930072069B號公告修正。
102.魏子孝、聶莉芳:中國古代醫藥衛生。台灣商務印書館股份有限公司,1994。
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