Summary

Recent developments and developments in the fields of anesthesia, surgery and medical have
expanded the functional scope of the anesthesiologist and thus increased his professional
responsibilities and obligations. While in the workplace, the anesthesiologist is exposed to a wide
range of potential risks that can damage his overall health. Many safety-related risks and concerns
are mentioned in the literature, but the magnitude of the challenges in practicing anesthesia is
much greater than those mentioned and expected. Often these difficult situations cannot be
avoided and the attending anesthesiologist must deal with them on an individual basis. These
risks not only affect public health, but can be very serious in various other ways that can increase
the potential risks of morbidity and mortality. This article is an attempt to spread public
awareness among the anesthesia brothers about the various health risks associated with the
practice of anesthesia. A real attempt has also been made to enumerate the various preventive
methods and precautions that should be adopted to make the practice of anesthesia safe and
smooth.

Keywords: anesthesia, drug use, risk, mortality, radiation, stress, suicide

 Introduction

Gradual advances in anesthesiology and surgical techniques as well as the advent of modern equipment
and newer drugs have also increased the tasks, responsibilities and expectations of the anesthesiologist
significantly in the past few years. However, the health of the anesthesiologist is greatly affected by the
ever-increasing professional and social burden both in the workplace and in personal life.]
Anesthesiologists are expected to offer safe and smooth anesthesia services not only in operating rooms
and intensive care units, but also in various remote locations, pre-intervention consultations, pain
clinics, magnetic resonance imaging (MRI) ward, and radiotherapy centers. Anesthesiologist is also an
essential part of the Trauma and Natural Disaster Management Team. In these locations,
anesthesiologists are exposed to a number of health risks, and even a simple needle prick from an
unknown source can provoke severe anxiety and fear among many anesthesiologists. [2, 3] This article
revolves around these health risks that can be extremely harmful to the professional and personal health
of the attending anesthesiologist.

Therefore, occupational health and safety are of paramount importance while performing professional
duties. The definition of occupational health, as presented by the World Health Organization in 1995,
has an important dimension when such issues are of concern. The definition aims to “promote and
maintain the highest degree of physical, mental and social well-being of workers in all professions;
prevent workers from de-health due to their working conditions; protect workers in their jobs from risks
caused by factors harmful to health; to place and maintain the worker in a professional environment
adapted to physiological and psychological abilities; summarize the adaptation of work to The basic
principle of this definition is Plan-Do-Check-Act (PDCA).

Risks can be broadly classified into the following categories:

Types of dangers

(A) Biological hazards

(B) Mechanical risks

(C) Chemical hazards

(D) The material dangers

(E) Personal dangers

Biological hazards

From ever the dangers of latent infectious diseases, anesthesiologists are exposed in daily practice to
many pathogens that include bacteria, viruses, etc. The incidence of such risks varies from hospital to
hospital and from country to country and a clinically asymptomatic pregnant condition results in an
outright lethal infection.] The risk is very high in developing countries such as India where many
airborne diseases and blood are spread not only in endemic form but also acquire epidemic proportions
very frequently. Besides current epidemics such as swine flu and dengue fever as well as the spread of
airborne pathogens such as tuberculosis, they are equally threatening. Airborne infections are commonly
transmitted in congested places either by direct spray infection or inhalation of infected droplet nuclei
while blood-borne infection is transmitted while securing venous lines, central venous catheterization,
and exposure to a number of body fluids from the patient. Blood-borne infections are commonly
transmitted during invasive procedures such as securing venous lines, central venous catheterization,
and exposure to a number of body fluids from the patient. Needle tingling injury, injury during central
venous catheter suture, injury during local infiltration and regional anesthesia, accidental fall of acute
objects on the legs and feet, exposure to affected spinal cord fluid, oral and pharynx secretions, infected
wounds, administration of anesthesia in infected people Burns and wounds are considered possible
mechanisms by which the an [5 ]

Preventive measures and precautions should be taken to prevent transmission of infection between the
patient and the anesthesiologist and vice versa, hand hygiene is the simplest procedure one can adopt in
the operating room. The work of the Situation Room should be strictly based on the institutional policies
established by the Infection Control Commission. All operating room equipment and anesthesia devices
must be sterilized on a regular basis in accordance with the recommendations of global protocols and
guidelines. There must be strict disposal procedures for equipment that can be used for one time as it
can be a potential source of infection from one patient to another and to anesthesiologist and this also
includes a bacterial filter. The Society of Anesthesiology in Great Britain and Ireland (AAGBI)
recommends changing the anesthesiology circuits on a daily basis in line with global protocols.
Anesthesia procedures, especially invasive procedures, must ensure complete sterilization and the
adoption of septum precautions especially while performing such procedures in high-risk patients.

Tuberculosis incidence and prevalence rate is much higher in developing countries such as India
compared to the West, so anesthesiologists in these countries are always at risk for surgical patients with
a clinically carrier condition of acute tuberculosis. [6] Risks of infection with tuberculosis. Fungal
bacteria increase during the implementation of various procedures in the operating room such as
laryngoscopy, intubation, bronchoscopy, rael tube insertion, mouth and pharynx suction, tracheal
suction, and the use of open circuits (Pains and Jackson Reis) for mechanical ventilation, etc. [ 7 ]
Preventive measures and precautionsThese risks can be minimized by using protective clothing, wearing
masks and gloves during suction and other oral procedures. [8] Possible or suspected exposure must be
confirmed by tuberculosis testing, and if positive, one must take pharmacotherapy for tuberculosis as
indicated or as specified or as indicated.

Swine flu Many swine flu patients have been admitted to emergency surgical wards and intensive care
units at the height of the pandemic. Besides the high probability of infection from a potential source
patient, the anesthesiologist had to manage at-risk pulmonary function, highly reactive airway; systemic
hypotension and multiple organ dysfunction in these patients.

Preventive measures and precautions Although only emergency surgeries are recommended in such
patients, precautions should be taken during such interventions especially in the intensive care unit
during procedures such as suction, bandages, intubation, etc. The role of protective clothing and
specially designed face masks (N95) is of great importance in providing adequate protection. Closed-
loop circuits should be used to avoid contamination and injury to other people in the operating room. In
case of exposure, a 5-day ocyltamyvir course is sufficient along with vaccination against the swine flu
virus.

HIV HIV prevalence among surgery patients and the consequent risks for anesthesiologists have
increased although it is still much lower than other viral infections. It is difficult to confirm the exact fall
of eroded and healthy skin but studies have observed 0.03% to 0.3% after percutaneous exposure to
HIV-infected blood and mucosal skin exposure respectively. Anesthesia, punctures during intramuscular
injection and blood sample withdrawal, during laryngoscopy, intubation and tube removal as well as
during oral and scabular suction.

Preventive measures and precautions The Centers for Disease Control and Prevention has developed
certain guidelines and must be followed in all forms of anesthesia practices to prevent any HIV
infection. Preventive post-exposure prophylaxis insists on immediate washing of the exposed site with
plain water and soap. Antiviral drugs should be taken within an hour and include tenofovir, mitristapine,
zidovudine, lamivudine, lobinavir, and ritonavir. Rapid HIV antibody testing should be done if the
exposure is less than 2 hours and the test should be repeated at 6 and 12 weeks and thereafter at 6
months as the source patients can be in the window period.

Hepatitis The incidence of hepatitis B-bearing condition is estimated at about 1 in 500 people in the
general population, which is a potential risk factor because the majority of these patients will experience
symptoms. The patient is the source in the period of severe infection, that is, the positive case of
hepatitis E antigen. 0.03 ml of infectious blood is enough to cause hepatitis B infection and more
infection occurs using hollow needles than hard needles, especially in unvaccinated health care workers.
[ 14 ] Complications and consequences after viral hepatitis virus infection include chronic hepatitis in
more than 80% of exposed people, including 20% of patients who can develop cirrhosis after 10-15
years and 3-5% can develop fatal hepatocellular carcinoma.

Preventive measures and precautions Anesthesiologists should ensure complete immunization with the
hepatitis B vaccine with an enhanced dose at regular intervals of 5 years. In unvaccinated health care
workers and also whose antibodies cannot be established, they should be treated with hepatitis B-
immunoglobulin along with three injections of the hepatitis B vaccine. However, in the case of hepatitis
C, no vaccine is available yet and post-exposure prophylaxis is of little importance. All abrasions and
wounds, careful disposal of contaminated materials, and sterilization of anesthesia equipment and
devices are sufficient to largely prevent infection. [ 16 ]

Mechanical risks

These are not common risks in routine anesthesia practice but can nevertheless be a potential source of
injury and damage to the workplace anesthesiologist. These can range from minor collisions with
equipment and objects in a narrow and crowded space of the operating room, sliding and falling into the
operating room, falling on pointed objects and cutting broken glass, falling due to entanglement with
various cables for monitoring devices, etc. Continuous injury mechanisms can vary in the form of
cracking, cutting, breaking, abrasions, cutting, and puncture.

Preventive measures and precautionsSimple measures to minimize injury from such risks include
covering all wires and cables of the monitors and the workstation in a single sheet that ust come from one
m

side only, measures to keep the OT area as crowded as possible, cutting off the drug ampoules using knife
pieces and using snap ampoules, using garbage bins and cleaning blood or

The material dangers

These risks can be from different sources such as noise pollution of different alarms, monitoring instruments,
ironing sounds, consistency and vibrations of various equipment, suction devices, bright lights, electrical
hazards from various electrical and electronic devices, and temperature changes in the operating room.

Radiation and nuclear risk Both ionizing and non-ionizing radiation are considered a potential risk for
anesthesiologists at their workplace. [1] The anesthesiologist is exposed to radiation six times more than other
people during interventional angiography procedures and the increased use of the C arm in the exposure of
orthopedic procedures of the anesthesiologist beyond the recommended dose limit of radiation of 15 millisv /
year, and the cumulative effects of radiation affect the entire body or cause local damage to Part of the disaster
management team has to face nuclear risks at times like the deadly Chernobyl disaster, most recently the
Fukushima nuclear threat.] These various sources of radiation may be threatening to the human body as a whole
or may cause local damage to a particular area of the body, depending on the extent and dose of irradiation.

Preventive measures and precautionsThe use of bulletproof vests and thyroid covering collars should be
mandatory for all persons; decals and a radiation dose measuring device should be analyzed on a monthly basis
to calculate cumulative exposure to radiation; maintain distance from the patient because the patient is a
potential source of radiation dispersion. [ 19, 20, 23 ]

Laser risks The most damaging effect of laser use of the eyes occurs from either direct exposure or reflection
across different surfaces and damages various eye tissues such as the cornea, retina, optic nerve, and lens. These
risks can be avoided simply by using special glasses to protect against lasers as well as notification at the
operating room door of a danger mark during the ongoing procedure in order to reduce unnecessary entry of
individuals and accidental laser injuries to them.

Radiological ward Pediatric, uncooperative and patients undergoing mechanical ventilation need the services of
anesthesiologists during radiological diagnostic interventions either in the form of procedural anesthesia or
general anesthesia, [25, 26] which can be fatal to such patients.

Preventive measures and precautionsThe anesthesiologist with these transplanted devices should refrain from
entering these areas and should be vigilant when taking these patients for the required interventions. Sound
vibrations and noises can be equally harmful leading to extreme dizziness, nausea and vomiting and should be
prevented with special earplugs.

Modern technology has provided various monitoring tools to assist the anesthesiologist during the surgery, but
at the same time exposes him to various potential risks from such electrical equipment. Although there are no
confirmed reports, it is generally assumed that exposure to electromagnetic fields of these monitoring
instruments can lead to possible cancer changes in the brain, breast, and blood formation system. These
concerns certainly require significant meta-analytical studies in the future.

Bone and soft tissue injuries Abrasions, tears, and cut-off injuries from the glass are common while picking up
drug ampoules. One of the most common aspects that is overlooked during the administration of general
anesthesia and neuroanaesthesia is the appointment of an anesthesiologist. Although the exact occurrence is
unknown, such a wrong situation while securing the airway and giving neuroaxial anesthesia is harmful to the
back muscles and can lead to disc problems in some at-risk individuals. The introduction of the laryngeal mask
into the airway (LMA) effectively eliminated the risk of first injury to the pharyngeal metatars joint due to
prolonged holding of the face mask during the short anesthesia period for daycare procedures.
Preventive measures and precautions, as far as possible, use specific methods of securing the airway
using LMA in cases of required short-term anesthesia. The position should be comfortable during
general anesthesia or nervous blockade or during laryngoscopy and intubation.

Chemical hazards

Harmful contaminants from phyto-convection and laser use Wearing regular surgical face masks is not
preventive enough and exposes anes anesthesiologists to inhaling toxic fumes, vapors, and gases during
the use of dialysis and lasers. The pore size of the surgical face mask cannot prevent inhaling particles
less than 0.5 μm in diameter while the volume of vapors and toxic gases during the use of thermal and
laser enforcement is usually less than 0.31 μm. Although no human studies have been published so far,
data from various animal studies have shown that inhaling such fumes can be carcinogenic and harmful
to the eyes and skin and can cause poisoning in the kidneys, liver and central nervous system.

Preventive measures and precautionsThese problems can be overcome by using a piston, liver filters,
scavenging systems, wearing protective glasses and using various suction equipment.

Anesthetic gases Nitrous oxide and various halogenated anesthetics such as halogen, isoflurane, and
influrane are involved in various adverse biological effects after absorption through the alveolar
capillary membrane. Anesthesiologist’s exposure to inhalation is higher compared to other operating
room personnel and may exceed environmental endurance limits. [3] Once these body fat-soluble agents
are metabolized, the adverse effects of their products that can cause liver, kidney, and lung toxicity
increase and reduce motor efficiency when chronic exposure. However, issues have been raised from
time to time about the teratogenic effects of anesthetic gases and the resulting congenital malformations
in newborns as well as the high rate of spontaneous abortion among anesthesiologists but nothing
conclusive has been proven so far. [24], the various studies conducted so far have failed to identify a
specific relationship and relationship between these claims.
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