Operational Hazard

Whether routine, like a tonsillectomy, or major, like a kidney transplant, surgery always poses a hazard for the patient. But those performing or assisting in the operation may also be taking a risk. A study released last week by the American Society of Anesthesiologists points out that operating-room personnel are more likely than others to develop cancer and kidney and liver disease, suffer miscarriages or have children with birth defects. The probable cause: anesthetic gases.

Doctors have long suspected that even small amounts of such gases, including nitrous oxide and halothane, may be harmful to those who are constantly in contact with them. Animals exposed to anesthetic gases more frequently produced offspring with birth defects. Limited human studies undertaken since 1967 have tended to strengthen the links between anesthetic exposure and a number of health problems. The A.S.A. study, which is the most comprehensive thus far conducted, significantly strengthens the circumstantial evidence against anesthetics.

The A.S.A. bases its indictment on questionnaires distributed to some 50,000 operating-room personnel--anesthesiologists, nurses and technicians --and to 24,000 medical personnel who do not work in the operating room.

The results of the survey are particularly sobering for women. Female anesthetists and operating-room nurses had spontaneous abortion, or miscarriage, rates of from 1.3 to 2.0 times those of unexposed personnel. Congenital abnormalities occurred twice as often in the offspring of exposed female physicians as they did in other women doctors. Women who work in the operating room were also found to be from 1.3 to 2.2 times as likely to develop liver disease, up to 1.4 times as likely to develop kidney disease and up to twice as likely to develop cancer as those who do not.

No Excuse. Male anesthetists were up to 1.6 times as likely to develop liver disease as male pediatricians whose work kept them out of the operating room. The study also found an increase of 25% over the normal rate in the incidence of congenital abnormalities in the children born to unexposed wives of male anesthetists.

The chairman of the A.S.A. committee, Dr. Ellis Cohen, of Stanford University, says that further study will be needed to confirm the case against anesthetic gases. Meanwhile, he urges hospitals to install equipment to remove waste gases from operating rooms. At present, says Cohen, only about 40% of the approximately 25,000 operating rooms in the U.S. have such equipment. The remainder have no excuse for not moving on the problem. Though monitoring gas levels is complex, the equipment for extracting anesthetics costs little more than $100 a room to install.

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