KEY POINTS

1. Escape of anesthetic vapors into the operating room atmosphere is unavoidable. In the United States, the limits of exposure to atmospheric waste gases are set by NIOSH, which recommends a time-weighted average of 25 ppm for nitrous oxide and 2 ppm for volatile anesthetics.
2. No definitive evidence has shown that trace concentrations of anesthetics present a health hazard to operating room personnel.
3. Occupational exposure to radiation comes primarily from x-rays scattered by the patient and surrounding equipment. A distance of 6 feet from the patient provides the same protection as 2.5 mm of lead. A distance of 3 feet from the patient is recommended to minimize occupational exposure.
4. Occupational exposure to HIV is most often the result of a percutaneous injury. The risk of transmission is greatest from hollow-bore needles, needles contaminated with visible blood, and a source patient with high viral titer.
5. Postexposure prophylaxis is recommended after occupational exposure to HIV or hepatitis B virus. The U.S. Public Health Service-recommended guidelines for postexposure prophylaxis are available on the CDC website. The National Post-Exposure Prophylaxis Hotline is open 24 hours a day for expert advice (1-888-448-4911).
6. To minimize occupational exposure to blood-borne pathogens, standard precautions should be practiced at all times. The appropriate barrier precautions for anticipated contact with blood or body fluids are published by the CDC. Whenever possible, needleless systems should be used.
7. Sleep deprivation has an adverse effect on physician mood, cognitive function, reaction time, and vigilance. The full impact on patient care has not yet been determined.
8. Anesthesiologists are overrepresented in drug treatment centers. The preference for and access to potent opioids contribute to the prevalence of drug addiction among anesthesiologists.
9. The rate of drug-related deaths is more than twice as high in anesthesiologists as internists.
10. Although many recovered anesthesiologists return to the practice of anesthesia, there is a significant relapse rate. The chance of relapse is highest in physicians who become addicted to potent narcotics early in their career. Successful recovery requires a lifelong commitment to treatment. In some cases, a change in specialty is the only solution.