14 Jan 2020

Occupational Hazards for Pregnant Anesthesia Providers

At the workplace, anesthesia providers are exposed to a variety of hazards that can be detrimental to their health.1 These hazards are biological, such as exposure to infectious diseases; mechanical, such as entanglement with cables from monitoring devices and falls in the operating theater; physical, such as radiation and lasers; chemical, such as pollutants, anesthetic gases, fire and explosion hazards and allergy risks; and personal, such as drug abuse, stress, burnout and exhaustion.1 Researchers have been studying the epidemiology of the occupational hazards in anesthesia for over 40 years,2 and results show that anesthesiologists have higher risk of drug-related death and cerebrovascular disease than general internal medicine practitioners.3 Aside from an elevated risk of suicide and drug addiction associated with work conditions, anesthesiology professionals may face unique issues including allergies to anesthetic drugs4 and operating room pollutants.5 Knowledge of these hazards is especially important for anesthesia providers of reproductive age, as exposure to teratogenic (i.e., causing abnormality to a fetus) or fertility-reducing toxins is possible in the operating room setting.6,7 Many recent studies have focused on occupational exposure to anesthetic gases during pregnancy.8 Anesthesia providers should be aware of the common work-related hazards faced by pregnant anesthesia professionals, as well as potential risks for practitioners and their pregnancies.

Pregnant anesthesia professionals are exposed to a variety of harms in the workplace. For one, pregnant anesthesia providers are subjected to high levels of stress in the operating room environment, which has an adverse effect on pregnancy outcomes.8 Also, chronic exposure to inhalational anesthetics in the operating room atmosphere can cause sensitivity to hepatitis, headaches, nausea, drowsiness, fatigue and irritability.5 When added to the uncomfortable symptoms that may accompany pregnancy, such as nausea, vomiting, moodiness and fatigue,9 gas exposure can make a pregnant anesthesiologist’s experience more unpleasant. Studies have also found that gaseous anesthetic agents can inhibit proper cell division and formation and cause chromosomal abnormalities.10 Furthermore, rapidly dividing cells (such as in fetal development) are highly susceptible to external injuries, meaning that radiation exposure in the operating room environment can alter proper embryo development.11 Also, all anesthesia providers are susceptible to infectious agents due to contact with patients and their bodily fluids.5 This is especially important to pregnant anesthesiology practitioners, whose developing pregnancies could be affected by hepatitis B and C and HIV.5 Though all anesthesia providers are faced with occupational hazards, stress, anesthetic exposure and risk of infection can be particularly harmful to the pregnant anesthesiologist.

Many studies have investigated the associations between work-related harms and reproductive outcomes. For example, a 1974 study by a committee of the American Society of Anesthesiologists12 and a 1983 review by Gold and Beran11 independently showed that pregnant practitioners exposed to anesthetic agents were at higher risk for miscarriage and fetal abnormalities. Cohen et al.’s study found a 2.3-fold increase in spontaneous abortion rates in dental assistants who were heavily exposed to anesthetic agents.13 Saurel-Cubizolles et al. also found that occupational exposure to the operating room environment was associated with spontaneous abortion, though they did not find an elevated risk of birth defects.14 According to Shuhaiber and Koren’s 2000 article, anesthetic exposure can contribute to risk of spontaneous abortion, though not major malformations.15 Meanwhile, Rosenberg and Vänttinen’s 1978 study found no indication that anesthetic gas exposure was harmful to pregnant anesthesiologists, despite a slightly shorter gestation time compared to pregnant pediatricians.6 Thus, the evidence remains mixed on the effects of inhaled anesthetics for pregnant practitioners.

Anesthesia providers face various biological, mechanical, physical, chemical and personal hazards in the workplace. Anesthesiology professionals’ pregnancies can be adversely affected by stress, anesthetic exposure and work-related infection. Though many older publications mention higher risk of fetal malformations and miscarriages in female clinicians who are exposed to anesthetic gases, the evidence remains mixed. Researchers should create prospective, longitudinal, cohort studies to investigate the effects of anesthetic gas exposure on pregnancy. Additionally, all practitioners should receive regular training and education concerning occupational risks and safety.16

1.         Bajwa SJS, Kaur J. Risk and safety concerns in anesthesiology practice: The present perspective. Anesthesia, Essays and Researches. 2012;6(1):14–20.

2.         Vessey MP. Epidemiological studies of the occupational hazards of anaesthesia: A review. Anaesthesia. 1978;33(5):430–438.

3.         Alexander Bruce H, Ph.D., Checkoway H, Ph.D., Nagahama Sonia I, B.A., Domino Karen B, M.D., M.P.H. Cause-specific Mortality Risks of Anesthesiologists. Anesthesiology: The Journal of the American Society of Anesthesiologists. 2000;93(4):922–930.

4.         Newman MJ, Goel P. An Anesthesiologist with an Allergy to Multiple Neuromuscular Blocking Drugs: A New Occupational Hazard. Anesthesia & Analgesia. 2010;110(2):601–602.

5.         Volquind D, Bagatini A, Carneiro Monteiro GM, Londero JR, Benvenutti GD. Occupational Hazards and Diseases Related to the Practice of Anesthesiology. Brazilian Journal of Anesthesiology. 2013;63(2):227–232.

6.         Rosenberg PH, Vänttinen H. Occupational Hazards to Reproduction and Health in Anaesthetists and Paediatricians. Acta Anaesthesiologica Scandinavica. 1978;22(3):202–207.

7.         Pizzorno J. Environmental Toxins and Infertility. Integrative Medicine. 2018;17(2):8–11.

8.         Woerlee GM. Exposure to Anesthetic Gases: Effects on Pregnancy and Health. Anesthesia: Problems & Answers 2020; http://www.anesthesiaweb.org/pollution.php.

9.         Mayo Clinic. Getting pregnant. Healthy Lifestyle 2020; https://www.mayoclinic.org/healthy-lifestyle/getting-pregnant/in-depth/symptoms-of-pregnancy/art-20043853.

10.       Tannenbaum TN, Goldberg RJ. Exposure to anesthetic gases and reproductive outcome: A review of the epidemiologic literature. Journal of Occupational Medicine. 1985;27(9):659–668.

11.       Gold CTK, Beran GW. Occupational Hazards to Pregnant Veterinarians. Iowa State University Veterinarian. 1983;45(1).

12.       American Society of Anesthesiologists. Occupational disease among operating room personnel: A national study. Report of an Ad Hoc Committee on the Effect of Trace Anesthetics on the Health of Operating Room Personnel. Anesthesiology. 1974;41(4):321–340.

13.       Cohen EN, Gift HC, Brown BW, et al. Occupational disease in dentistry and chronic exposure to trace anesthetic gases. Journal of the American Dental Association (1939). 1980;101(1):21–31.

14.       Saurel-Cubizolles MJ, Hays M, Estryn-Behar M. Work in operating rooms and pregnancy outcome among nurses. International Archives of Occupational and Environmental Health. 1994;66(4):235–241.

15.       Shuhaiber S, Koren G. Occupational exposure to inhaled anesthetic. Is it a concern for pregnant women? Canadian Family Physician. 2000;46:2391–2392.

16.       Kim DD, Kimura Jr A, Pontes DKL, Oliveira MLS, Cumino DO. Evaluation of anesthesiologists’ knowledge about occupational health: Pilot study. BMC Anesthesiology. 2018;18(1):193.