WASHINGTON -- Exposure to fentanyl in the operating room may fuel the consistently high rates of substance abuse among anesthesiologists, Mark S. Gold, M.D., reported at the annual conference of the Association for Medical Education and Research in Substance Abuse.
Although substance use problems among physicians receive more attention than they did in the past, few studies have examined possible prognostic factors, said Dr. Gold, chief of addiction medicine at the University of Florida, Gainesville.
When ether, chloroform, and nitrous gas were used, anesthesiologists would keep track of their mental status because they knew there was a danger of secondhand exposure. What they don't know is that the risk remains despite the use of intravenous analgesics, he said at the conference, also sponsored by Brown Medical School.
When a patient is injected with fentanyl in the operating room, Dr. Gold proposed, he or she becomes the vector for distribution of the analgesic into the air by breathing it out through the mouth. This puts anesthesiologists at increased risk for secondhand exposure because they work directly over the patient. Dr. Gold and his colleagues collected samples of the air in a cardiovascular surgery suite where massive amounts of fentanyl were used--more than the body could metabolize--and found that fentanyl was expired by patients and available for secondhand exposure.
"We collected air and compared chromatograms, and we could extract fentanyl from the air over the patient's mouth, where the anesthesiologist would be," Dr. Gold explained.
The clinical implications of these findings may prompt hospital administrators to reassess their operating room setups. "Just because a drug is injected intravenously does not mean that it won't contaminate the air," Dr. Gold said. Fentanyl is released into the air simply by popping open the vial, for example, or there could be leakage from the intravenous line during surgery.
"We are convinced, based on these data, that further studies are indicated, and we have ongoing sampling of anesthesiologists during cardiovascular surgery to measure their fentanyl levels through second-hand exposure," he said. "We also are planning a provocative functional brain image study where we show a picture of an operating room and measure brain imaging changes."
The air collection study focused on fentanyl because it is 100 times more powerful than morphine and is injected in very high doses. The Department of Defense took an interest in the research, and made a financial contribution, because fentanyl was the drug used to put Russian theater-goers to sleep in 2002 after Chechen rebels had stormed the building.
Fentanyl is a common drug of abuse in Florida. "If you look at the database for the state of Florida, fentanyl is abused in 90% of cases of physician addicts," and if fentanyl is being abused by a physician, there's a "9-out-of-10 chance that it is an anesthesiologist," he said. …