Second-hand exposure to aerosolized intravenous anesthetics propofol and fentanyl may cause sensitization and subsequent opiate addiction among anesthesiologists and surgeons

McAuliffe, Priscilla F.; Gold, Mark S.; Bajpai, Lakshmikant; Merves, Michele L.; Frost-Pineda, Kimberly; Pomm, Raymond M.; Goldberger, Bruce A.; Melker, Richard J.; Cendán, Juan C.

doi:10.1016/j.mehy.2005.10.030

« Previous Next »Medical Hypotheses
Volume 66, Issue 5 , Pages 874-882, 2006

Second-hand exposure to aerosolized intravenous anesthetics propofol and fentanyl may cause sensitization and subsequent opiate addiction among anesthesiologists and surgeons☆

Priscilla F. McAuliffe
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100286, Gainesville, FL 32610, United States
- Corresponding author. Tel.: +1 352 265 0494; fax: +1 352 265 0676 (P.F. McAuliffe).
- Supported in part by a T32 Training Grant (T32 GM-08721-05), funded by the National Institute of General Medical Sciences.
Mark S. Gold
- Department of Psychiatry, University of Florida College of Medicine, PO Box 100183, Gainesville, FL 32610, United States
Lakshmikant Bajpai
- Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, Gainesville, FL 32610, United States
Michele L. Merves
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, PO Box 100275, Gainesville, FL 32610, United States
Kimberly Frost-Pineda
- Department of Psychiatry, University of Florida College of Medicine, PO Box 100183, Gainesville, FL 32610, United States
Raymond M. Pomm
- State of Florida Professionals Resource Network, University of Florida College of Engineering, Gainesville, FL 32611, United States
Bruce A. Goldberger
- Department of Psychiatry, University of Florida College of Medicine, PO Box 100183, Gainesville, FL 32610, United States
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida College of Medicine, PO Box 100275, Gainesville, FL 32610, United States
Richard J. Melker
- Department of Anesthesiology, University of Florida College of Medicine, PO Box 100254, Gainesville, FL 32610, United States
- Department of Biomedical Engineering, University of Florida College of Engineering, Gainesville, FL 32611, United States
Juan C. Cendán
- Department of Surgery, University of Florida College of Medicine, 1600 SW Archer Road, PO Box 100286, Gainesville, FL 32610, United States

Received 17 July 2005; accepted 25 October 2005. published online 23 January 2006.

Summary

We hypothesize that aerosolization of anesthetics administered intravenously to patients in the operating room may be an unintended source of exposure to physicians. This may lead to inadvertent sensitization, which is associated with an increased risk for developing addiction. This may contribute to the over-representation of certain specialties among physicians with addiction.

We retrospectively reviewed the de-identified demographic information of all licensed physicians treated for substance abuse in the State of Florida since 1980, to determine if medical specialty was associated with addiction in this group of individuals. Then, to identify the potential for exposure, two mass spectrometry assays were developed to detect two intravenously administered drugs, fentanyl and propofol, in air.

Since 1980, 7.6% of licensed Florida physicians underwent treatment for addiction. Addiction in anesthesiologists was higher than expected. Opiate abuse was greater in anesthesiologists and surgeons compared to other specialties. Aerosolized fentanyl was detected in the air of the cardiothoracic operating room, in patients’ expiratory circuits, and in the headspace above sharps boxes, but not in adjoining hallways. Aerosolized propofol was detected in the expirations of a patient undergoing transurethral prostatectomy.

While access and stress may place anesthesiologists and surgeons at greater risk for substance abuse, an additional risk factor may be unintended occupational exposure to addictive drugs. This report provides preliminary evidence of detection of aerosolized intravenous anesthetics using two newly developed analytical methods. We conclude that the potential exists for chronic exposure to low levels of airborne intravenously administered drugs. Further studies are under way to determine the significance of this exposure.