Waste gas scavenging during inhalational pediatric anesthesia in Belgium: results of a nationwide questionnaire survey

Background: Volatile anesthetic agents remain a cornerstone in pediatric anesthesia. Studies have shown that staff exposure to waste anesthetic gases is highest during inhalational induction in this subgroup. Aim: This survey was undertaken to assess the current practice in pediatric anesthesia, waste anesthetic gas scavenging and the related air quality measurements in Belgian anesthesiology departments. Method: The 17-question electronic survey using Questback™ was sent to the chairmen of all 94 Belgian departments of anesthesiology. This survey assessed the department’s characteristics and the departmental practices regarding induction and maintenance of anesthesia in pediatric patients. Special attention was given to which type of breathing system was used in pediatric anesthesia and the presence of gas scavenging systems both in and out of the operating room. Further areas of interest were the type and frequency of waste anesthetic gas concentration measurements performed in the hospital. Results: Seventy-one departments (75,5%) responded. Gas scavenging during mask induction in pediatric anesthesia is rather infrequently applied in Belgian hospitals and the open breathing system remains the circuit of choice. During maintenance of pediatric anesthesia, gas scavenging application is twice higher compared to the induction phase. N2O remains a popular agent during induction in pediatric anesthesia. Waste anesthetic gases concentration measurements were conducted in only 25% of all Belgian hospitals and we found a strong relationship between use of gas scavenging during mask induction and implementation of waste anesthetic gases concentration measurements in the operating room. Conclusion: Despite associated occupational health outcomes, the open system without gas scavenging and use of N2O remain popular in pediatric anesthesia, especially during induction. Therefore, we advocate the implementation of standardized European exposure limits, maximal use of waste anesthetic gases scavenging in and outside the operating room and frequent waste anesthetic gases concentration measurements in the operating room to reduce occupational exposure.