When a female anesthesia provider becomes pregnant, she may develop a new concern that she has not experienced previously—what exactly are the potential hazards of working in the operating room for her baby? Unfortunately, this a difficult question because there are a number of potential hazards and there is really no definitive answer.

Historically, there was concern about the effects on the fetus from exposure to trace anesthetic gases. Studies dating back to the 1960s have attempted to analyze epidemiologic surveys to assess the effects of anesthetic gases on reproductive outcome. Conclusions showing that there was an increased risk of spontaneous abortion and congenital abnormalities in babies of operating room (OR) women have been countered by other reviews that reveal inconsistencies in the data. Also, there was no statistically significant difference between reproductive outcome from exposed and nonexposed groups. A later study in the 1980s did find a statistically significant relative risk of spontaneous abortion and congenital abnormalities due to trace anesthetic gases, but concluded the risk is very small compared to other, more documented environmental hazards. Essentially, pregnant OR staff have the same risk as women working in radiology, agriculture, and horticulture and do not incur meaningful additional risk to their pregnancies because of exposure to anesthetic gas.

Conflicting data exist regarding the implication that trace anesthetic gases may adversely affect any practitioner’s vigilance and may decrease psychomotor function. So then the question becomes, is the mother’s baseline health affected, apart from teratogenic effects? Review of articles from the 1990s to the early 2000s emphasized that with improvement of environmental conditions as required by modern occupational protection and
health care regulations, the use of inhalational anesthetics can be considered to pose no health risk. Some articles, however, do suggest that exposure of health care personnel may exceed recommended levels in poorly ventilated postanesthesia care units. In summary, no studies have demonstrated that trace concentrations of anesthetic waste gases adversely affect women in the OR. With routine use of scavenging techniques, environmental anesthetic levels have been lowered to the extent that proving any adverse outcomes using epidemiologic data will continue to be very difficult.

However, negative reproductive outcomes may be related to other jobassociated factors, such as radiation exposure, fatigue, stress, infections, dehydration, and exposure to other toxic substances. Radiation exposure is probably the biggest concern to the anesthesia provider. The majority of pregnant anesthesiologists handles this issue by simply not working fluoroscopy cases in the OR or any type of case in the radiology suites. Modern OR fluoroscopy machines expose staff to much lower levels of radiation than previously, but there is no recommended safe level of radiation exposure for the developing fetus, especially during the first trimester when organogenesis is taking place. Most anesthesiologists and nurse anesthetists who have been pregnant will tell you that it’s just not worth the anxiety, even with “double lead” and trying to stay a minimum of 6 to 10 feet away from the beam.