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The Effect of the Double Mask on Anesthetic Waste Gas Levels During Pediatric Mask Inductions in Dental Offices

A significant portion of office-based general anesthesia for pediatric patients is performed in dental offices and involves mask inductions with inhaled drugs. This can lead to significant pollution with waste gases. We assessed occupational exposure to anesthetic drugs during pediatric general anesthesia in dental offices and assessed the effectiveness of the “double mask.” Nine freestanding dental offices had measurements of anesthetic waste gas levels taken before and immediately after implementation of a double-mask system. Levels of nitrous oxide decreased from a median of 40.0 parts per million (ppm; interquartile range [IQR] = 23.0–46.0 ppm, n = 9) to 3.0 ppm, (IQR = 2.3–4.7 ppm, n = 9, P = 0.0055) and exceeded 25 ppm in 0% of the 9 offices (upper 95% confidence limit 34%) when using the double mask. Levels of sevoflurane decreased from a median of 4.60 ppm (IQR = 3.10–7.00 ppm, n = 9) to 0 ppm (IQR = 0–0.39 ppm, n = 9, P = 0.0024) and exceeded 2 ppm in 0% of the 9 offices (upper 95% confidence limit 34%) when using the double mask. We demonstrated in our study that the double-mask system, when used with dental “high-volumes” suctions (high-volume evacuators producing approximately 12 m3/h) in freestanding dental offices, was sufficient to decrease the exposure to anesthetic waste gas during pediatric mask induction in at least two thirds of offices when compared with the traditional mask.