A comparison of different types of hazardous material respirators available to anesthesiologists


  • Keith A. Candiotti, MD
  • Yiliam Rodriguez, MD
  • Ilya Shekhter, MS
  • Catalina Castillo-Pedraza, MD
  • Lisa Forman Rosen, MA
  • Kristopher L. Arheart, EdD
  • David J. Birnbach, MD, MPH




weapons of mass destruction, HAZMAT gear, infectious disease control, mass casualty


Objective: Despite anesthesiology personnel involvement in initial treatment of patients exposed to potentially lethal agents, less than 40 percent of US anesthesiology training programs conduct training to manage these patients.1 No previous studies have evaluated performance of anesthesiologists wearing protective gear. The authors compared the performance of anesthesiologists intubating a high-fidelity mannequin while wearing either a powered air-purifying respirator (PAPR) or a negative pressure respirator (NPR).
Methods: Twenty participants practiced intubations on a high-fidelity simulator until comfortable. Each subject performed 10 repetitions, initially without any gear, then while wearing a protective suit, gloves, and respirator. The order of gear use was randomized and all subjects used both devices. Time for task completion were recorded, and at the end of the trial, subjects were asked to rate their comfort with the equipment.
Results: After controlling for other variables, overall statistically slower total performance times were observed with use of the PAPR when compared to the control arm and use of the NPR (p = 0.01 and p < 0.007, respectively). Of the total 90 intubations, only one proved to be esophageal and initially undetected.
Conclusions: The use of an NPR or PAPR does not preclude an anesthesiologist from successfully intubating, but practice is necessary. The slightly better performance with the NPR is weighed against the improved comfort of the PAPR and the fact that PAPR users could wear eyeglasses. Neither type of gear allowed the users to auscultate the lung fields to confirm correct endotracheal tube placement.

Author Biographies

Keith A. Candiotti, MD

Professor, Clinical Anesthesiology and Internal Medicine, Vice Chair, Clinical Research, University of Miami-Miller School of Medicine, Miami, Florida.

Yiliam Rodriguez, MD

Assistant Professor, Clinical Anesthesiology, Department of Anesthesiology, Division of Cardiac Anesthesia Perioperative Medicine & Pain Management, University of Miami-Miller School of Medicine, Miami, Florida.

Ilya Shekhter, MS

Manager, Simulation Lab, University of Miami- Miller School of Medicine, Miami, Florida.

Catalina Castillo-Pedraza, MD

Post Doctoral Associate, Department of Anesthesiology, University of Miami-Miller School of Medicine, Miami, Florida.

Lisa Forman Rosen, MA

Senior Researcher, Department of Anesthesiology, University of Miami-Jackson Memorial Hospital Center for Patient Safety, Miami, Florida.

Kristopher L. Arheart, EdD

Associate Professor, Epidemiology & Public Health Department, University of Miami-Miller School of Medicine, Miami, Florida.

David J. Birnbach, MD, MPH

Professor and Executive Vice Chairman, Department of Anesthesiology, Associate Dean and Director, UM-JMH Center for Patient Safety, Miami, Florida.


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How to Cite

Candiotti, MD, K. A., Y. Rodriguez, MD, I. Shekhter, MS, C. Castillo-Pedraza, MD, L. F. Rosen, MA, K. L. Arheart, EdD, and D. J. Birnbach, MD, MPH. “A Comparison of Different Types of Hazardous Material Respirators Available to Anesthesiologists”. American Journal of Disaster Medicine, vol. 7, no. 4, Sept. 2012, pp. 313-9, doi:10.5055/ajdm.2012.0104.




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