1
|
Jabaudon M, Vallabh B, Bacher HP, Badenes R, Kehl F. Balancing patient needs with environmental impacts for best practices in general anesthesia: Narrative review and clinical perspective. Anaesth Crit Care Pain Med 2024; 43:101389. [PMID: 38710324 DOI: 10.1016/j.accpm.2024.101389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 04/09/2024] [Accepted: 04/17/2024] [Indexed: 05/08/2024]
Abstract
Discussions of the environmental impacts of general anesthetics have focused on greenhouse gas (GHG) emissions from inhaled agents, with those of total intravenous anesthesia (TIVA) recently coming to the forefront. Clinical experts are calling for the expansion of research toward life cycle assessment (LCA) to comprehensively study the impact of general anesthetics. We provide an overview of proposed environmental risks, including direct GHG emissions from inhaled anesthetics and non-GHG impacts and indirect GHG emissions from propofol. A practical description of LCA methodology is also provided, as well as how it applies to the study of general anesthesia. We describe available LCA studies comparing the environmental impacts of a lower carbon footprint inhaled anesthetic, sevoflurane, to TIVA/propofol and discuss their life cycle steps: manufacturing, transport, clinical use, and disposal. Significant hotspots of GHG emission were identified as the manufacturing and disposal of sevoflurane and use (attributed to the manufacture of the required syringes and syringe pumps) for propofol. However, the focus of these studies was solely on GHG emissions, excluding other environmental impacts of wasted propofol, such as water/soil toxicity. Other LCA gaps included a lack of comprehensive GHG emission estimates related to the manufacturing of TIVA plastic components, high-temperature incineration of propofol, and gas capture technologies for inhaled anesthetics. Considering that scarce LCA evidence does not allow for a definite conclusion to be drawn regarding the overall environmental impacts of sevoflurane and TIVA, we conclude that current anesthetic practice involving these agents should focus on patient needs and established best practices as more LCA research is accumulated.
Collapse
Affiliation(s)
- Matthieu Jabaudon
- Department of Perioperative Medicine, CHU Clermont-Ferrand and iGReD, Université Clermont Auvergne, CNRS, INSERM, Clermont-Ferrand, France.
| | - Bhadrish Vallabh
- Global Medical Affairs, AbbVie Biopharmaceuticals GmbH, Dubai, United Arab Emirates
| | - H Peter Bacher
- Global Medical Affairs, AbbVie Inc., North Chicago, IL, USA
| | - Rafael Badenes
- Department of Anesthesiology and Surgical-Trauma Intensive Care and Pain Clinic, Hospital Clínico Universitario de Valencia, University of Valencia, Valencia, Spain
| | - Franz Kehl
- Department of Anesthesia and Intensive Care Medicine, Klinikum Karlsruhe, Karlsruhe, Germany
| |
Collapse
|
2
|
Yang L, Hubert J, Gitundu S, Brovman E, Cobey F. Carbon Footprint of Total Intravenous and Inhalation Anesthesia in the Transcatheter Aortic Valve Replacement Procedure. J Cardiothorac Vasc Anesth 2024; 38:1314-1321. [PMID: 38490897 DOI: 10.1053/j.jvca.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 02/11/2024] [Accepted: 02/18/2024] [Indexed: 03/17/2024]
Abstract
OBJECTIVES To quantify and compare the emissions for deep sedation with total intravenous anesthesia (TIVA) and general anesthesia with inhaled agents during the transcatheter aortic valve replacement procedure. DESIGN A retrospective study. SETTING A tertiary hospital in Boston, Massachusetts. PARTICIPANTS The anesthesia records of 604 consecutive patients who underwent the transcatheter aortic valve replacement procedure between January 1, 2018, and March 31, 2022, were reviewed and analyzed. INTERVENTIONS Data were examined and compared in the following 2 groups: general anesthesia with inhaled agents and deep sedation with TIVA. MEASUREMENTS AND MAIN RESULTS The gases, drugs, airway management devices, and anesthesia machine electricity were collected and converted into carbon dioxide emissions (CO2e). The carbon emissions of intravenous medications were converted with the CO2e data for anesthetic pharmaceuticals from the Parvatker et al. study. For inhaled agents, inhaled anesthetics and oxygen/air flow rate were collected at 15-minute intervals and calculated using the anesthetic gases calculator provided by the Association of Anesthetists. The airway management devices were converted based on life-cycle assessments. The electricity consumed by the anesthesia machine during general anesthesia was estimated from the manufacturer's data (Dräger, GE) and local Energy Information Administration data. The data were analyzed in the chi-squared test or Wilcoxon rank-sum test. There were no significant differences in the patients' demographic characteristics, such as age, sex, weight, height, and body mass index. The patients who received general anesthesia with inhaled agents had statistically higher total CO2e per case than deep sedation with TIVA (16.188 v 1.518 kg CO2e; p < 0.001), primarily due to the inhaled agents and secondarily to airway management devices. For deep sedation with TIVA, the major contributors were intravenous medications (71.02%) and airway management devices (16.58%). A subgroup study of patients who received sevoflurane only showed the same trend with less variation. CONCLUSIONS The patients who received volatile anesthesia were found to have a higher CO2e per case. This difference remained after a subgroup analysis evaluating those patients only receiving sevoflurane and after accounting for the differences in the duration of anesthesia. Data from this study and others should be collectively considered as the healthcare profession aims to provide the best care possible for their patients while limiting the harm caused to the environment.
Collapse
Affiliation(s)
- Lei Yang
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA.
| | - Joshua Hubert
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Samwel Gitundu
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Ethan Brovman
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| | - Frederick Cobey
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Boston, MA
| |
Collapse
|
3
|
Baker MB, Hsieh A, Gupta V, Kim Y, Merriel M, Nozari A, Binda DD. The Color of Climate Change: Can Choice of Anesthetic Be Institutionally Racist? Anesth Analg 2024; 138:1154-1158. [PMID: 38771597 DOI: 10.1213/ane.0000000000006809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Affiliation(s)
- Maxwell B Baker
- From the Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Adam Hsieh
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, ON, Canada
| | - Vaibhav Gupta
- From the Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Yeahan Kim
- From the Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Mason Merriel
- From the Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Ala Nozari
- From the Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Dhanesh D Binda
- From the Department of Anesthesiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| |
Collapse
|
4
|
Tee NCH, Yeo JA, Choolani M, Poh KK, Ang TL. Healthcare in the era of climate change and the need for environmental sustainability. Singapore Med J 2024; 65:204-210. [PMID: 38650058 PMCID: PMC11132617 DOI: 10.4103/singaporemedj.smj-2024-035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 04/25/2024]
Abstract
ABSTRACT Climate change is an existential threat to humanity. While the healthcare sector must manage the health-related consequences of climate change, it is a significant contributor to greenhouse gas emissions, responsible for up to 4.6% of global emission, aggravating global warming. Within the hospital environment, the three largest contributors to greenhouse gas emissions are the operating theatre, intensive care unit and gastrointestinal endoscopy. Knowledge of the health-related burden of climate change and the potential transformative health benefits of climate action is important to all health professionals, as they play crucial roles in effecting change. This article summarises the available literature on the impact of healthcare on climate change and efforts in mitigation, focusing on the intrinsic differences and similarities across the operating theatre complex, intensive care unit and gastrointestinal endoscopy unit. It also discusses strategies to reduce carbon footprint.
Collapse
Affiliation(s)
- Nicholas Chin Hock Tee
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Jo-Anne Yeo
- Duke-NUS Medical School, Singapore
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, Singapore
| | - Mahesh Choolani
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Obstetrics and Gynaecology, National University Hospital, Singapore
| | - Kian Keong Poh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Cardiology, National University Hospital, Singapore
| | - Tiing Leong Ang
- Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore
- Duke-NUS Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| |
Collapse
|
5
|
Jain R, Hudson S, Osmond MH, Trottier ED, Poonai N, Ali S. Nitrous oxide use in Canadian pediatric emergency departments: a survey of physician's knowledge, attitudes, and practices. CAN J EMERG MED 2024; 26:47-56. [PMID: 37855985 DOI: 10.1007/s43678-023-00602-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 09/24/2023] [Indexed: 10/20/2023]
Abstract
OBJECTIVES Nitrous oxide (N2O) is an inhaled analgesic/ anxiolytic gas with evidence supporting its safety and efficacy for distressing procedures in children. Despite this, its use is not consistent across Canadian pediatric emergency departments (EDs). We aimed to characterize a) physicians' knowledge and practices with N2O and b) site-specific N2O protocols in Canadian pediatric EDs to help optimize its use nationally. METHODS This cross-sectional survey was distributed to physician members of Pediatric Emergency Research Canada (PERC) in early 2021. Survey items addressed practice patterns, clinician comfort, and perceived barriers/ facilitators to use. Further, a representative from each ED completed a site-specific inventory of N2O policies and procedures. RESULTS N2O was available in 40.0% of 15 pediatric EDs, with 83.3% of these sites having written policies in place. Of 230 distributed surveys, 67.8% were completed with mean (SD) attending experience of 14.7 (8.6) years and 70.1% having pediatric emergency subspecialty training. Of the 156 respondents, 48.7% used N2O in their clinical practice. The most common indications for use were digit fracture/ dislocation reduction (69.7%), wound closure (60.5%), and incision & drainage (59.2%). Commonly perceived facilitators were N2O equipment availability (73.0% of 156) and previous clinical experience (71.7% of 156). Of the 51.3% of physicians who reported not using N2O, 93.7% did not have availability at their site; importantly, the majority indicated a desire to acquire access. They identified concerns about ventilation/ scavenging systems (71.2% of 80) and unfamiliarity with equipment (52.5% of 80) as the most common barriers to use. CONCLUSIONS Despite evidence to support its use, only half of Canadian pediatric ED physicians surveyed use N2O in their clinical practice for treating procedure-related pain and distress. Increased availability of N2O equipment, protocols, and training may improve clinicians' abilities to better manage pediatric acute pain and distress in the ED.
Collapse
Affiliation(s)
- Rini Jain
- Faculty of Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada.
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
- Faculty of Medicine, Department of Pediatrics, Division of Emergency Medicine, Jim Pattison Children's Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| | - Summer Hudson
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Martin H Osmond
- Faculty of Medicine, Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Evelyne D Trottier
- Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montreal, Quebec, Canada
| | - Naveen Poonai
- Departments of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Samina Ali
- Faculty of Medicine and Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Women and Children's Health Research Institute, Edmonton, Alberta, Canada
| |
Collapse
|
6
|
Rao A, Menikefs P. Anesthesiologists should lead nitrous oxide mitigation efforts. Can J Anaesth 2024; 71:152-153. [PMID: 37853280 DOI: 10.1007/s12630-023-02625-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Affiliation(s)
- Anita Rao
- Ontario's Anesthesiologists Environmental Sustainability Working Group, Toronto, ON, Canada.
- Trillium Health Partners, Mississauga, ON, Canada.
| | - Peter Menikefs
- Ontario's Anesthesiologists Environmental Sustainability Working Group, Toronto, ON, Canada
- Unity Health, St. Joseph's Health Centre, Toronto, ON, Canada
| |
Collapse
|
7
|
Lum BX, Liu EH, Tan AY. Excessive N 2O consumption due to pipeline leakages detected through integrated financial and carbon accounting. Can J Anaesth 2023; 70:1707-1708. [PMID: 37656343 DOI: 10.1007/s12630-023-02555-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 09/02/2023] Open
Affiliation(s)
- B X Lum
- Office of Sustainability, National University Health System, Singapore, Singapore.
| | - E H Liu
- Department of Anaesthesia, National University Hospital, Singapore, Singapore
| | - A Y Tan
- Department of Anaesthesia, Alexandra Hospital, Singapore, Singapore
| |
Collapse
|
8
|
See KC. Improving environmental sustainability of intensive care units: A mini-review. World J Crit Care Med 2023; 12:217-225. [PMID: 37745260 PMCID: PMC10515098 DOI: 10.5492/wjccm.v12.i4.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/08/2023] [Accepted: 07/17/2023] [Indexed: 09/05/2023] Open
Abstract
The carbon footprint of healthcare is significantly impacted by intensive care units, which has implications for climate change and planetary health. Considering this, it is crucial to implement widespread efforts to promote environmental sustainability in these units. A literature search for publications relevant to environmental sustainability of intensive care units was done using PubMed. This mini-review seeks to equip intensive care unit practitioners and managers with the knowledge necessary to measure and mitigate the carbon cost of healthcare for critically ill patients. It will also provide an overview of the current progress in this field and its future direction.
Collapse
Affiliation(s)
- Kay Choong See
- Department of Medicine, National University Hospital, Singapore 119228, Singapore
| |
Collapse
|
9
|
Nottelmann K, Menzen A, Röding T, Kehl F, Grünewald M. [Anesthesia in obesity surgery: many roads lead to Rome]. DIE ANAESTHESIOLOGIE 2023:10.1007/s00101-023-01298-w. [PMID: 37316577 DOI: 10.1007/s00101-023-01298-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/16/2023]
Affiliation(s)
- Klaus Nottelmann
- Anästhesiologie, Intensiv- und Schmerzmedizin, Schön Klinik Hamburg Eilbek, Hamburg, Deutschland.
| | - Angelika Menzen
- Anästhesiologie und Intensivmedizin, St. Marien-Hospital Friesoythe, Friesoythe, Deutschland
| | - Thomas Röding
- Adipositaszentrum der Klinik Ernst von Bergmann, Bad Belzig und Adipositaszentrum im Klinikum Ernst von Bergmann, Potsdam, Deutschland
| | - Franz Kehl
- Klinik für Anästhesie und Intensivmedizin, Städtisches Klinikum Karlsruhe gGmbH, Karlsruhe, Deutschland
| | - Matthias Grünewald
- Klinik für Anästhesiologie und Operative Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| |
Collapse
|
10
|
Greener Gases Starter Pack: a tool for transitioning to more sustainable anesthetic volatile agents. Can J Anaesth 2023; 70:445-446. [PMID: 36814056 DOI: 10.1007/s12630-022-02394-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/17/2022] [Accepted: 05/30/2022] [Indexed: 02/24/2023] Open
|
11
|
Schwarz SKW. "Green anesthesia" in the "Green Journal". Can J Anaesth 2023; 70:291-294. [PMID: 36814058 DOI: 10.1007/s12630-022-02396-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 12/14/2022] [Accepted: 12/14/2022] [Indexed: 02/24/2023] Open
Affiliation(s)
- Stephan K W Schwarz
- Department of Anesthesiology, Pharmacology & Therapeutics, The University of British Columbia, and Department of Anesthesia, St. Paul's Hospital/Providence Health Care, 3rd Floor, Providence Bldg., 1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.
| |
Collapse
|