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Grunert M, Hunt MF, Decker M. The environmental impacts of anesthesia. Curr Opin Urol 2024:00042307-990000000-00168. [PMID: 38898779 DOI: 10.1097/mou.0000000000001192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
PURPOSE OF REVIEW The healthcare sector has a substantial environmental footprint, and the delivery of anesthesia contributes significantly. Inhaled anesthetics themselves are potent greenhouse gases, unused intravenous medication exert toxic effects on the environment, and the increasing reliance on single-use devices has led to an ever-growing amount of solid waste produced in operating rooms. This review discusses many of these environmental impacts and suggests practices to mitigate the environmental footprint of anesthetic practice. RECENT FINDINGS The choice of anesthesia maintenance has significant environmental implications, with nitrous oxide and desflurane having the highest carbon footprint of all anesthetic agents. Using low fresh gas flows and supplementing or replacing inhalational agents with propofol leads to a significant reduction in emissions. Many intravenous anesthetic agents pose a risk of environmental toxicity, and efforts should be made to decrease medication waste and ensure appropriate disposal of unused medications to minimize their environmental impacts. Additionally, consideration should be given to replacing single-use devices in the operating rooms with reusable alternatives that are often both environmentally and economically superior. And solid waste generated in the operating room should be segregated thoughtfully, as processing regulated medical waste is a highly energy-intensive process. SUMMARY Significant opportunities exist to improve the environmental footprint of anesthesia practice, and with the rapidly worsening climate crisis, the importance of implementing changes is greater than ever.
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Affiliation(s)
- Matthew Grunert
- Department of Anesthesiology, Critical Care, and Pain Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Taconet C, Hafiani EM, Daigne D, Camus F, Didier M, Paubel P, Siorat V, Tano M, Quesnel C. Potential cost savings and environmental benefits of prefilled syringes of suxamethonium in anaesthesia practice. Br J Anaesth 2024:S0007-0912(24)00145-4. [PMID: 38631943 DOI: 10.1016/j.bja.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 02/24/2024] [Accepted: 03/01/2024] [Indexed: 04/19/2024] Open
Affiliation(s)
- Clémentine Taconet
- Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, DMU DREAM, Sorbonne Université, Paris, France.
| | - El Mahdi Hafiani
- Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, DMU DREAM, Sorbonne Université, Paris, France
| | - Daisy Daigne
- Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, DMU DREAM, Sorbonne Université, Paris, France
| | - Françoise Camus
- Department of Pharmacy, Tenon Hospital, APHP Sorbonne Université, Paris, France
| | - Matthias Didier
- Sustainable Development Projects, Assistance Publique-Hôpitaux de Paris (AP-HP), Strategy and Transformation Department, Paris, France
| | - Pascal Paubel
- General Agency of Equipment and Health Products (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Health Law and Health Economics Department, Faculty of Pharmacy, Paris University, Université Paris Cité, Paris, France; Health Law Institute, Inserm, Paris University, Université Paris Cité, Paris, France
| | - Virginie Siorat
- General Agency of Equipment and Health Products (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Marion Tano
- General Agency of Equipment and Health Products (AGEPS), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Health Law and Health Economics Department, Faculty of Pharmacy, Paris University, Université Paris Cité, Paris, France; Health Law Institute, Inserm, Paris University, Université Paris Cité, Paris, France
| | - Christophe Quesnel
- Department of Anesthesiology and Critical Care Medicine, Tenon University Hospital, DMU DREAM, Sorbonne Université, Paris, France
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Bernat M, Boyer A, Roche M, Richard C, Bouvet L, Remacle A, Antonini F, Poirier M, Pastene B, Hammad E, Fond G, Bruder N, Leone M, Zieleskiewicz L. Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients. Anaesthesia 2024; 79:309-317. [PMID: 38205529 DOI: 10.1111/anae.16221] [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] [Accepted: 12/14/2023] [Indexed: 01/12/2024]
Abstract
Global warming is a major public health concern. Volatile anaesthetics are greenhouse gases that increase the carbon footprint of healthcare. Modelling studies indicate that total intravenous anaesthesia is less carbon intensive than volatile anaesthesia, with equivalent quality of care. In this observational study, we aimed to apply the findings of previous modelling studies to compare the carbon footprint per general anaesthetic of an exclusive TIVA strategy vs. a mixed TIVA-volatile strategy. This comparative retrospective study was conducted over 2 years in two French hospitals, one using total intravenous anaesthesia only and one using a mixed strategy including both intravenous and inhalation anaesthetic techniques. Based on pharmacy procurement records, the quantity of anaesthetic sedative drugs was converted to carbon dioxide equivalents. The primary outcome was the difference in carbon footprint of hypnotic drugs per intervention between the two strategies. From 1 January 2021 to 31 December 2022, 25,137 patients received general anaesthesia in the hospital using the total intravenous anaesthesia strategy and 22,020 in the hospital using the mixed strategy. The carbon dioxide equivalent footprint of hypnotic drugs per intervention in the hospital using the total intravenous anaesthesia strategy was 20 times lower than in the hospital using the mixed strategy (emissions of 2.42 kg vs. 48.85 kg carbon dioxide equivalent per intervention, respectively). The total intravenous anaesthesia strategy significantly reduces the carbon footprint of hypnotic drugs in general anaesthesia in adult patients compared with a mixed strategy. Further research is warranted to assess the risk-benefit ratio of the widespread adoption of total intravenous anaesthesia.
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Affiliation(s)
- M Bernat
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - A Boyer
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Roche
- Pharmacy Department, Service Central des Opérations Pharmaceutiques, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - C Richard
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - L Bouvet
- Department of Anesthesia and Critical Care, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Lyon, France
| | - A Remacle
- Departement of Medical Information, Hôpital Nord, Marseille, France
| | - F Antonini
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Poirier
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - B Pastene
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - E Hammad
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - G Fond
- CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Marseille, France
| | - N Bruder
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - M Leone
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
| | - L Zieleskiewicz
- Department of Anaesthesia and Intensive Care Medicine, Hôpital de la Conception, Assistance Publique des Hôpitaux de Marseille, Aix Marseille University, Marseille, France
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4
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Jabaudon M, Constantin JM. Sedation with volatile anaesthetics in intensive care. BJA Educ 2024; 24:77-80. [PMID: 38375492 PMCID: PMC10874737 DOI: 10.1016/j.bjae.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 02/21/2024] Open
Affiliation(s)
- Matthieu Jabaudon
- CHU Clermont-Ferrand, Clermont-Ferrand, France
- iGReD, Université Clermont Auvergne, Clermont-Ferrand, France
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Dubernet M, Delagnes A, Hadhoum A, Hubert T, Lukowiak O, Moussa M. Using the Anesthetic Gas Filter CONTRAfluran While on Cardiopulmonary Bypass: Preliminary Study of the Feasibility, Security, and Efficiency. J Cardiothorac Vasc Anesth 2024; 38:586-588. [PMID: 38061918 DOI: 10.1053/j.jvca.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/03/2023] [Indexed: 01/27/2024]
Affiliation(s)
- Martin Dubernet
- Department of Cardiovascular Anaesthesia and Intensive Care, CHU Lille, Lille France.
| | - Alexandre Delagnes
- Department of Cardiovascular Anaesthesia and Intensive Care, CHU Lille, Lille France
| | - Ahmed Hadhoum
- Department of Cardiovascular Anaesthesia and Intensive Care, CHU Lille, Lille France
| | - Thomas Hubert
- Department of Cardiovascular Anaesthesia and Intensive Care, CHU Lille, Lille France
| | - Oliver Lukowiak
- Department of Cardiovascular Anaesthesia and Intensive Care, CHU Lille, Lille France
| | - Mouhamed Moussa
- Department of Cardiovascular Anaesthesia and Intensive Care, CHU Lille, Lille France
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Lefrant JY, Pirracchio R, Benhamou D, Lorne E, Roquilly A. Good Luck ACCPM. Anaesth Crit Care Pain Med 2024; 43:101329. [PMID: 37981026 DOI: 10.1016/j.accpm.2023.101329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Affiliation(s)
- Jean Yves Lefrant
- UR-UM103 IMAGINE, University of Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nimes University Hospital, Montpellier, France.
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, 1001 Potrero Avenue, San Francisco, USA
| | - Dan Benhamou
- Paris Sud University, Department of Anaesthesia and Intensive Care Medicine, Bicêtre Hospital, Le Kremlin-Bicêtre, France
| | - Emmanuel Lorne
- Clinique du Millénaire, Department of Anesthesiology and Intensive Care (Akomé), Montpellier, France
| | - Antoine Roquilly
- University of Nantes - Anaesthesiology and Intensive Care Unit, Nantes, France
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Bouvet L, Chasseigne V, Bonnet L, d'Aranda E, Zieleskiewicz L. Sustainability in anesthesia and critical care: Achievements, needs and barriers. Anaesth Crit Care Pain Med 2023; 42:101297. [PMID: 37597838 DOI: 10.1016/j.accpm.2023.101297] [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: 08/11/2023] [Accepted: 08/11/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Lionel Bouvet
- Department of Anesthesiology and Critical Care, Hospices Civils de Lyon, Femme Mère Enfant Hospital, Bron, France; APCSe VetAgro Sup UP 2021.A101 - University of Lyon, Université Claude Bernard Lyon 1, Villeurbanne, France.
| | - Virginie Chasseigne
- Department of Pharmacy, Nîmes University Hospital, University of Montpellier, Nîmes, France; Institute Desbrest of Epidemiology and Public Health, INSERM, University Montpellier, Montpellier, France
| | - Laure Bonnet
- Department of Anesthesiology and Critical Care, Centre Hospitalier Princesse Grace, Monaco; French Society of Anesthesiology and Intensive Care (SFAR) Sustainable Development Committee, Paris, France
| | - Erwan d'Aranda
- French Society of Anesthesiology and Intensive Care (SFAR) Sustainable Development Committee, Paris, France; Intensive Care Unit, Sainte-Anne Military Teaching Hospital, Toulon, France
| | - Laurent Zieleskiewicz
- Department of Anesthesiology and Critical Care, Hôpital Nord, AP-HM, Aix Marseille Université, C2VN, Marseille, France
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