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Nolan BC, Hoskins MJ, Phillips B, Evans KL. Promoting behavioural change by educating anaesthetists about the environmental impact of inhalational anaesthetic agents: A systematic review. Anaesth Intensive Care 2024:310057X241263113. [PMID: 39212176 DOI: 10.1177/0310057x241263113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Of the total carbon footprint of Australia, 7% is attributed to healthcare. In the UK, inhalational agents make up 5% of the healthcare carbon footprint. This systematic review aims to determine which methods of education about the environmental impact of inhalational anaesthetic agents can be utilised to promote behaviour change, reducing the anaesthetic-related carbon footprint. This systematic review sourced records from CINAHL, EMBASE, ERIC, JBI and MEDLINE from 1970 to March 2022. The search identified 589 records, 13 of which met eligibility criteria after the screening process, in which 10 of these records were conference abstracts. Education curricula focused on inhalational agent choice (69%), lowering the fresh gas flow during maintenance anaesthesia (69%), encouraging alternatives such as total intravenous anaesthesia (23%) and/or switching off the gas on transfer (8%). The most common teaching techniques utilised in education curricula were didactic lectures (85%), visual prompts (54%), emails (46%), and conversation forums (31%). All but one study reported a positive relationship between teaching sessions and behavioural change resulting in lower inhalational anaesthetic use by participants and their organisations, reducing healthcare-associated emissions. This systematic review has demonstrated that single education sessions as well as multi-focused, multimodal education curricula on the topic of greener anaesthesia can be beneficial in promoting behavioural change.
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Affiliation(s)
- Brieana C Nolan
- Discipline of Health Professions Education, The University of Western Australia, Crawley, Australia
- Department of General Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Michael J Hoskins
- Discipline of Health Professions Education, The University of Western Australia, Crawley, Australia
- Department of General Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia
| | - Bríd Phillips
- Centre for Arts, The University of Western Australia, Crawley, Australia
| | - Kiah L Evans
- Discipline of Health Professions Education, The University of Western Australia, Crawley, Australia
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2
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Ackermann BW, Merkenschlager A. The Role of TRPV1 in Febrile Seizure Susceptibility: Inflammation, Respiratory Alkalosis, and Seizure Threshold. Am J Respir Cell Mol Biol 2024; 71:139-140. [PMID: 38701493 PMCID: PMC11299084 DOI: 10.1165/rcmb.2024-0182ed] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Indexed: 05/05/2024] Open
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3
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John JB, Collins M, Eames S, O'Flynn K, Briggs TWR, Gray WK, McGrath JS. The carbon footprint of the perioperative transurethral resection of bladder tumour pathway. BJU Int 2024. [PMID: 39051536 DOI: 10.1111/bju.16477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
OBJECTIVES To evaluate the carbon footprint of the perioperative transurethral resection of bladder tumour (TURBT) pathway from decision to treat to postoperative discharge, and model potential greenhouse gas (GHG) emissions reduction strategies. MATERIALS AND METHODS This process-based attributional cradle-to-grave life-cycle assessment (LCA) of GHG emissions modelled the perioperative TURBT pathway at a hospital in Southwest England. We included travel, energy and water use, all reusable and consumable items, and laundry and equipment sterilisation. Resource use for 30 patients undergoing surgery was recorded to understand average GHG emissions and the inter-case variability. Sensitivity analysis was performed for manufacturing location, pharmaceutical manufacturing carbon-intensity, and theatre list utilisation. RESULTS The median (interquartile range) perioperative TURBT carbon footprint was 131.8 (119.8-153.6) kg of carbon dioxide equivalent. Major pathway categories contributing to GHG emissions were surgical equipment (22.2%), travel (18.6%), gas and electricity (13.3%), and anaesthesia/drugs and associated adjuncts (27.0%), primarily due to consumable items and processes. Readily modifiable GHG emissions hotspots included patient travel for preoperative assessment, glove use, catheter use, irrigation delivery and extraction, and mitomycin C disposal. GHG emissions were higher for those admitted as inpatients after surgery. CONCLUSIONS This cradle-to-grave LCA found multiple modifiable GHG emissions hotspots. Key mitigation themes include minimising avoidable patient travel, rationalising equipment use, optimally filling operating theatre lists, and safely avoiding postoperative catheterisation and hospital admission where possible. A crucial next step is to design and deliver an implementation strategy for the environmentally sustainable changes demonstrated herein.
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Affiliation(s)
- Joseph B John
- University of Exeter Medical School, Exeter, UK
- Department of Urology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Getting it Right First Time Programme, NHS England, London, UK
| | | | - Sophie Eames
- Department of Urology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | - Kieran O'Flynn
- Getting it Right First Time Programme, NHS England, London, UK
- Department of Urology, Salford Royal, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Tim W R Briggs
- Getting it Right First Time Programme, NHS England, London, UK
- Department of Surgery, Royal National Orthopaedic Hospital, Stanmore, London, UK
| | - William K Gray
- Getting it Right First Time Programme, NHS England, London, UK
| | - John S McGrath
- University of Exeter Medical School, Exeter, UK
- Department of Urology, Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
- Getting it Right First Time Programme, NHS England, London, UK
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4
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Lui B, White RS, Bryant-Huppert J, Kelleher DC. Environmental sustainability in obstetric anesthesia. Int J Obstet Anesth 2024; 60:104216. [PMID: 39018740 DOI: 10.1016/j.ijoa.2024.104216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 03/15/2024] [Accepted: 06/06/2024] [Indexed: 07/19/2024]
Affiliation(s)
- B Lui
- Weill Cornell Medical College, New York, NY, USA
| | - R S White
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - J Bryant-Huppert
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
| | - D C Kelleher
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
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Nielsen OJ, Sulbaek Andersen MP. Inhalational volatile anaesthetic agents: the atmospheric scientists' viewpoint. Anaesthesia 2024; 79:246-251. [PMID: 38206102 DOI: 10.1111/anae.16119] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2023] [Indexed: 01/12/2024]
Abstract
All sectors of society must reduce their carbon footprint to mitigate climate change, and the healthcare community is no exception. This narrative review focuses on the environmental concerns associated with the emissions of volatile anaesthetic agents, some of which are potent greenhouse gases. This review provides an understanding of the global warming potential metric, as well as the concepts of atmospheric lifetime and radiative efficiency. The state of knowledge of the environmental impact and possible climate forcing of emitted volatile anaesthetic agents are reviewed. Additionally, the review discusses how climate metrics can guide mitigation strategies to reduce emissions and suggests present and future options for mitigating the climate impact.
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Affiliation(s)
- O J Nielsen
- Copenhagen Center for Atmospheric Research, Department of Chemistry, University of Copenhagen, Copenhagen, Denmark
| | - M P Sulbaek Andersen
- Copenhagen Center for Atmospheric Research, Department of Chemistry, University of Copenhagen, Copenhagen, Denmark
- Department of Chemistry and Biochemistry, California State University Northridge, Northridge, CA, USA
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6
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Vukalović J, Marinković BP, Rosado J, Blanco F, García G, Maljković JB. Investigating theoretical and experimental cross sections for elastic electron scattering from isoflurane. Phys Chem Chem Phys 2024; 26:985-991. [PMID: 38088093 DOI: 10.1039/d3cp05052a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
We present a comprehensive analysis of elastic electron scattering from isoflurane in the intermediate energy range of 50-300 eV. This research is motivated by the significant impact of this molecule on global warming effects. We conducted this investigation through experimental measurements using a crossed-beam apparatus and covering a wide angular range from 25 to 125 degrees. Relative differential cross sections (DCSs) were obtained and subsequently normalized on an absolute scale by using the relative flow technique, with argon as the reference gas. These DCS values were then extrapolated and integrated to determine the experimental integral cross sections (ICSs). Additionally, we employed the independent atom model and the screening corrected additivity rule with incorporated Interference effects (IAM-SCAR+I) to calculate the theoretical differential and integral cross-sections. Remarkably, the calculated cross sections align closely with the experimental measurements across the entire energy and angular range. Furthermore, this study involved a comparison of the DCSs for isoflurane with previously published DCS values for two other volatile anesthetics, sevoflurane and halothane.
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Affiliation(s)
- Jelena Vukalović
- Institute of Physics Belgrade, University of Belgrade, Pregrevica 118, Belgrade, 11080, Serbia.
- Faculty of Science, University of Banja Luka, Mladena Stojanovic'a 2, 78000 Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
| | - Bratislav P Marinković
- Institute of Physics Belgrade, University of Belgrade, Pregrevica 118, Belgrade, 11080, Serbia.
| | - Jaime Rosado
- Departamento de Física Atómica Molecular y Nuclear, Facultad de Ciencias Físicas, Universidad Complutense, Avda. Complutense s/n, E-28040 Madrid, Spain
| | - Francisco Blanco
- Departamento de Física Atómica Molecular y Nuclear, Facultad de Ciencias Físicas, Universidad Complutense, Avda. Complutense s/n, E-28040 Madrid, Spain
| | - Gustavo García
- Instituto de Física Fundamental, Consejo Superior de Investigaciones Científicas, Serrano 121, 28006 Madrid, Spain
| | - Jelena B Maljković
- Institute of Physics Belgrade, University of Belgrade, Pregrevica 118, Belgrade, 11080, Serbia.
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Gasciauskaite G, Lunkiewicz J, Tucci M, Von Deschwanden C, Nöthiger CB, Spahn DR, Tscholl DW. Environmental and economic impact of sustainable anaesthesia interventions: a single-centre retrospective observational study. Br J Anaesth 2024:S0007-0912(23)00692-X. [PMID: 38177005 DOI: 10.1016/j.bja.2023.11.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/03/2023] [Accepted: 11/16/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Anaesthesia contributes substantially to the environmental impact of healthcare. To reduce the ecological footprint of anaesthesia, a set of sustainability interventions was implemented in the University Hospital Zurich, Switzerland. This study evaluates the environmental and economic implications of these interventions. METHODS This was a single-centre retrospective observational study. We analysed the environmental impact and financial implications of changes in sevoflurane, desflurane, propofol, and plastic consumption over 2 yr (April 2021 to March 2023). The study included pre-implementation, implementation, and post-implementation phases. RESULTS After implementation of sustainability measures, desflurane use was eliminated, there was a decrease in the consumption of sevoflurane from a median (inter-quartile range) of 25 (14-39) ml per case to 11 (6-22) ml per case (P<0.0001). Propofol consumption increased from 250 (150-721) mg per case to 743 (370-1284) mg per case (P<0.0001). Use of plastics changed: in the first quarter analysed, two or more infusion syringes were used in 62% of cases, compared with 74% of cases in the last quarter (P<0.0001). Two or more infusion lines were used in 58% of cases in the first quarter analysed, compared with 68% of cases in the last quarter (P<0.0001). This resulted in an 81% reduction in overall environmental impact from 3 (0-7) to 1 (0-3) CO2 equivalents in kg per case (P<0.0001). The costs during the final study phase were 11% lower compared with those in the initial phase: from 25 (13-41) to 21 (14-31) CHF (Swiss francs) per case (P<0.0001). CONCLUSIONS Implementing sustainable anaesthesia interventions can significantly reduce the environmental impact and cost of anaesthesia.
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Affiliation(s)
- Greta Gasciauskaite
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland.
| | - Justyna Lunkiewicz
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Tucci
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | | | | | - Donat R Spahn
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
| | - David W Tscholl
- Institute of Anaesthesiology, University Hospital Zurich, Zurich, Switzerland
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8
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Cachefo-Pereira A, Souza Neto EPD. Greening the operating room. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2024; 74:744464. [PMID: 37717924 PMCID: PMC10877345 DOI: 10.1016/j.bjane.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/19/2023]
Affiliation(s)
| | - Edmundo Pereira de Souza Neto
- Intensive care anesthetist at Montauban Hospital, Montauban, France; Intensive care anesthetist at Army Hospital Robert Picqué, Bordeaux, France; Intensive care anesthetist at fire and rescue service, Montauban, France; Committee of Protection of Persons Sud-Ouest et Outre-Mer II, Toulouse, France; Tarn-et-Garonne Medical Council, Montauban, France.
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9
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Ponsonnard S. The end of desflurane. Comment on Br J Anaesth 2022; 129: e81-2. Br J Anaesth 2023:S0007-0912(23)00670-0. [PMID: 38114356 DOI: 10.1016/j.bja.2023.11.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 11/10/2023] [Accepted: 11/23/2023] [Indexed: 12/21/2023] Open
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Gasciauskaite G, Lunkiewicz J, Spahn DR, Von Deschwanden C, Nöthiger CB, Tscholl DW. Environmental sustainability from anesthesia providers' perspective: a qualitative study. BMC Anesthesiol 2023; 23:377. [PMID: 37978425 PMCID: PMC10655271 DOI: 10.1186/s12871-023-02344-1] [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: 07/07/2023] [Accepted: 11/14/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND The world faces a significant global health threat - climate change, which makes creating more environmentally sustainable healthcare systems necessary. As a resource-intensive specialty, anesthesiology contributes to a substantial fraction of healthcare's environmental impact. This alarming situation invites us to reconsider the ecological health determinants and calls us to action. METHODS We conducted a single-center qualitative study involving an online survey to explore the environmental sustainability from anesthesia providers' perspectives in a center implementing internal environmentally-sustainable anesthesia guidelines. We asked care providers how they perceive the importance of environmental issues in their work; the adverse effects they see on ecological sustainability in anesthesia practice; what measures they take to make anesthesia more environmentally friendly; what barriers they face in trying to do so; and why they are unable to adopt ecologically friendly practices in some instances. Using a thematic analysis approach, we identified dominating themes in participants' responses. RESULTS A total of 62 anesthesia providers completed the online survey. 89% of the participants stated that environmental sustainability is essential in their work, and 95% reported that they implement measures to make their practice greener. A conscious choice of anesthetics was identified as the most common step the respondents take to reduce the environmental impact of anesthesia. Waste production and improper waste management was the most frequently mentioned anesthesia-associated threat to the environment. Lacking knowledge/teaching in sustainability themes was recognized as a crucial barrier to achieving ecology goals. CONCLUSIONS Sustainable anesthesia initiatives have the potential to both encourage engagement among anesthesia providers and raise awareness of this global issue. These findings inspire opportunities for action in sustainable anesthesia and broaden the capacity to decrease the climate impact of health care.
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Affiliation(s)
- Greta Gasciauskaite
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland.
| | - Justyna Lunkiewicz
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Donat R Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Corinna Von Deschwanden
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - Christoph B Nöthiger
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
| | - David W Tscholl
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, Zurich, 8091, Switzerland
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11
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Pauchard JC, Hafiani EM, Bonnet L, Cabelguenne D, Carenco P, Cassier P, Garnier J, Lallemant F, Pons S, Sautou V, De Jong A, Caillard A. Guidelines for reducing the environmental impact of general anaesthesia. Anaesth Crit Care Pain Med 2023; 42:101291. [PMID: 37562688 DOI: 10.1016/j.accpm.2023.101291] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To provide guidelines for reducing the environmental impact of general anaesthesia. DESIGN A committee of ten experts from SFAR and SF2H and SFPC learned societies was set up. A policy of declaration of competing interests was applied and observed throughout the guideline-writing process. Likewise, it did not benefit from any funding from a company marketing a health product (drug or medical device). The committee followed the GRADE® method (Grading of Recommendations Assessment, Development and Evaluation) to assess the quality of the evidence on which the recommendations were based. METHODS We aimed to formulate recommendations according to the GRADE® methodology for three different fields: anaesthesia vapours and gases; intravenous drugs; medical devices and the working environment. Each question was formulated according to the PICO format (Population, Intervention, Comparator, Outcome). The literature review and recommendations were formulated according to the GRADE® methodology. RESULTS The experts' work on the synthesis and application of the GRADE® method led to the formulation of 17 recommendations. Since the GRADE® method could not be entirely applied to all of the questions, some of the recommendations were formulated as expert opinions. CONCLUSION Based on strong agreement between experts, we produced 17 recommendations designed to guide reducing the environmental impact of general anaesthesia.
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Affiliation(s)
- Jean-Claude Pauchard
- Ramsay Santé, Member of Société Française d'Anesthésie Réanimation (SFAR) Substainable Development Committee, Clinique Aguiléra, Biarritz, France.
| | - El-Madhi Hafiani
- Department of Anaesthesia, Resuscitation and Perioperative Medicine, DMU DREAM - Tenon Hospital, AP-HP Sorbonne University, Paris, France.
| | - Laure Bonnet
- Department of Anesthesia and Intensive Care, Centre Hospitalier Princess Grace, Monaco
| | | | - Philipe Carenco
- Hygiene Department CHU de Nice, Nice, France; CPias PACA, Marseille, France; AFNOR, La Plaine Saint-Denis, France; Comité Européen de Normalisation, Brussels, Belgium; Bureau de Normalisation de l'Industrie Textile et de l'Habillement (BNITH), domaine des textiles en santé, Paris, France
| | - Pierre Cassier
- Institute of Infectious Agents, Hospices Civils de Lyon, Lyon, France; CIRI, Centre International de Recherche en Infectiologie, Université de Lyon, Inserm, U1111, Université Claude Bernard Lyon 1, CNRS, UMR5308, ENS de Lyon, Lyon, France
| | - Jérémie Garnier
- Department of Anesthesia and Intensive Care Unit, CHU Amiens-Picardie, 1 Rond-Point du Pr Christian Cabrol, 80054 Amiens Cedex 1, France
| | - Florence Lallemant
- Department of Anesthesia and Intensive Care Unit, CHU Lille, F-59000 Lille, France; CHU Lille, Pôle des Urgences, F-59000 Lille, France
| | - Stéphanie Pons
- DMU DREAM, Department of Anesthesiology and Critical Care, Sorbonne University, GRC 29, AP-HP, Pitié-Salpêtrière, Paris, France
| | - Valérie Sautou
- Clermont Auvergne University, Clermont Auvergne INP, CNRS, CHU Clermont Ferrand, ICCF, F-63000 Clermont-Ferrand, France
| | - Audrey De Jong
- PhyMedExp, Montpellier University, INSERM, CNRS, CHU Montpellier, France; Department of Anesthesia and Intensive Care Unit, St-Eloi Hospital, France
| | - Anaïs Caillard
- Department of Anesthesia and Intensive Care Unit, CHU Brest, Cavale Blanche Hospital, France; ORPHY, EA 4324, France
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Liu L, Gu YC, Zhang CP. Recent Advances in the Synthesis and Transformation of Carbamoyl Fluorides, Fluoroformates, and Their Analogues. CHEM REC 2023; 23:e202300071. [PMID: 37098875 DOI: 10.1002/tcr.202300071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/07/2023] [Indexed: 04/27/2023]
Abstract
Carbamoyl fluorides, fluoroformates, and their analogues are a class of important compounds and have been evidenced as versatile building blocks for the preparation of useful molecules in organic chemistry. While major achievements were made in the synthesis of carbamoyl fluorides, fluoroformates, and their analogues in the last half of 20th century, an increasing number of reports have focused on using O/S/Se=CF2 species or their equivalents as the fluorocarbonylation reagents for the direct construction of these compounds from the parent heteroatom-nucleophiles in recent years. This review mainly summarizes the advances in the synthesis and typical application of carbamoyl fluorides, fluoroformates, and their analogues by the halide exchanges and fluorocarbonylation reactions since 1980.
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Affiliation(s)
- Lei Liu
- School of Materials Science and Engineering & School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, 122 Luoshi Road, Wuhan, 430070, China
| | - Yu-Cheng Gu
- Syngenta, Jealott's Hill International Research Centre, Bracknell, Berkshire, RG426EY, UK
| | - Cheng-Pan Zhang
- School of Materials Science and Engineering & School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, 122 Luoshi Road, Wuhan, 430070, China
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13
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Sulbaek Andersen MP, Nielsen OJ, Sherman JD. Assessing the potential climate impact of anaesthetic gases. Lancet Planet Health 2023; 7:e622-e629. [PMID: 37438003 DOI: 10.1016/s2542-5196(23)00084-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 07/14/2023]
Abstract
There is increasing concern within the health-care community about the role care delivery plays in environmental degradation, sparking research into how to reduce pollution from clinical practice. Inhaled anaesthetics is a particular research area of interest for two reasons. First, several gases are potent greenhouse gases, and waste gas is mostly emitted directly to the environment. Second, there are options to reduce gas waste and substitute medications and procedures with fewer embodied emissions while delivering high-quality care. Performance improvements are contingent on a proper understanding of the emission estimates and climate metrics used to ensure consistent application in guiding mitigation strategies and accounting at various scales. We review the current literature on the environmental impact and the estimation of the potential climate forcing of common inhaled anaesthetic drugs: desflurane, sevoflurane, isoflurane, methoxyflurane, and nitrous oxide.
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Affiliation(s)
- Mads Peter Sulbaek Andersen
- Department of Chemistry and Biochemistry, California State University Northridge, Northridge, CA, USA; Copenhagen Center for Atmospheric Research, Department of Chemistry, University of Copenhagen, Copenhagen, Denmark.
| | - Ole John Nielsen
- Copenhagen Center for Atmospheric Research, Department of Chemistry, University of Copenhagen, Copenhagen, Denmark
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, CT, USA
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14
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Davies JF, Trajceska L, Weinberg L. The financial and environmental impact of purchased anaesthetic agents in an Australian tertiary hospital. Anaesth Intensive Care 2023; 51:141-148. [PMID: 36722013 DOI: 10.1177/0310057x221129291] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Anaesthetic agents have various financial and environmental impacts. Climate change is one of the biggest threats to human health, and anaesthetic gases contribute to global heating by acting as greenhouse gases. The primary aim of this study was to quantify the financial and environmental impacts of anaesthesia maintenance agents used during surgery in an Australian university teaching hospital. The volume of desflurane, sevoflurane, isoflurane and propofol purchased by a university teaching hospital between 2010 and 2020 was analysed and described in terms of financial and environmental impact. Estimated carbon emissions and financial costs of each agent per annum were calculated using the volumes purchased for each agent. A model of ideal anaesthetic agent usage was used to hypothesise the financial and environmental impact of replacing desflurane (the most environmentally damaging and expensive agent) with alternative agents. Using 2019 as an example year at our health service, replacing desflurane with low flow sevoflurane would save greenhouse gas emissions equivalent to driving over 1.4 million kilometres in an average petrol car. Removing desflurane from machines at our institution could save an estimated A$14,630 per annum through reduced machine testing alone. Our findings and calculations indicate that reducing the use of desflurane would have both financial and environmental benefits for healthcare.
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Affiliation(s)
- Jessica F Davies
- Anaesthesia Department, Austin Health, Heidelberg, Australia.,Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | | | - Laurence Weinberg
- Anaesthesia Department, Austin Health, Heidelberg, Australia.,Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
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15
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Rübsam ML, Kruse P, Dietzler Y, Kropf M, Bette B, Zarbock A, Kim SC, Hönemann C. A call for immediate climate action in anesthesiology: routine use of minimal or metabolic fresh gas flow reduces our ecological footprint. Can J Anaesth 2023; 70:301-312. [PMID: 36814057 PMCID: PMC10066075 DOI: 10.1007/s12630-022-02393-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 02/24/2023] Open
Abstract
PURPOSE Climate change is a global threat, and inhalational anesthetics contribute to global warming by altering the photophysical properties of the atmosphere. On a global perspective, there is a fundamental need to reduce perioperative morbidity and mortality and to provide safe anesthesia. Thus, inhalational anesthetics will remain a significant source of emissions in the foreseeable future. It is, therefore, necessary to develop and implement strategies to minimize the consumption of inhalational anesthetics to reduce the ecological footprint of inhalational anesthesia. SOURCE We have integrated recent findings concerning climate change, characteristics of established inhalational anesthetics, complex simulative calculations, and clinical expertise to propose a practical and safe strategy to practice ecologically responsible anesthesia using inhalational anesthetics. PRINCIPAL FINDINGS Comparing the global warming potential of inhalational anesthetics, desflurane is about 20 times more potent than sevoflurane and five times more potent than isoflurane. Balanced anesthesia using low or minimal fresh gas flow (≤ 1 L·min-1) during the wash-in period and metabolic fresh gas flow (0.35 L·min-1) during steady-state maintenance reduces CO2 emissions and costs by approximately 50%. Total intravenous anesthesia and locoregional anesthesia represent further options for lowering greenhouse gas emissions. CONCLUSION Responsible anesthetic management choices should prioritize patient safety and consider all available options. If inhalational anesthesia is chosen, the use of minimal or metabolic fresh gas flow reduces the consumption of inhalational anesthetics significantly. Nitrous oxide should be avoided entirely as it contributes to depletion of the ozone layer, and desflurane should only be used in justified exceptional cases.
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Affiliation(s)
- Marie-Luise Rübsam
- Department of Anaesthesia, Intensive Care, Emergency and Pain Medicine, University Medicine of Greifswald, Greifswald, Germany
| | - Philippe Kruse
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Yvonne Dietzler
- Department of Anaesthesia, St. Marienhospital Vechta, Marienstraße 6-8, 49377, Vechta, Germany
| | - Miriam Kropf
- Department of Anaesthesia, Intensive Care, Emergency and Pain Medicine, BG Klinikum Hamburg, Hamburg, Germany
| | - Birgit Bette
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Alexander Zarbock
- Department of Anesthesiology and Critical Care, University Hospital of Muenster, Münster, Germany
| | - Se-Chan Kim
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Bonn, Bonn, Germany
| | - Christian Hönemann
- Department of Anaesthesia, St. Marienhospital Vechta, Marienstraße 6-8, 49377, Vechta, Germany.
- Department of Anesthesiology and Critical Care, University Hospital of Muenster, Münster, Germany.
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Davies JF, Seglenieks R, Cameron R, Kuruvilla NA, Grove EM, Shrivathsa A, Grobler S. Operation clean up: A model for eco-leadership and sustainability implementation. Anaesth Intensive Care 2023; 51:88-95. [PMID: 36721955 DOI: 10.1177/0310057x221102469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Healthcare contributes to environmental harm. Trainee-led Research and Audit in Anaesthesia for Sustainable Healthcare (TRA2SH) is an Australasian network focused on sustainable anaesthesia practice. TRA2SH hypothesised that trainee-led audits alongside education presented on a scheduled national day, called Operation Clean Up, can improve engagement with sustainability initiatives. This paper aims to describe the first two years of Operation Clean Up in terms of goals, achievements and data collected so far. Environmental themes for Operation Clean Up were chosen based on available evidence (life cycle analyses and observational studies). The first Operation Clean Up (OCU 2020) focused on reducing the unnecessary use of single-use disposable absorbent pads (known as 'blueys' in Australia, 'greenies' in New Zealand). OCU 2021 included: refuse desflurane, reduce bluey use, reuse drug trays, and recycle paper and cardboard. TRA2SH provided an information pack to trainees who presented educational material to their department and fed back procurement figures to quantify each item. Descriptive statistics were used to analyse de-identified pooled data submitted to a centralised database.Eight departments submitted data for OCU 2020 and six provided follow-up data. Bluey use was reduced from a median of 37 to 34 blueys per ten surgical encounters. Fifteen departments submitted pre-campaign data for OCU 2021 with follow-up data to be collected during OCU 2022. Baseline data showed a median bluey use of 31 per ten surgical encounters. Volatile-related emissions were calculated; desflurane's proportion was 70% of these emissions yet was 11% of volatile procurement. Two participating departments removed desflurane from their formulary following OCU 2021. Operation Clean Up is a practical model for implementing sustainability initiatives using trainees as eco-leaders.
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Affiliation(s)
- Jessica F Davies
- Department of Anaesthesia, 3805Austin Health, Heidelberg, Australia.,Department of Critical Care, University of Melbourne, Parkville, Australia
| | - Richard Seglenieks
- Department of Critical Care, University of Melbourne, Parkville, Australia.,Department of Anaesthesia, Pain and Perioperative Medicine, Western Health, Footscray, Victoria
| | - Rose Cameron
- Department of Anaesthesia, 58991Auckland City Hospital, Auckland, New Zealand
| | - Niketh A Kuruvilla
- Department of Anaesthesia and Pain Medicine, Mercy Health, Heidelberg, Australia.,Department of Anaesthesia, Perioperative Medicine and Pain Management, Canberra Health, Canberra, Australia
| | - Emma M Grove
- Department of Anaesthesia, 4085Ipswich Hospital, West Moreton Health, Australia
| | - Archana Shrivathsa
- Department of Anaesthesia, Pain and Perioperative Medicine, Fiona Stanley and Fremantle Hospitals Group, Perth, Australia
| | - Sophia Grobler
- Department of Critical Care, University of Melbourne, Parkville, Australia
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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
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18
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Martínez Ruíz A, Maroño Boedo MJ, Guereca Gala A, Escontrela Rodríguez BA, Bergese SD. [ Zero Emissions. A shared responsibility. Gas capture and recycling project at the Cruces University Hospital (Spain).]. Rev Esp Salud Publica 2023; 97:e202301001. [PMID: 36625131 PMCID: PMC10540894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 12/20/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The use of volatile anesthetics plays an important role in the production of greenhouse gases and other environmental pollutants that negatively affect global health. Programs to reduce anesthesia contaminants have been shown to be effective and reduce costs. For this reason, we conducted a study to implementing a Zero Emissions Program for zero carbon dioxide emissions derived from anesthetic gases used in the operating room, as recommended by the Green Deal of the European Union by 2030 and be climate neutral in 2050, maintaining satisfaction and current clinical results. METHODS A Zero Emissions Program was implemented within the Zero safety programs of the Cruces University Hospital in order to produce zero emissions of carbon dioxide derived from the anesthetic gases used in the operating rooms. The contribution of anesthetic gases to carbon dioxide production before and after implementation of program was determined. Data analysis was conducted descriptively to analyze program effectiveness. RESULTS The implementation of a Zero Emissions Program allowed us to achieve a reduction in emissions to zero. CONCLUSIONS Anesthesiologists must understand that minimizing our harmful impact on environmental health sustainability is not only desirable, but ethically necessary. A way to contribute to this ethical responsibility is Zero Emissions Programs which are effective in reducing emissions to zero, probably improving our impact on planet health.
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Affiliation(s)
- Alberto Martínez Ruíz
- Departmento de Anestesia, Reanimación y Terapéutica del Dolor, Hospital Universitario de Cruces. Biocruces Instituto de Investigación Médica. Barakaldo. España
- Facultad de Medicina, Universidad del País Vasco. Leioa. España
| | - María Jesús Maroño Boedo
- Departmento de Anestesia, Reanimación y Terapéutica del Dolor, Hospital Universitario de Cruces. Biocruces Instituto de Investigación Médica. Barakaldo. España
| | - Ane Guereca Gala
- Departmento de Anestesia, Reanimación y Terapéutica del Dolor, Hospital Universitario de Cruces. Biocruces Instituto de Investigación Médica. Barakaldo. España
| | - Blanca Anuncia Escontrela Rodríguez
- Departamento de Anestesia y Reanimación, Hospital Universitario Infanta Leonor. Unidad de Cuidados Intensivos, Hospital de Emergencias Isabel Zendal. Madrid. España
| | - Sergio D Bergese
- Departamento de Anestesiología, Universidad Stony Brook. Nueva York. Estados Unidos
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Saleh JR, Mitchell A, Kha ST, Outterson R, Choi A, Allen L, Chang T, Ladd AL, Goodman SB, Fox P, Chou L. The Environmental Impact of Orthopaedic Surgery. J Bone Joint Surg Am 2023; 105:74-82. [PMID: 36574633 DOI: 10.2106/jbjs.22.00548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
➤ There are a growing number of opportunities within the field of orthopaedic surgery to address climate change and investigate ways to promote sustainability. ➤ Orthopaedic surgeons can take a proactive role in addressing climate change and its impacts within the areas of operating-room waste, carbon emissions from transportation and implant manufacturing, anesthetic gases, and water usage. ➤ Future studies are needed to further these initiatives on quantifying and decreasing environmental impact and furthering sustainable use of our resources.
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Affiliation(s)
- Jason R Saleh
- VA Palo Alto Health Care System, Palo Alto, California
| | - Allison Mitchell
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Stephanie T Kha
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Rachel Outterson
- Department of Anesthesia, Perioperative and Pain Medicine, Stanford University, Redwood City, California
| | - Aiden Choi
- Stanford University, Stanford, California
| | | | - Tony Chang
- Stanford University, Stanford, California
| | - Amy L Ladd
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Stuart B Goodman
- Departments of Orthopaedic Surgery and Bioengineering, Stanford University, Redwood City, California
| | - Paige Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Stanford, California
| | - Loretta Chou
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
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20
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Chambrin C, de Souza S, Gariel C, Chassard D, Bouvet L. Association Between Anesthesia Provider Education and Carbon Footprint Related to the Use of Inhaled Halogenated Anesthetics. Anesth Analg 2023; 136:101-110. [PMID: 35986678 DOI: 10.1213/ane.0000000000006172] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Inhaled halogenated anesthetics are responsible for half of operating room total greenhouse gas emissions. Sustainable anesthesia groups were set up in 4 Lyon, France, university hospitals (Hospices Civils de Lyon) in January 2018 and have supported a specific information campaign about the carbon footprint related to the use of inhaled halogenated anesthetics in June 2019. We aimed to assess whether implementing such information campaigns was associated with a decrease in the carbon footprint related to inhaled halogenated anesthetics. METHODS This retrospective cohort study was conducted from January 1, 2015, to February 29, 2020, in 4 hospitals of the Hospices Civils de Lyon in France. Information meetings on sustainable anesthesia practices were organized by sustainable anesthesia groups that were set up in January 2018. In addition, a specific information campaign about the carbon footprint related to inhaled halogenated anesthetics was conducted in June 2019; it was followed by a questionnaire to be completed online. The monthly purchase of sevoflurane, desflurane, and propofol was recorded, and the estimated monthly carbon footprint from desflurane- and sevoflurane-related perioperative emissions was calculated. The interrupted time-series data from January 2015 to February 2020 were analyzed by segmented regression, considering both interventions (setting up of the sustainable anesthesia groups and specific information campaign) in the analysis and adjusting for 2 confounding factors (seasonality of the data and number of general anesthesia uses). RESULTS Among the 641 anesthesia providers from the study hospitals, 121 (19%) attended the information meetings about the carbon footprint of inhaled halogenated anesthetics, and 180 (28%) completed the questionnaire. The anesthetic activity from all 641 providers was considered in the analysis. After the sustainable anesthesia groups were set up, the carbon footprint of sevoflurane and desflurane started decreasing: the slope significantly changed ( P < .01) and became significantly negative, from -0.27 (95% confidence interval [CI], -1.08 to 0.54) tons.month -1 to -14.16 (95% CI, -16.67 to -11.65) tons.month -1 . After the specific information campaign, the carbon footprint kept decreasing, with a slope of -7.58 (95% CI, -13.74 to -1.41) tons.month -1 ( P = .02), which was not significantly different from the previous period ( P = .07). CONCLUSIONS The setup of the sustainable anesthesia groups was associated with a dramatic reduction in the carbon footprint related to halogenated anesthetics. These results should encourage health care institutions to undertake information campaigns toward anesthesia providers so that they also take into account the environmental impact in the choice of anesthetic drugs, in addition to the benefits for the patient and economic concerns.
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Affiliation(s)
- Coralie Chambrin
- From the Department of Anesthesia and Critical Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Lyon, France
| | - Sander de Souza
- Department of Medical Public Health, Hospices Civils de Lyon, Lyon, France
| | - Claire Gariel
- From the Department of Anesthesia and Critical Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Lyon, France
| | - Dominique Chassard
- From the Department of Anesthesia and Critical Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Lyon, France
| | - Lionel Bouvet
- From the Department of Anesthesia and Critical Care, Femme Mère Enfant Hospital, Hospices Civils de Lyon, Lyon, France
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21
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Haseler CJ, West E, Louro LF, Petruccione I, White KL, Pierce JMT. Sustainable development in equine anaesthesia. EQUINE VET EDUC 2022. [DOI: 10.1111/eve.13752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
| | - Eleanor West
- Davies Veterinary Specialists Manor Farm Business Park Hertfordshire UK
| | | | | | - Kate L. White
- School of Veterinary Medicine and Science University of Nottingham Leicestershire UK
| | - J. M. Tom Pierce
- Department of Anaesthesia University Hospital Southampton NHS Foundation Trust Southampton UK
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22
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Hendrickx JFA, Nielsen OJ, De Hert S, De Wolf AM. The science behind banning desflurane: A narrative review. Eur J Anaesthesiol 2022; 39:818-824. [PMID: 36036420 DOI: 10.1097/eja.0000000000001739] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Potent inhaled anaesthetics are halogenated hydrocarbons with a large global warming effect. The use of fluorinated hydrocarbons (most are not anaesthetics) are being restricted but volatile anaesthetics have been exempted from legislation, until now: the EU has formulated a proposal to ban or at least severely restrict the use of desflurane starting January 2026. This narrative review addresses the implications of a politics-driven decision - without prior consultation with major stakeholders, such as the European Society of Anaesthesiology and Intensive Care (ESAIC) - on daily anaesthesia practice and reviews the potential scientific arguments that would support stopping the routine use of desflurane in anaesthetic practice. Of note, banning or severely restricting the use of one anaesthetic agent should not distract the user from sensible interventions like reducing fresh gas flows and developing technology to capture and recycle or destroy the wasted potent inhaled anaesthetics that we will continue to use. We call to join efforts to minimise our professional environmental footprint.
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Affiliation(s)
- Jan F A Hendrickx
- From the Department of Anesthesiology, Onze-Lieve-Vrouw Hospital, Aalst (JFAH), Department of Basic and Applied Medical Sciences, Ghent University, Ghent (JFAH, SDH), Department of Anesthesiology, University Hospital and Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium (JFAH), Department of Chemistry, University of Copenhagen, Copenhagen, Denmark (OJN), Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent, Belgium (SDH) and Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA (AMDW)
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23
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Brooks P, Absalom AR. When will we call time on desflurane? Comment on Br J Anaesth 2022. Br J Anaesth 2022; 129:e81-e82. [PMID: 35931566 DOI: 10.1016/j.bja.2022.06.026] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/24/2022] [Accepted: 06/24/2022] [Indexed: 11/02/2022] Open
Affiliation(s)
- Peter Brooks
- Anaesthetic Department, Chelsea and Westminster Hospital, London, UK
| | - Anthony R Absalom
- Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
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24
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Cahill TM. Increases in Trifluoroacetate Concentrations in Surface Waters over Two Decades. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2022; 56:9428-9434. [PMID: 35736541 PMCID: PMC9261931 DOI: 10.1021/acs.est.2c01826] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 05/18/2022] [Accepted: 06/08/2022] [Indexed: 06/01/2023]
Abstract
Trifluoroacetate (TFA) is a persistent perfluorinated alkanoic acid anion that has many anthropogenic sources, with fluorocarbon refrigerants being a major one. After an initial burst of research in the late 1990s and early 2000s, research on this ubiquitous pollutant declined as atmospheric emissions of the precursor compounds grew rapidly. Thus, there is little contemporaneous information about the concentrations of TFA in the environment and how they have changed over time. This research determined the change in TFA concentrations in streams by resampling a transect that was originally sampled in 1998. The transect was designed to determine the regional distribution of TFA both upwind and downwind of major metropolitan areas in Northern California as well as a set of globally remote sites in Alaska. The results showed that TFA concentrations increased by an average of 6-fold over the intervening 23 years, which resulted in a median concentration of 180 ng/L (range 21.3-2790). The highest concentrations were found in streams immediately downwind of the San Francisco Bay Area, while substantially lower concentrations were found in the upwind, regionally remote, and globally remote sites. The C3 to C5 perfluorinated alkanoic acids were also investigated, but they were rarely detected with this methodology.
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Affiliation(s)
- Thomas M. Cahill
- School of Mathematical and Natural
Sciences Arizona State University West Campus 4701 W Thunderbird Rd Glendale, Arizona 85306, United States
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25
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McGain F, Wickramarachchi K, Sheridan N, McAlister S. Carbon Footprint of Anesthesia: Reply. Anesthesiology 2022; 137:123-125. [PMID: 35507727 DOI: 10.1097/aln.0000000000004230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Forbes McGain
- Western Health, Melbourne, Australia; University of Melbourne, Melbourne, Australia; School of Public Health, University of Sydney, Sydney, Australia (F.M.).
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26
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Lachowska S, Antończyk A, Tunikowska J, Godniak M, Kiełbowicz Z. Reduction of greenhouse gases emission through the use of tiletamine and zolazepam. Sci Rep 2022; 12:9508. [PMID: 35681078 PMCID: PMC9184519 DOI: 10.1038/s41598-022-13520-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/25/2022] [Indexed: 11/30/2022] Open
Abstract
Isoflurane is an anaesthetic gas widely used in both human and veterinary medicine. All currently used volatile anaesthetics are ozone-depleting halogenated compounds. The use of total intravenous anaesthesia (TIVA) allows to induce the effect of general anaesthesia by administering drugs only intravenously without the use of anaesthetic gases. This allows you to create a protocol that is safe not only for the patient, but also for doctors and the environment. However, so far, no anaesthetic protocol based on induction of anaesthesia with tiletamine-zolazepam without the need to maintain anaesthesia with anaesthetic gas has been developed. Our study showed that the use of this combination of drugs for induction does not require the use of additional isoflurane to maintain anaesthesia. Thanks to Dixon's up-and-down method we proved that with the induction of anaesthesia with tiletamine-zolazepam at a dose of 5 mg/kg the use of isoflurane is not needed to maintain anaesthesia in minimally invasive surgical procedures. Until now, this dose has been recommended by the producer for more diagnostic than surgical procedures or for induction of general anaesthesia. The maintenance was required with anaesthetic gas or administration of another dose of the tiletamine-zolazepam. The results obtained in this study will allow for a significant reduction in the consumption of isoflurane, a gas co-responsible for the deepening of the greenhouse effect, having a negative impact on patients and surgeons. These results are certainly the first step to achieving a well-balanced and safe TIVA-based anaesthetic protocol using tiletamine-zolazepam, the obvious goal of which will be to maximize both the safety of the patient, people involved in surgical procedures, and the environment itself. Being aware of the problem of the greenhouse effect, we are committed to reducing the consumption of anaesthetic gases by replacing them with infusion agents.
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Affiliation(s)
- Sonia Lachowska
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environment and Life Sciences, Pl. Grunwaldzki 51, 50-366, Wroclaw, Poland.
| | - Agnieszka Antończyk
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environment and Life Sciences, Pl. Grunwaldzki 51, 50-366, Wroclaw, Poland
| | - Joanna Tunikowska
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environment and Life Sciences, Pl. Grunwaldzki 51, 50-366, Wroclaw, Poland
| | - Martyna Godniak
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Midlothian, EH25 9RG, UK
| | - Zdzisław Kiełbowicz
- Department and Clinic of Surgery, Faculty of Veterinary Medicine, Wroclaw University of Environment and Life Sciences, Pl. Grunwaldzki 51, 50-366, Wroclaw, Poland
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Affiliation(s)
- Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, Connecticut, USA
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Affiliation(s)
- Alain F Kalmar
- IBiTech, Ghent University, Ghent, Belgium; AZ Sint Jan Hospital, Bruges, Belgium (A.F.K.).
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29
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Ren H, Zhu G, Li J, Yang J. Atmospheric chemistry of sevoflurane radical: A degradation reaction mechanism in the presence of NO from a theoretical perspective. COMPUT THEOR CHEM 2022. [DOI: 10.1016/j.comptc.2022.113706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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30
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Paula Badenes M. Theoretical structural and thermochemical characterization of partially fluorinated alcohols. COMPUT THEOR CHEM 2022. [DOI: 10.1016/j.comptc.2022.113600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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31
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Blázquez S, Espinosa S, Antiñolo M, Albaladejo J, Jiménez E. Kinetics of CF3CH2OCH3 (HFE-263fb2), CHF2CF2CH2OCH3 (HFE-374pcf), and CF3CF2CH2OCH3 (HFE-365mcf3) with OH radicals, IR absorption cross sections, and global warming potentials. Phys Chem Chem Phys 2022; 24:14354-14364. [DOI: 10.1039/d2cp00160h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hydrofluoroethers (HFEs), like CF3CH2OCH3 (HFE-263fb2), CHF2CF2CH2OCH3 (HFE-374pcf), and CF3CF2CH2OCH3 (HFE-365mcf3), have been proposed in the last decades as the third-generation replacements of perfluorocarbons (PFCs) and hydrofluorocarbons (HFCs) because of their...
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32
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Skowno J, Weatherall A. Lighting a candle, or cursing the darkness? Delivering a climate friendly anaesthetic. J Paediatr Child Health 2021; 57:1781-1784. [PMID: 34792239 DOI: 10.1111/jpc.15760] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 02/06/2023]
Abstract
With up to 7% of national emissions coming from health care in industrial nations, and volatile anaesthetics and nitrous oxide being particularly effective greenhouse gases, anaesthetists can potentially reduce their medical carbon footprint substantially. Operating theatres create 25% of hospital waste, and there are many other avenues for 'greening' in the perioperative environment, including recycling and avoiding unnecessary operations. However, it is vital to understand how to produce a real change in practice that continues into the future and is normalised. Health-care choices we make in 2021 cannot be allowed to lead to a climate catastrophe in 2050.
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Affiliation(s)
- Justin Skowno
- Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Andrew Weatherall
- Department of Anaesthesia, The Children's Hospital at Westmead, Sydney, New South Wales, Australia.,Discipline of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
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Lee R, Nader D. Practical environmental considerations in anesthesia practice. J Clin Anesth 2021; 79:110522. [PMID: 34598863 DOI: 10.1016/j.jclinane.2021.110522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Robert Lee
- Department of Anesthesiology, University at Buffalo, United States.
| | - D Nader
- Department of Anesthesiology, University at Buffalo, United States
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Andersen MPS, Nielsen OJ, Sherman JD. The Global Warming Potentials for Anesthetic Gas Sevoflurane Need Significant Corrections. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2021; 55:10189-10191. [PMID: 34296868 DOI: 10.1021/acs.est.1c02573] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Mads Peter Sulbaek Andersen
- Department of Chemistry and Biochemistry, California State University Northridge, Northridge, California 91330-8262, United States
- Copenhagen Center for Atmospheric Research, Department of Chemistry, University of Copenhagen, Copenhagen DK-2100, Denmark
| | - Ole John Nielsen
- Copenhagen Center for Atmospheric Research, Department of Chemistry, University of Copenhagen, Copenhagen DK-2100, Denmark
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, New Haven, Connecticut 06520, United States
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Abstract
BACKGROUND The climate crisis is the most serious threat to global health in the twenty-first century. In western countries 5-10% of all greenhouse gas emissions originate from the healthcare sector and the main contributing factors are energy-intense departments (intensive care units, operating suits and prehospital emergency services). OBJECTIVE The aim of this review is to provide background knowledge and practical ideas to achieve climate-neutral hospitals. MATERIAL AND METHODS Narrative review with information on the topics of (I) volatile anesthetics as greenhouse gases, (II) energy supply in hospitals and (III) solid waste management. RESULTS AND CONCLUSION (I) Volatile anesthetics are highly potent greenhouse gases, especially desflurane has a major global warming potential. Total intravenous anesthesia (TIVA) with propofol or regional anesthetic techniques have a much lower impact on the climate. (II) Using sustainable energy sources as well as initiating energy sparing techniques, such as light-emitting diodes (LED) and motion sensors, can reduce CO2 emissions. (III) Waste can be managed by the reduce, reuse, recycle, rethink and research concept. Doctors should actively contribute to reach the climate goals.
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Affiliation(s)
- S Koch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum und Campus Mitte, Augustenburger Platz 1, 13353, Berlin, Deutschland.
| | - S Pecher
- Klinik für Anästhesie und Intensivmedizin, Diakonie Klinikum Stuttgart, Stuttgart, Deutschland
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Bai FY, Deng MS, Chen MY, Kong L, Ni S, Zhao Z, Pan XM. Atmospheric oxidation of fluoroalcohols initiated by ˙OH radicals in the presence of water and mineral dusts: mechanism, kinetics, and risk assessment. Phys Chem Chem Phys 2021; 23:13115-13127. [PMID: 34075970 DOI: 10.1039/d1cp01324f] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The transport and formation of fluorinated compounds are greatly significant due to their possible environmental risks. In this work, the ˙OH-mediated degradation of CF3CF2CF2CH2OH and CF3CHFCF2CH2OH in the presence of O2/NO/NO2 was studied by using density functional theory and the direct kinetic method. The formation mechanisms of perfluorocarboxylic/hydroperfluorocarboxylic acids (PFCAs/H-PFCAs), which were produced from the reactions of α-hydroxyperoxy radicals with NO/NO2 and the ensuing oxidation of α-hydroxyalkoxy radicals, were clarified and discussed. The roles of water and silica particles in the rate constants and ˙OH reaction mechanism with fluoroalcohols were investigated theoretically. The results showed that water and silica particles do not alter the reaction mechanism but obviously change the kinetic properties. Water could retard fluoroalcohol degradation by decreasing the rate constants by 3-5 orders of magnitude. However, the heterogeneous ˙OH-rate coefficients on the silica particle surfaces, including H4SiO4, H6Si2O7, and H12Si6O18, are larger than that of the naked reaction by 1.20-24.50 times. This finding suggested that these heterogeneous reactions may be responsible for the atmospheric loss of fluoroalcohols and the burden of PFCAs. In addition, fluoroalcohols could be exothermically trapped by H12Si6O18, H6Si2O7, and H4SiO4, in which the chemisorption on H12Si6O18 is stronger than that on H6Si2O7 or H4SiO4. The global warming potentials and radiative forcing of CF3CF2CF2CH2OH/CF3CHFCF2CH2OH were calculated to assess their contributions to the greenhouse effect. The toxicities of individual species were also estimated via the ECOSAR program and experimental measurements. This work enhances the understanding of the environmental formation of PFCAs and the transformation of fluoroalcohols.
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Affiliation(s)
- Feng-Yang Bai
- Institute of Catalysis for Energy and Environment, College of Chemistry and Chemical Engineering, Shenyang Normal University, Shenyang, Liaoning 110034, P. R. China.
| | - Ming-Shuai Deng
- Institute of Catalysis for Energy and Environment, College of Chemistry and Chemical Engineering, Shenyang Normal University, Shenyang, Liaoning 110034, P. R. China.
| | - Mei-Yan Chen
- Institute of Catalysis for Energy and Environment, College of Chemistry and Chemical Engineering, Shenyang Normal University, Shenyang, Liaoning 110034, P. R. China.
| | - Lian Kong
- Institute of Catalysis for Energy and Environment, College of Chemistry and Chemical Engineering, Shenyang Normal University, Shenyang, Liaoning 110034, P. R. China.
| | - Shuang Ni
- National & Local United Engineering Lab for Power Battery, Faculty of Chemistry, Northeast Normal University, Changchun 130024, P. R. China.
| | - Zhen Zhao
- Institute of Catalysis for Energy and Environment, College of Chemistry and Chemical Engineering, Shenyang Normal University, Shenyang, Liaoning 110034, P. R. China. and State Key Laboratory of Heavy Oil Processing, China University of Petroleum, Chang Ping, Beijing 102249, P. R. China
| | - Xiu-Mei Pan
- National & Local United Engineering Lab for Power Battery, Faculty of Chemistry, Northeast Normal University, Changchun 130024, P. R. China.
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Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature. Animals (Basel) 2021; 11:ani11061777. [PMID: 34198637 PMCID: PMC8232193 DOI: 10.3390/ani11061777] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 12/26/2022] Open
Abstract
Simple Summary Recovery is the most dangerous phase of general anaesthesia in horses. Numerous publications have reported about this phase, but structured reviews that try to reduce the risk of bias of narrative reviews/expert opinions, focussing on the topic are missing. Therefore, the aim of the present article was to publish the first structured review as a summary of the literature focussing on the recovery phase after general anaesthesia in horses. The objective was to summarise the available literature, taking into account the scientific evidence of the individual studies. A structured approach was followed with two experts in the field independently deciding on article inclusion and its level of scientific evidence. A total number of 444 articles, sorted by topics and classified based on their levels of evidence, were finally included into the present summary. The most important findings were summarised and discussed. The present structured review can be used as a compilation of the publications that, to date, focus on the recovery phase after general anaesthesia in adult horses. This type of review tries to minimise the risk of bias inherent to narrative reviews/expert opinions. Abstract Recovery remains the most dangerous phase of general anaesthesia in horses. The objective of this publication was to perform a structured literature review including levels of evidence (LoE) of each study with the keywords “recovery anaesthesia horse”, entered at once, in the search browsers PubMed and Web of Science. The two authors independently evaluated each candidate article. A final list with 444 articles was obtained on 5 April 2021, classified as: 41 “narrative reviews/expert opinions”, 16 “retrospective outcome studies”, 5 “surveys”, 59 “premedication/sedation and induction drugs”, 27 “maintenance with inhalant agents”, 55 “maintenance with total intravenous anaesthesia (TIVA)”, 3 “TIVA versus inhalants”, 56 “maintenance with partial intravenous anaesthesia (PIVA)”, 27 “other drugs used during maintenance”, 18 “drugs before/during recovery”, 18 “recovery systems”, 21 “respiratory system in recovery”, 41 “other factors”, 51 “case series/reports” and 6 “systems to score recoveries”. Of them, 167 were LoE 1, 36 LoE 2, 33 LoE 3, 110 LoE 4, 90 LoE 5 and 8 could not be classified based on the available abstract. This review can be used as an up-to-date compilation of the literature about recovery after general anaesthesia in adult horses that tried to minimise the bias inherent to narrative reviews.
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Feldman JM, Hendrickx J, Kennedy RR. Carbon Dioxide Absorption During Inhalation Anesthesia: A Modern Practice. Anesth Analg 2021; 132:993-1002. [PMID: 32947290 DOI: 10.1213/ane.0000000000005137] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
CO2 absorbents were introduced into anesthesia practice in 1924 and are essential when using a circle system to minimize waste by reducing fresh gas flow to allow exhaled anesthetic agents to be rebreathed. For many years, absorbent formulations consisted of calcium hydroxide combined with strong bases like sodium and potassium hydroxide. When Sevoflurane and Desflurane were introduced, the potential for toxicity (compound A and CO, respectively) due to the interaction of these agents with absorbents became apparent. Studies demonstrated that strong bases added to calcium hydroxide were the cause of the toxicity, but that by eliminating potassium hydroxide and reducing the concentration of sodium hydroxide to <2%, compound A and CO production is no longer a concern. As a result, CO2 absorbents have been developed that contain little or no sodium hydroxide. These CO2 absorbent formulations can be used safely to minimize anesthetic waste by reducing fresh gas flow to approach closed-circuit conditions. Although absorbent formulations have been improved, practices persist that result in unnecessary waste of both anesthetic agents and absorbents. While CO2 absorbents may seem like a commodity item, differences in CO2 absorbent formulations can translate into significant performance differences, and the choice of absorbent should not be based on unit price alone. A modern practice of inhalation anesthesia utilizing a circle system to greatest effect requires reducing fresh gas flow to approach closed-circuit conditions, thoughtful selection of CO2 absorbent, and changing absorbents based on inspired CO2.
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Affiliation(s)
- Jeffrey M Feldman
- From the Department of Anesthesiology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,the Department of Anesthesiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jan Hendrickx
- The Department of Basic and Applied Medical Sciences, Ghent University, Ghent, Belgium, and the Department of Anesthesiology, Onze-Lieve-Vrouw (OLV) Hospital, Aalst, Belgium
| | - R Ross Kennedy
- the Department of Anaesthesia, Christchurch Hospital and University of Otago-Christchurch, Christchurch, Aotearoa-New Zealand
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Tennison I, Roschnik S, Ashby B, Boyd R, Hamilton I, Oreszczyn T, Owen A, Romanello M, Ruyssevelt P, Sherman JD, Smith AZP, Steele K, Watts N, Eckelman MJ. Health care's response to climate change: a carbon footprint assessment of the NHS in England. Lancet Planet Health 2021; 5:e84-e92. [PMID: 33581070 PMCID: PMC7887664 DOI: 10.1016/s2542-5196(20)30271-0] [Citation(s) in RCA: 283] [Impact Index Per Article: 94.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/05/2020] [Accepted: 10/27/2020] [Indexed: 05/21/2023]
Abstract
BACKGROUND Climate change threatens to undermine the past 50 years of gains in public health. In response, the National Health Service (NHS) in England has been working since 2008 to quantify and reduce its carbon footprint. This Article presents the latest update to its greenhouse gas accounting, identifying interventions for mitigation efforts and describing an approach applicable to other health systems across the world. METHODS A hybrid model was used to quantify emissions within Scopes 1, 2, and 3 of the Greenhouse Gas Protocol, as well as patient and visitor travel emissions, from 1990 to 2019. This approach complements the broad coverage of top-down economic modelling with the high accuracy of bottom-up data wherever available. Available data were backcasted or forecasted to cover all years. To enable the identification of measures to reduce carbon emissions, results were disaggregated by organisation type. FINDINGS In 2019, the health service's emissions totalled 25 megatonnes of carbon dioxide equivalent, a reduction of 26% since 1990, and a decrease of 64% in the emissions per inpatient finished admission episode. Of the 2019 footprint, 62% came from the supply chain, 24% from the direct delivery of care, 10% from staff commute and patient and visitor travel, and 4% from private health and care services commissioned by the NHS. INTERPRETATION This work represents the longest and most comprehensive accounting of national health-care emissions globally, and underscores the importance of incorporating bottom-up data to improve the accuracy of top-down modelling and enabling detailed monitoring of progress as health systems act to reduce emissions. FUNDING Wellcome Trust.
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Affiliation(s)
| | | | | | | | - Ian Hamilton
- UCL Energy Institute, University College London, London, UK
| | - Tadj Oreszczyn
- UCL Energy Institute, University College London, London, UK
| | - Anne Owen
- School of Earth and Environment, University of Leeds, Leeds, UK
| | - Marina Romanello
- Institute for Global Health, University College London, London, UK
| | | | - Jodi D Sherman
- Department of Anesthesiology, Yale University, New Haven, CT, USA
| | | | | | - Nicholas Watts
- Institute for Global Health, University College London, London, UK
| | - Matthew J Eckelman
- Department of Civil and Environmental Engineering, Northeastern University, Boston, MA, USA.
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Weber B, Weber J, Eberhart L, Knoth S. Fokus – NarCO2se und Umwelt. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55:720-730. [PMID: 33242905 DOI: 10.1055/a-1084-9925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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41
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McGain F, Muret J, Lawson C, Sherman JD. Environmental sustainability in anaesthesia and critical care. Br J Anaesth 2020; 125:680-692. [PMID: 32798068 PMCID: PMC7421303 DOI: 10.1016/j.bja.2020.06.055] [Citation(s) in RCA: 169] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/29/2020] [Accepted: 06/13/2020] [Indexed: 01/17/2023] Open
Abstract
The detrimental health effects of climate change continue to increase. Although health systems respond to this disease burden, healthcare itself pollutes the atmosphere, land, and waterways. We surveyed the 'state of the art' environmental sustainability research in anaesthesia and critical care, addressing why it matters, what is known, and ideas for future work. Focus is placed upon the atmospheric chemistry of the anaesthetic gases, recent work clarifying their relative global warming potentials, and progress in waste anaesthetic gas treatment. Life cycle assessment (LCA; i.e. 'cradle to grave' analysis) is introduced as the definitive method used to compare and contrast ecological footprints of products, processes, and systems. The number of LCAs within medicine has gone from rare to an established body of knowledge in the past decade that can inform doctors of the relative ecological merits of different techniques. LCAs with practical outcomes are explored, such as the carbon footprint of reusable vs single-use anaesthetic devices (e.g. drug trays, laryngoscope blades, and handles), and the carbon footprint of treating an ICU patient with septic shock. Avoid, reduce, reuse, recycle, and reprocess are then explored. Moving beyond routine clinical care, the vital influences that the source of energy (renewables vs fossil fuels) and energy efficiency have in healthcare's ecological footprint are highlighted. Discussion of the integral roles of research translation, education, and advocacy in driving the perioperative and critical care environmental sustainability agenda completes this review.
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Affiliation(s)
| | - Jane Muret
- French Society of Anaesthesia and Intensive Care (SFAR), Institut Curie PSL Research University, Paris, France
| | - Cathy Lawson
- Newcastle upon Tyne Hospitals, Newcastle upon Tyne, England, UK
| | - Jodi D Sherman
- Department of Anesthesiology, Yale School of Medicine, Department of Environmental Health Sciences, Yale School of Public Health, New Haven, CT, USA
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Wang Y, Ming XX, Zhang CP. Fluorine-Containing Inhalation Anesthetics: Chemistry, Properties and Pharmacology. Curr Med Chem 2020; 27:5599-5652. [DOI: 10.2174/0929867326666191003155703] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 08/27/2019] [Accepted: 09/05/2019] [Indexed: 02/07/2023]
Abstract
Studies on fluorinated inhalation anesthetics, including synthesis, physical chemistry and
pharmacology, have been summarized in this review. Retrospecting the history of inhalation anesthetics
revealed their increasing reliance on fluorine and ether structures. Halothane causes a rare but
severe immune-based hepatotoxicity, which was replaced by enflurane in the 1970s. Isoflurane replaced
enflurane in the 1980s, showing modest advantages (e.g. lower solubility, better metabolic
stability, and without convulsive predisposition). Desflurane and sevoflurane came into use in the
1990s, which are better anesthetics than isoflurane (less hepatotoxicity, lower solubility, and/or
markedly decreased pungency). However, they are still less than perfect. To gain more ideal inhalation
anesthetics, a large number of fluorinated halocarbons, polyfluorocycloalkanes, polyfluorocycloalkenes,
fluoroarenes, and polyfluorooxetanes, were prepared and their potency and toxicity were
evaluated. Although the pharmacology studies suggested that some of these agents produced anesthesia,
no further studies were continued on these compounds because they showed obvious lacking
as anesthetics. Moreover, the anesthetic activity cannot be simply predicted from the molecular
structures but has to be inferred from the experiments. Several regularities were found by experimental
studies: 1) the potency and toxicity of the saturated linear chain halogenated ether are enhanced
when its molecular weight is increased; 2) the margin of safety decreases and the recovery
time is prolonged when the boiling point of the candidate increases; and 3) compounds with an
asymmetric carbon terminal exhibit good anesthesia. Nevertheless, the development of new inhalation
anesthetics, better than desflurane and sevoflurane, is still challenging not only because of the
poor structure/activity relationship known so far but also due to synthetic issues.
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Affiliation(s)
- Yuzhong Wang
- The State Key Laboratory Breeding Base of Basic Science of Stomatology (Hubei-MOST) & Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, 237 Luoyu Road, Wuhan 430079, China
| | - Xiao-Xia Ming
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, 205 Luoshi Road, Wuhan 430070, China
| | - Cheng-Pan Zhang
- School of Chemistry, Chemical Engineering and Life Science, Wuhan University of Technology, 205 Luoshi Road, Wuhan 430070, China
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A general review of the environmental impact of health care, hospitals, operating rooms, and anesthetic care. Int Anesthesiol Clin 2020; 58:64-69. [PMID: 32925236 DOI: 10.1097/aia.0000000000000295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Rauchenwald V, Rollins MD, Ryan SM, Voronov A, Feiner JR, Šarka K, Johnson MS. New Method of Destroying Waste Anesthetic Gases Using Gas-Phase Photochemistry. Anesth Analg 2020; 131:288-297. [PMID: 32543805 DOI: 10.1213/ane.0000000000004119] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The inhalation anesthetics are potent greenhouse gases. To reduce the global environmental impact of the health care sector, technologies are sought to limit the release of waste anesthetic gas into the atmosphere. METHODS Using a photochemical exhaust gas destruction system, removal efficiencies for nitrous oxide, desflurane, and sevoflurane were measured at various inlet concentrations (25% and 50%; 1.5%, 3.0%, and 6.0%; and 0.5%, 1.0%, and 2.0%, respectively) with flow rates ranging from 0.25 to 2.0 L/min. To evaluate the economic competitiveness of the anesthetic waste gas destruction system, its price per ton of carbon dioxide equivalent was calculated and compared to other greenhouse gas abatement technologies and current market prices. RESULTS All inhaled anesthetics evaluated demonstrate enhanced removal efficiencies with decreasing flow rates (P < .0001). Depending on the anesthetic and its concentration, the photochemical exhaust gas destruction system exhibits a constant first-order removal rate, k. However, there was not a simple relation between the removal rate k and the species concentration. The costs for removing a ton of carbon dioxide equivalents are <$0.005 for desflurane, <$0.114 for sevoflurane, and <$49 for nitrous oxide. CONCLUSIONS Based on this prototype study, destroying sevoflurane and desflurane with this photochemical anesthetic waste gas destruction system design is efficient and cost-effective. This is likely also true for other halogenated inhalational anesthetics such as isoflurane. Due to differing chemistry of nitrous oxide, modifications of this prototype photochemical reactor system are necessary to improve its removal efficiency for this gas.
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Affiliation(s)
- Verena Rauchenwald
- From the Department of Chemistry, University of Copenhagen, Copenhagen, Denmark
| | - Mark D Rollins
- Department of Anesthesiology, University of Utah, Salt Lake City, Utah
| | - Susan M Ryan
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
| | | | - John R Feiner
- Department of Anesthesia and Perioperative Care, University of California, San Francisco, California
| | - Karolis Šarka
- From the Department of Chemistry, University of Copenhagen, Copenhagen, Denmark
| | - Matthew S Johnson
- From the Department of Chemistry, University of Copenhagen, Copenhagen, Denmark
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Hynniewta S, Baidya B, Chandra AK. Theoretical investigation on the kinetics of reaction of methoxyflurane (CH3OCF2CHCl2) with OH radical and its atmospheric impact. COMPUT THEOR CHEM 2020. [DOI: 10.1016/j.comptc.2020.112819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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McGain F, Ma SC, Burrell RH, Percival VG, Roessler P, Weatherall AD, Weber IA, Kayak EA. Why be sustainable? The Australian and New Zealand College of Anaesthetists Professional Document PS64: Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice and its accompanying background paper. Anaesth Intensive Care 2019; 47:413-422. [PMID: 31684744 DOI: 10.1177/0310057x19884075] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Healthcare’s environmental sustainability is increasingly an area of research and advocacy focus. The Australian and New Zealand College of Anaesthetists (ANZCA) has produced a professional document, PS64, Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice, and a background paper, PS64 BP. The purpose of the statement is to affirm ANZCA’s commitment to environmental sustainability and support anaesthetists in promoting environmentally sustainable work practices. This article presents the main features of PS64 and its background paper, and the associated supporting evidence. The healthcare sector is highly interconnected with activities that emit pollution to air, water and soils, considerably adding to humanity’s collective ecological footprint. As anaesthetists, we are uniquely high-carbon doctors due to our work anaesthetising with greenhouse gases (particularly desflurane and nitrous oxide) and our exposure and contribution to large amounts of resource and energy use and waste generation in operating theatres. Discussion is made of the improving research base of anaesthetic life-cycle assessments—that is, cradle-to-grave studies of how much energy, water and so on a product or process requires throughout its entire life. Thereafter, reducing, reusing and recycling as well as water use are examined. Ongoing research efforts within environmentally sustainable anaesthesia are highlighted. Environmentally sustainable anaesthesia requires scholarship, health advocacy, leadership, communication and collaboration. The focus is placed on practical initiatives within PS64 and the background paper that can be achieved by all anaesthetists striving towards more sustainable healthcare practices that reduce waste, reap financial benefits and improve health.
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Affiliation(s)
- Forbes McGain
- Department of Anaesthesia and Intensive Care, Western Health, Footscray Hospital, Melbourne, Australia
| | - Scott Cy Ma
- Department of Children's Anaesthesia, Women's and Children's Hospital, Adelaide, Australia
| | - Rob H Burrell
- Department of Anaesthesia and Intensive Care, Middlemore Hospital, Auckland, New Zealand
| | | | - Peter Roessler
- Australian and New Zealand College of Anaesthetists, Melbourne, Australia
| | | | - Ingo A Weber
- Department of Anaesthesia and Pain Medicine, Flinders University of South Australia, Adelaide, Australia
| | - Eugenie A Kayak
- Department of Anaesthesia, Alfred Health, Melbourne, Australia
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Özelsel TJP, Sondekoppam RV, Buro K. The future is now-it's time to rethink the application of the Global Warming Potential to anesthesia. Can J Anaesth 2019; 66:1291-1295. [PMID: 31069721 DOI: 10.1007/s12630-019-01385-w] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 04/25/2019] [Accepted: 04/25/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Timur J-P Özelsel
- Department of Anesthesia and Pain Medicine, University of Alberta, Edmonton, AB, Canada. .,Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, T6G 2G3, Canada.
| | - Rakesh V Sondekoppam
- Department of Anesthesia and Pain Medicine, University of Alberta, Edmonton, AB, Canada
| | - Karen Buro
- Department of Mathematics and Statistics, Macewan University, Edmonton, AB, Canada
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Burdick RK, Villabona-Monsalve JP, Mashour GA, Goodson T. Modern Anesthetic Ethers Demonstrate Quantum Interactions with Entangled Photons. Sci Rep 2019; 9:11351. [PMID: 31383882 PMCID: PMC6683176 DOI: 10.1038/s41598-019-47651-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/08/2019] [Indexed: 11/09/2022] Open
Abstract
Despite decades of research, the mechanism of anesthetic-induced unconsciousness remains incompletely understood, with some advocating for a quantum mechanical basis. Despite associations between general anesthesia and changes in physical properties such as electron spin, there has been no empirical demonstration that general anesthetics are capable of functional quantum interactions. In this work, we studied the linear and non-linear optical properties of the halogenated ethers sevoflurane (SEVO) and isoflurane (ISO), using UV-Vis spectroscopy, time dependent-density functional theory (TD-DFT) calculations, classical two-photon spectroscopy, and entangled two-photon spectroscopy. We show that both of these halogenated ethers interact with pairs of 800 nm entangled photons while neither interact with 800 nm classical photons. By contrast, nonhalogenated diethyl ether does not interact with entangled photons. This is the first experimental evidence that halogenated anesthetics can directly undergo quantum interaction mechanisms, offering a new approach to understanding their physicochemical properties.
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Affiliation(s)
- Ryan K Burdick
- Department of Chemistry, University of Michigan, Ann Arbor, MI, 48109, USA
| | | | - George A Mashour
- Center for Consciousness Science, Department of Anesthesiology, University of Michigan Medical School, Ann Arbor, MI, 48109-5048, USA.
| | - Theodore Goodson
- Department of Chemistry, University of Michigan, Ann Arbor, MI, 48109, USA.
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Le XT, Mai TVT, Duong MV, Huynh LK. Kinetics of hydrogen abstraction from desflurane by OH and Cl radicals – A theoretical study. Chem Phys Lett 2019. [DOI: 10.1016/j.cplett.2019.04.059] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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50
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Zuegge KL, Bunsen SK, Volz LM, Stromich AK, Ward RC, King AR, Sobeck SA, Wood RE, Schliewe BE, Steiner RP, Rusy DA. Provider Education and Vaporizer Labeling Lead to Reduced Anesthetic Agent Purchasing With Cost Savings and Reduced Greenhouse Gas Emissions. Anesth Analg 2019; 128:e97-e99. [PMID: 31094796 DOI: 10.1213/ane.0000000000003771] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Anesthetic agents are known greenhouse gases with hundreds to thousands of times the global warming impact compared with carbon dioxide. We sought to mitigate the negative environmental and financial impacts of our practice in the perioperative setting through multidisciplinary staff engagement and provider education on flow rate reduction and volatile agent choice. These efforts led to a 64% per case reduction in carbon dioxide equivalent emissions (163 kg in Fiscal Year 2012, compared with 58 kg in Fiscal Year 2015), as well as a cost savings estimate of $25,000 per month.
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Affiliation(s)
| | | | | | | | - Russel C Ward
- UW Health Clinical Engineering, University of Wisconsin, Madison, Wisconsin
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