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Gonzalez-Pizarro P, Brazzi L, Koch S, Trinks A, Muret J, Sperna Weiland N, Jovanovic G, Cortegiani A, Fernandes TD, Kranke P, Malisiova A, McConnell P, Misquita L, Romero CS, Bilotta F, De Robertis E, Buhre W. European Society of Anaesthesiology and Intensive Care consensus document on sustainability: 4 scopes to achieve a more sustainable practice. Eur J Anaesthesiol 2024; 41:260-277. [PMID: 38235604 DOI: 10.1097/eja.0000000000001942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Climate change is a defining issue for our generation. The carbon footprint of clinical practice accounts for 4.7% of European greenhouse gas emissions, with the European Union ranking as the third largest contributor to the global healthcare industry's carbon footprint, after the United States and China. Recognising the importance of urgent action, the European Society of Anaesthesiology and Intensive Care (ESAIC) adopted the Glasgow Declaration on Environmental Sustainability in June 2023. Building on this initiative, the ESAIC Sustainability Committee now presents a consensus document in perioperative sustainability. Acknowledging wider dimensions of sustainability, beyond the environmental one, the document recognizes healthcare professionals as cornerstones for sustainable care, and puts forward recommendations in four main areas: direct emissions, energy, supply chain and waste management, and psychological and self-care of healthcare professionals. Given the urgent need to cut global carbon emissions, and the scarcity of evidence-based literature on perioperative sustainability, our methodology is based on expert opinion recommendations. A total of 90 recommendations were drafted by 13 sustainability experts in anaesthesia in March 2023, then validated by 36 experts from 24 different countries in a two-step Delphi validation process in May and June 2023. To accommodate different possibilities for action in high- versus middle-income countries, an 80% agreement threshold was set to ease implementation of the recommendations Europe-wide. All recommendations surpassed the 80% agreement threshold in the first Delphi round, and 88 recommendations achieved an agreement >90% in the second round. Recommendations include the use of very low fresh gas flow, choice of anaesthetic drug, energy and water preserving measures, "5R" policies including choice of plastics and their disposal, and recommendations to keep a healthy work environment or on the importance of fatigue in clinical practice. Executive summaries of recommendations in areas 1, 2 and 3 are available as cognitive aids that can be made available for quick reference in the operating room.
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Affiliation(s)
- Patricio Gonzalez-Pizarro
- From the Department of Paediatric Anaesthesia and Critical Care. La Paz University Hospital, Madrid, Spain (PGP), the Department of Anaesthesia, Intensive Care and Emergency, 'Citta' della Salute e della Scienza' University Hospital, Department of Surgical Science, University of Turin, Turin, Italy (LB), the University of Southern Denmark (SDU) Odense, Department of Anesthesia, Hospital of Nykobing Falster, Denmark (SK), the Department of Anesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt Universität zu Berlin, Campus Charité Mitte, and Campus Virchow Klinikum (SK), the Department of Anaesthesiology. LMU University Hospital, LMU Munich, Germany (AT), the Department of Anaesthesia and Intensive Care. Institute Curie & PSL Research University, Paris, France (JM), the Department of Anaesthesiology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands (NSW), the Department of Anaesthesia and Perioperatve Medicine. Medical Faculty, University of Novi Sad, Novi Sad, Serbia (GJ), the Department of Surgical, Oncological and Oral Science, University of Palermo, Italy. Department of Anesthesia, Intensive Care and Emergency, University Hospital Policlinico Paolo Giaccone, Palermo, Italy (AC), the Department of Anaesthesiology, Hospital Pedro Hispano, Matosinhos, Portugal (TDF), the Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Germany (PK), the Department of Anaesthesiology and Pain. P&A Kyriakou Children's Hospital Athens Greece (AM), Royal Alexandra Hospital. Paisley, Scotland, United Kingdom (PM), Department of Neuro-anaesthesia and Neurocritical Care, The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Trust, London, England, United Kingdom (LM), the Department of Anesthesia, Critical care and Pain Unit, Hospital General Universitario de Valencia. Research Methods Department, European University of Valencia, Spain (CR), the "Sapienza" University of Rome, Department of Anesthesiology and Critical Care, Rome, Italy (FB), the Division of Anaesthesia, Analgesia, and Intensive Care - Department of Medicine and Surgery - University of Perugia Ospedale S. Maria della Misericordia, Perugia, Italy (EDR), the Division of Anaesthesiology, Intensive Care and Emergency Medicine, Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands (WB)
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Wyssusek KH, Keys MT, van Zundert AAJ. Operating room greening initiatives - the old, the new, and the way forward: A narrative review. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2019; 37:3-19. [PMID: 30132405 DOI: 10.1177/0734242x18793937] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Healthcare waste is a rampant issue in Australian hospitals. The operating room (OR) contributes disproportionately to total hospital waste. There has been considerable research in the literature concentrating on strategies to improve OR and hospital waste accumulation, in an attempt to provide guidance and direction on how to reduce the healthcare ecological footprint. We reviewed the literature for leading greening initiatives currently utilised in the OR in Australia and internationally. This narrative literature review focuses on the trend of OR greening initiatives over the last 25 years, comparing different innovative approaches, the successes and setbacks, and the financial implications of initiatives. A variety of measures that hospital management, surgeons, anaesthetists, nurses and other healthcare personnel can take to reduce the ecological footprint of their healthcare facility are outlined. Greening initiatives include reducing, recycling, reusing, rethinking and researching, as well as novel technology and smarter architectural design. We also evaluated the barriers to improving waste management, which include lack of leadership, misconceptions among staff, and an overall resistance to change. In conclusion, in a world where greenhouse gas emissions cause unprecedented climate change and landfill space is finite, it is incumbent upon hospitals to help reduce the environmental impact of their facility. Reducing pollution and greenhouse gas emissions would moderate the incidence of human disease, save money for the healthcare system and society as a whole, and contribute to a safer and healthier world we all would like to live in.
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Affiliation(s)
- Kerstin H Wyssusek
- 1 Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Australia
- 2 Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Maggie T Keys
- 2 Faculty of Medicine, University of Queensland, Brisbane, Australia
- 3 Department of Medicine, Royal Brisbane and Women's Hospital, Australia
| | - André A J van Zundert
- 1 Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Australia
- 2 Faculty of Medicine, University of Queensland, Brisbane, Australia
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Kafal AR, Vinh DC, Langelier MJ. Prefilled syringes for immunoglobulin G (IgG) replacement therapy: clinical experience from other disease settings. Expert Opin Drug Deliv 2018; 15:1199-1209. [DOI: 10.1080/17425247.2018.1546692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Ayman R. Kafal
- Medical Affairs, CSL Behring LLC, King of Prussia, PA, USA
| | - Donald C. Vinh
- Infectious Disease Susceptibility Program, Research Institute – McGill University Health Centre, Montreal, Quebec, Canada
| | - Mélanie J. Langelier
- Infectious Disease Susceptibility Program, Research Institute – McGill University Health Centre, Montreal, Quebec, Canada
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Quan AT, Li F. Hyperinflation of Vasopressors (Vasopressin, Norepinephrine, Ephedrine, etc). J Pharm Pract 2018; 31:399-402. [PMID: 29938596 DOI: 10.1177/0897190018770062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE Hyperinflation refers to the increasing cost of drugs which occurs due to continued drug shortages and rebranding. Hyperinflation has significant implications in increasing overall healthcare costs with reduced reimbursement, increased patient acuity, and an aging population, but published strategies to reduce costs and minimize waste are limited. OBJECTIVE To describe the hyperinflation and cost mitigation strategies of three vasopressor medications, vasopressin, epinephrine, and ephedrine. CONCLUSION The steep increase in medications is expected to continue, and mitigation strategies to reduce waste and select the most cost effective therapy to offset the price increase is crucial for healthcare systems.
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Affiliation(s)
- Ashley Thompson Quan
- 1 University of California San Francisco Medical Center at Parnassus, San Francisco, CA, USA
| | - Fanny Li
- 1 University of California San Francisco Medical Center at Parnassus, San Francisco, CA, USA
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Bauducel M, Piriou V, Dussart C, Aulagner G, Armoiry X. Current trends in vasopressor use to the operating room: A pharmacoepidemiologic study in French teaching and military hospitals. ANNALES PHARMACEUTIQUES FRANÇAISES 2017; 75:276-284. [PMID: 28347475 DOI: 10.1016/j.pharma.2017.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 02/06/2017] [Accepted: 02/08/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Phenylephrine, ephedrine and norepinephrine are the vasopressors most commonly used in the operating room to treat anaesthesia-induced hypotension. Two new diluted forms of phenylephrine were released in 2011 (500μg/10mL and 500μg/5mL). We initiated a study to evaluate trends in the use of vasopressors in the operating room in French hospitals over the period 2011-2014. METHODS We conducted a longitudinal, retrospective, observational study between 2011 and 2014 in French teaching and military hospitals. A questionnaire was sent in February 2015 to hospital pharmacists of each centre to retrospectively collect the consumption of each type of vasopressor. Yearly numbers of vasopressor ampoules were divided by the yearly numbers of anaesthetics recorded. For each vasopressor, we calculated the number of ampoules per 100 anaesthetics recorded (/100A). RESULTS Thirty-two hospitals (82%) completed the questionnaire. One hundred per cent of hospitals had registered the diluted form of phenylephrine (61% had chosen the dilution 500μg/10mL), whereas concentrated ampoules were available in 68% of hospitals. Over the period, an exponential increase in the use of diluted phenylephrine was observed (from 1.0 ampoule/100A in 2012 to 31.7 in 2014), the use of ephedrine remained stable (26 ampoules and 17 prefilled syringe/100A), and use of norepinephrine trended upwards (from 6.7 to 8.2 ampoules/100A). CONCLUSIONS The use of diluted phenylephrine has exponentially increased without reducing consumption of other vasopressors. This trend might be secondary to practice changes in hypotension treatment following the release of French guidelines in 2013 related to fluid management, the restriction of indications of hydroxylethyl-starch solutions in 2013, and a better knowledge of the benefit of blood pressure optimisation to reduce postoperative morbidity.
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Affiliation(s)
- M Bauducel
- Service d'anesthésie-réanimation, hospices civils de Lyon, groupement hospitalier Sud, Claude-Bernard université Lyon 1, 69310 Pierre-Bénite, France.
| | - V Piriou
- Service d'anesthésie-réanimation, hospices civils de Lyon, groupement hospitalier Sud, Claude-Bernard université Lyon 1, 69310 Pierre-Bénite, France
| | - C Dussart
- Service de pharmacie, hôpital d'instruction des armées Desgenettes, 69003 Lyon, France
| | - G Aulagner
- Service pharmaceutique, UMR-CNRS 5510/MATEIS, hospices civils de Lyon, groupement hospitalier Est, 69500 Bron, France
| | - X Armoiry
- Délégation à la recherche clinique et a l'innovation, cellule innovation, UMR-CNRS 5510/MATEIS, hospices civils de Lyon, 69500 Bron, France
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