1
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Endersby RVW, Ip VHY, Moser JJ, Walker AM, Baghirzada L, Spencer AO, Ho ECY. Fast-track spinal anaesthesia reduces length of motor blockade and facilitates earlier discharge after joint arthroplasty. Acta Anaesthesiol Scand 2024. [PMID: 38693899 DOI: 10.1111/aas.14435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/17/2024] [Indexed: 05/03/2024]
Affiliation(s)
| | - Vivian Hui Yun Ip
- Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada
| | - Joanna J Moser
- Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada
| | - Andrew M Walker
- Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada
| | - Leyla Baghirzada
- Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada
| | - Adam O Spencer
- Department of Anesthesia, University of Calgary, Calgary, Alberta, Canada
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2
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Wu CL. 2024 Gaston Labat Award Lecture-outcomes research in Regional Anesthesia and Acute Pain Medicine: past, present and future. Reg Anesth Pain Med 2024:rapm-2024-105286. [PMID: 38395462 DOI: 10.1136/rapm-2024-105286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024]
Affiliation(s)
- Christopher L Wu
- Department of Anesthesiology, Critical Care Medicine and Pain Management, Hospital for Special Surgery, New York, New York, USA
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
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3
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Bareka M, Ntalouka MP, Angelis F, Mermiri M, Tsiaka A, Hantes M, Arnaoutoglou E. Femoral-Obturator-Sciatic (FOS) Nerve Block as an Anesthetic Triad for Arthroscopic ACL Reconstruction: Is This the Magic Trick We Were Missing? J Clin Med 2024; 13:1054. [PMID: 38398367 PMCID: PMC10889400 DOI: 10.3390/jcm13041054] [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: 12/22/2023] [Revised: 01/25/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Arthroscopic anterior cruciate ligament (ACL) reconstruction with hamstring grafting is a common orthopedic procedure that is associated with moderate-to-severe pain. Peripheral nerve blockade as an anesthetic technique is an appealing option in the era of modern anesthesia. The aim of this narrative review is to document the efficacy and safety of the combination of femoral, obturator, and sciatic (FOS) nerve blocks as an exclusive method for anesthesia in patients undergoing ACL reconstruction. An electronic search of the literature published up to October 2023 was conducted in the Medline, Embase, Cochrane, Web of Science, and Google Scholar databases to find studies on ACL reconstruction and peripheral obturator nerve block. Overall, 8 prospective studies-with a total of 315 patients-published between 2007 and 2022 were included in this review. Ultrasound-guided peripheral FOS nerve blockade is an effective anesthetic technique for ACL reconstruction, offering good perioperative pain management, minimal opioid consumption, and an excellent safety profile. Further well-designed prospective studies are needed to determine the best approach for obturator nerve blockade and the appropriate type and dosage of local anesthetic.
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Affiliation(s)
- Metaxia Bareka
- Department of Anaesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa University Hospital, 41110 Larissa, Greece; (M.B.); (M.P.N.)
| | - Maria P. Ntalouka
- Department of Anaesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa University Hospital, 41110 Larissa, Greece; (M.B.); (M.P.N.)
| | - Fragkiskos Angelis
- Department of Orthopaedic Surgery and Musculoskelatal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa University Hospital, 41110 Larissa, Greece
| | - Maria Mermiri
- Department of Anaesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa University Hospital, 41110 Larissa, Greece; (M.B.); (M.P.N.)
| | - Aikaterini Tsiaka
- Department of Anaesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa University Hospital, 41110 Larissa, Greece; (M.B.); (M.P.N.)
| | - Michael Hantes
- Department of Orthopaedic Surgery and Musculoskelatal Trauma, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa University Hospital, 41110 Larissa, Greece
| | - Eleni Arnaoutoglou
- Department of Anaesthesiology, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa University Hospital, 41110 Larissa, Greece; (M.B.); (M.P.N.)
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4
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Sénémaud J, Gouel-Chéron A, Tesmoingt C, Barret E, Montravers P, Castier Y. Carbon Footprint of Elective Endovascular Abdominal Aortic Aneurysm Repair. Eur J Vasc Endovasc Surg 2023; 66:877-878. [PMID: 37647983 DOI: 10.1016/j.ejvs.2023.08.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/31/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Affiliation(s)
- Jean Sénémaud
- Department of Vascular Surgery, Bichat University Hospital, Paris, France; Université Paris Cité, France.
| | - Aurélie Gouel-Chéron
- Université Paris Cité, France; Department of Anaesthesiology and Critical Care Medicine, Bichat University Hospital, Paris, France
| | - Chloé Tesmoingt
- Department of Pharmacy, Bichat University Hospital, Paris, France
| | - Eliza Barret
- Department of Pharmacy, Bichat University Hospital, Paris, France
| | - Philippe Montravers
- Université Paris Cité, France; Department of Anaesthesiology and Critical Care Medicine, Bichat University Hospital, Paris, France
| | - Yves Castier
- Department of Vascular Surgery, Bichat University Hospital, Paris, France; Université Paris Cité, France
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5
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Biyani G, Metta R. Green anesthesia: How green is our practice? J Anaesthesiol Clin Pharmacol 2023; 39:519-520. [PMID: 38269172 PMCID: PMC10805192 DOI: 10.4103/joacp.joacp_515_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/26/2024] Open
Affiliation(s)
- Ghansham Biyani
- Department of Anaesthesiology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
| | - Rajasekhar Metta
- Department of Anaesthesiology, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, India
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6
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McKenzie BJ, Haas R, Ferreira GE, Maher CG, Buchbinder R. The environmental impact of health care for musculoskeletal conditions: A scoping review. PLoS One 2022; 17:e0276685. [PMID: 36441677 PMCID: PMC9704655 DOI: 10.1371/journal.pone.0276685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Health care has significant environmental impact. We performed a scoping review to map what is known about the environmental impact of health care for musculoskeletal conditions. METHODS We included published papers of any design that measured or discussed environmental impact of health care or health support services for any musculoskeletal condition in terms of climate change or global warming (e.g., greenhouse gas emissions it produces). We searched MEDLINE and Embase from inception to 2 May 2022 using keywords for environmental health and musculoskeletal conditions, and performed keyword searches using Google and Google Scholar. Two independent reviewers screened studies. One author independently charted data, verified by a second author. A narrative synthesis was performed. RESULTS Of 12,302 publications screened and 73 identified from other searches, 122 full-text articles were assessed for eligibility, and 49 were included (published 1994 to 2022). Of 24 original research studies, 11 measured environmental impact relating to climate change in orthopaedics (n = 10), and medical aids for the knee (n = 1), one measured energy expenditure of laminar versus turbulent airflow ventilation systems in operating rooms during simulated hip replacements and 12 measured waste associated with orthopaedic surgery but did not relate waste to greenhouse gas emissions or environmental effects. Twenty-one editorials described a need to reduce environmental impact of orthopaedic surgery (n = 9), physiotherapy (n = 9), podiatry (n = 2) or occupational therapy (n = 1). Four narrative reviews discussed sustainability relating to hand surgery (n = 2), orthopaedic surgery (n = 1) and orthopaedic implants (n = 1). CONCLUSION Despite an established link between health care and greenhouse gas emissions we found limited empirical data estimating the impact of musculoskeletal health care on the environment. These data are needed to determine whether actions to lower the carbon footprint of musculoskeletal health care should be a priority and to identify those aspects of care that should be prioritised.
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Affiliation(s)
- Bayden J. McKenzie
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
- * E-mail:
| | - Romi Haas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
| | - Giovanni E. Ferreira
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Chris G. Maher
- Institute for Musculoskeletal Health, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Rachelle Buchbinder
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Melbourne, Australia
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7
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Khatkar H, Kyrdiakides J, McNamara J. The environmental impact of orthopaedic surgery: assessing strategies for change. Br J Hosp Med (Lond) 2022; 83:1-4. [DOI: 10.12968/hmed.2022.0388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Climate change poses one of the most critical threats to humanity. Surgical care needs to be considered in relation to the impending climate emergency. Little thought appears to have been given to the role of operating departments as a high-yield target for environmental change. This article evaluates the environmental impact of orthopaedic surgery, focusing on anaesthesia, waste management and surgical hardware. Developing ‘green’ operating protocols should be the minimum expectation of orthopaedic departments. Just as the management of complex surgical pathology requires a multidisciplinary approach, mitigating the environmental impact of surgical endeavour requires collective action and buy-in.
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Affiliation(s)
- Harman Khatkar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, UK
| | | | - John McNamara
- Department of Trauma and Orthopaedics, Stoke Mandeville Hospital, Aylesbury, UK
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8
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Wortzel JR, Guerrero APS, Aggarwal R, Coverdale J, Brenner AM. Climate Change and the Professional Obligation to Socialize Physicians and Trainees into an Environmentally Sustainable Medical Culture. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2022; 46:556-561. [PMID: 35879599 PMCID: PMC9312321 DOI: 10.1007/s40596-022-01688-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
| | | | | | | | - Adam M Brenner
- University of Texas Southwestern Medical Center, Dallas, TX, USA
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9
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Choi BJ, Chen CL. The Triple Bottom Line and Stabilization Wedges: A Framework for Perioperative Sustainability. Anesth Analg 2022; 134:475-485. [PMID: 35180164 PMCID: PMC9556165 DOI: 10.1213/ane.0000000000005890] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We present a narrative review of environmental sustainability aimed at perioperative clinicians. The review will familiarize readers with the triple bottom line framework, which aims to align the goals of delivering high-quality patient care, promoting environmental sustainability, and improving the financial position of health care organizations. We introduce the stabilization wedges model for climate change action adopted for the perioperative setting and discuss areas in which perioperative leaders can make sustainable choices. The goal of this review is to increase awareness among perioperative physicians of the environmental impacts of surgical and anesthetic care, promote engagement with sustainability efforts as a topic of professional concern for our specialty, and inspire new research in perioperative environmental sustainability.
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Affiliation(s)
| | - Catherine L. Chen
- Department of Anesthesiology and Perioperative Care, University of California, San Francisco, Philip R. Lee Institute for Health Policy Studies, School of Medicine, University of California, San Francisco
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10
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Waaijers-van der Loop S, van Bruggen A, Beijer NRM, Sips A, de Roda Husman AM, Cassee F, Peijnenburg W. Improved science-based transformation pathways for the development of safe and sustainable plastics. ENVIRONMENT INTERNATIONAL 2022; 160:107055. [PMID: 34995967 DOI: 10.1016/j.envint.2021.107055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/30/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
Projected plastic production volumes are rising, as is societal and political attention to plastic pollution and possible health impacts. In line with ambitions for climate mitigation and the circular economy, various national and international policies and action plans address the reduction of impacts of plastics. Quantitative scenario analyses show that even if current ambitious targets to reduce plastics are achieved, plastics will remain a source of millions of tons of environmental pollution annually. To achieve a sustainable transformation of the global plastics economy, 'extraordinary effort' and 'coordinated global action' beyond current ambitions are needed. While mapping knowledge gaps for the effects of micro and nano plastics (MNP) is crucial, mapping alone is not enough to achieve the needed transition. In this communication, we propose a scope for the exploration of societal transformation pathways to safe and sustainable plastics. To see which efforts are needed globally we need to advance in the following three areas: (i) embedding risk assessment methodologies in wider cost-benefit and life cycle analyses; (ii) using safe-and-sustainable design strategies that include alternative solutions and look at multiple life cycles, and (iii) reflecting on the societal transformation pathways with stakeholders by using co-created quantitative models. We believe that these practices are crucial in the coming decade to realise the extraordinary effort of defining safe and sustainable plastics.
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Affiliation(s)
- Susanne Waaijers-van der Loop
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven 3721 MA, the Netherlands.
| | - Anne van Bruggen
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven 3721 MA, the Netherlands.
| | - Nick R M Beijer
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven 3721 MA, the Netherlands.
| | - Adrienne Sips
- Centre for Safety of Substances and Products, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven 3721 MA, the Netherlands.
| | - Ana Maria de Roda Husman
- Infectious Disease Control (CIb), National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven 3721 MA, the Netherlands; Institute for Risk Assessment Science (IRAS), Utrecht University, Yalelaan 2, Utrecht 3584 CM, the Netherlands.
| | - Flemming Cassee
- Centre for Sustainability, Environment and Health, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven 3721 MA, the Netherlands; Institute for Risk Assessment Science (IRAS), Utrecht University, Yalelaan 2, Utrecht 3584 CM, the Netherlands.
| | - Willie Peijnenburg
- Centre for Safety of Substances and Products, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, Bilthoven 3721 MA, the Netherlands; Institute of Environmental Sciences (CML), Leiden University, Einsteinweg 2, Leiden 2333 CC, the Netherlands.
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11
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White SM, Shelton CL, Gelb AW, Lawson C, McGain F, Muret J, Sherman JD. Principles of environmentally-sustainable anaesthesia: a global consensus statement from the World Federation of Societies of Anaesthesiologists. Anaesthesia 2022; 77:201-212. [PMID: 34724710 PMCID: PMC9298028 DOI: 10.1111/anae.15598] [Citation(s) in RCA: 59] [Impact Index Per Article: 29.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2021] [Indexed: 12/16/2022]
Abstract
The Earth's mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convened a Working Group of 45 anaesthesia providers with a recognised interest in sustainability, and used a three-stage modified Delphi consensus process to agree on principles of environmentally sustainable anaesthesia that are achievable worldwide. The Working Group agreed on the following three important underlying statements: patient safety should not be compromised by sustainable anaesthetic practices; high-, middle- and low-income countries should support each other appropriately in delivering sustainable healthcare (including anaesthesia); and healthcare systems should be mandated to reduce their contribution to global warming. We set out seven fundamental principles to guide anaesthesia providers in the move to environmentally sustainable practice, including: choice of medications and equipment; minimising waste and overuse of resources; and addressing environmental sustainability in anaesthetists' education, research, quality improvement and local healthcare leadership activities. These changes are achievable with minimal material resource and financial investment, and should undergo re-evaluation and updates as better evidence is published. This paper discusses each principle individually, and directs readers towards further important references.
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Affiliation(s)
- S. M. White
- Department of AnaesthesiaUniversity Hospitals Sussex NHS Foundation TrustBrightonUK
| | - C. L. Shelton
- Department of AnaesthesiaWythenshawe HospitalManchester University NHS Foundation TrustManchesterUK,Lancaster Medical SchoolFaculty of Health and MedicineLancaster UniversityLancasterUK
| | - A. W. Gelb
- Department of Anesthesia and Peri‐operative CareUniversity of California San FranciscoSan FranciscoCAUSA
| | - C. Lawson
- Royal Victoria InfirmaryNewcastle upon TyneUK
| | - F. McGain
- Departments of Anaesthesia and Intensive CareWestern HealthMelbourneVic.Australia,Department of Critical CareUniversity of MelbourneMelbourneVic.Australia
| | - J. Muret
- Departments of Anaesthesia and Intensive CareInstitut CuriePSL Research UniversityParisFrance
| | - J. D. Sherman
- Yale School of Medicine and Associate Professor of Epidemiology in Environmental Health SciencesYale School of Public HealthNew HavenCTUSA
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12
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Baxter NB, Yoon AP, Chung KC. Variability in the Use of Disposable Surgical Supplies: A Surgeon Survey and Life Cycle Analysis. J Hand Surg Am 2021; 46:1071-1078. [PMID: 34275683 DOI: 10.1016/j.jhsa.2021.05.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 05/02/2021] [Accepted: 05/19/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE A substantial amount of waste is generated during surgery, yet few studies have investigated this problem. Therefore, we conducted a multicenter survey to investigate how the variation in the use of disposable supplies contributes to the environmental and financial burdens of health care. METHODS We created a questionnaire to identify differences in supply use and practice characteristics among hand surgeons who participated in the Wrist and Radius Injury Surgical Trial. We determined the average cumulative cost of 10 key surgical items based on the responses. Subsequently, we estimated the kilograms of carbon dioxide emitted during the life cycle of supplies, from raw material extraction to production and disposal, using economic input-output life cycle analysis. RESULTS Thirty-five surgeons from 19 institutions responded to the survey (65% response rate). Based on the difference in costs between surgeons who used the fewest and the most supplies, we determined that expenditures and carbon dioxide emissions could decrease by $22.47 and 10.9 kg per procedure, respectively, with leaner use of 10 key items. Furthermore, assuming that surgeon variation in supply use is present in other surgical subspecialties, we estimated that $2.4 billion in savings and an 800.6 thousand metric ton reduction in carbon emissions could be achieved if all US surgeons reduced their supply use by this amount. CONCLUSIONS This study revealed considerable variations in the use of disposable supplies among hand surgeons, highlighting the need for evidence-based tools, policies, and education campaigns to reduce hospital waste across health care systems. CLINICAL RELEVANCE Optimal use of disposable supplies is necessary to reduce the cost and environmental burden of hand surgery care.
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Affiliation(s)
- Natalie B Baxter
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI
| | - Alfred P Yoon
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI
| | - Kevin C Chung
- Department of Surgery, Section of Plastic Surgery, Michigan Medicine, Ann Arbor, MI.
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13
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McGinnis S, Johnson-Privitera C, Nunziato JD, Wohlford S. Environmental Life Cycle Assessment in Medical Practice: A User's Guide. Obstet Gynecol Surv 2021; 76:417-428. [PMID: 34324694 DOI: 10.1097/ogx.0000000000000906] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Importance The environmental impacts of medical practice are becoming more important as the unsustainable activities of global societies continue to damage the environment and contribute to health problems. Life cycle assessment (LCA) is a methodology to quantify a wide range of environmental impacts, including global warming, over the full life cycle of products, processes, and systems, to allow for data-driven environmental decisions. Objective This article introduces the concepts, terminology, and methodology of LCA using examples from the medical industry. It provides guidance and best practices for the standard steps of an LCA study. Evidence Acquisition A review of the literature was done to provide examples of the use of LCA and carbon footprints in medicine. Hypothetical medical products were modeled using LCA software to illustrate the capabilities and limitations of this method. Results Life cycle assessment examples in medicine illustrate the ability of this method to compare environmental impacts for products that perform the same function. They also highlight the relative scale of damage across all life cycle phases for a variety of environmental impact categories. Resources have also been provided for various useful LCA tools. Conclusions and Relevance Life cycle assessment can provide medical practitioners with quantified environmental metrics in order to make decisions that minimize the environmental impacts of medical products, processes, and systems. Carbon footprints are LCA studies that focus only on the impact of climate change. Life cycle assessment is expected to grow as a tool for environmental decisions in medical practice.
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Affiliation(s)
- Sean McGinnis
- Associate Professor of Practice, Department of Materials Science and Engineering; Director, VT Green Engineering Program, Virginia Tech College of Engineering, Blacksburg, VA
| | | | - Jaclyn D Nunziato
- Assistant Professor, Obstetrics and Gynecology, Carilion Clinic/Virginia Tech Carilion School of Medicine
| | - Sara Wohlford
- Efficiency and Sustainability Manager, Carilion Clinic, Roanoke, VA
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14
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Hoyler MM, White RS, Mack PF, Kelleher DC. Environmental report cards in anesthesia care: A quality metric for patients, providers and institutions. J Clin Anesth 2021; 73:110355. [PMID: 34058695 DOI: 10.1016/j.jclinane.2021.110355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/09/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Marguerite M Hoyler
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, Department of Anesthesiology. 525 East 68th Street, Box 124, New York, NY 10065, USA.
| | - Robert S White
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, Department of Anesthesiology. 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Patricia Fogarty Mack
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, Department of Anesthesiology. 525 East 68th Street, Box 124, New York, NY 10065, USA
| | - Deirdre C Kelleher
- Department of Anesthesiology, New York-Presbyterian/Weill Cornell Medical Center, Department of Anesthesiology. 525 East 68th Street, Box 124, New York, NY 10065, USA
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15
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Koytcheva MK, Sauerwein LK, Webb TL, Baumgarn SA, Skeels SA, Duncan CG. A Systematic Review of Environmental Sustainability in Veterinary Practice. Top Companion Anim Med 2021; 44:100550. [PMID: 34051396 DOI: 10.1016/j.tcam.2021.100550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/29/2022]
Abstract
A transition toward environmentally conscious business practices is underway in many sectors. For healthcare, the topic is both concerning and tragically ironic as hospitals have substantial environmental footprints, which are now known to contribute to significant health problems that the system itself was designed to treat. The human medical field has been proactive in taking steps to reduce waste and carbon emissions by identifying best practices to minimize such impacts. Characterization of needs and gaps has been addressed through reviews of the literature regarding environmental sustainability in the context of human hospitals. Our objective was to replicate methods used in a recent review of environmental sustainability in human hospitals to summarize information available to clinical veterinarians. Two search algorithms were used across 8 databases, however only 3 peer-reviewed opinion articles specific to veterinary medicine were identified. These papers included 1 on anesthesia and 2 on production animals. Interestingly, all articles were written by United Kingdom-based authors and none were specific to companion animal practice, the largest sector in the veterinary industry in the United States. Results of this review highlight need for research and communication that supports veterinary clinics in adopting more environmentally sustainable practices. Proposed starting points informed from research in other sectors, including 5 physical themes of energy efficiency, water, waste, sustainable procurement, and transportation, and human behavior changes on the individual, group, and organizational levels, are discussed. Additional work is needed to support veterinarians and other animal health professionals to practice medicine in a way that upholds the veterinary profession's oath to promote the health of animals, the public, and the environment we all share.
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Affiliation(s)
- Maria K Koytcheva
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Leah K Sauerwein
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Tracy L Webb
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Stacey A Baumgarn
- Facilities Management, Colorado State University, Fort Collins, CO, USA
| | - Sadie A Skeels
- Veterinary Teaching Hospital Library, Colorado State University, Fort Collins, CO, USA
| | - Colleen G Duncan
- Department of Microbiology, Immunology and Pathology, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado, USA.
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16
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Van Zundert A. The green footprint of anaesthesia. Anaesth Crit Care Pain Med 2021; 40:100872. [PMID: 33910084 DOI: 10.1016/j.accpm.2021.100872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 10/21/2022]
Affiliation(s)
- André Van Zundert
- Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital & The University of Queensland, Brisbane, QLD, Australia.
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17
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Varughese S, Ahmed R. Environmental and Occupational Considerations of Anesthesia: A Narrative Review and Update. Anesth Analg 2021; 133:826-835. [PMID: 33857027 PMCID: PMC8415729 DOI: 10.1213/ane.0000000000005504] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
With an estimated worldwide volume of 266 million surgeries in 2015, the call for general inhalation anesthesia is considerable. However, widely used volatile anesthetics such as N2O and the highly fluorinated gases sevoflurane, desflurane, and isoflurane are greenhouse gases, ozone-depleting agents, or both. Because these agents undergo minimal metabolism in the body during clinical use and are primarily (≥95%) eliminated unchanged via exhalation, waste anesthetic gases (WAGs) in operating rooms and postanesthesia care units can pose a challenge for overall elimination and occupational exposure. The chemical properties and global warming impacts of these gases vary, with atmospheric lifetimes of 1-5 years for sevoflurane, 3-6 years for isoflurane, 9-21 years for desflurane, and 114 years for N2O. Additionally, the use of N2O as a carrier gas for the inhalation anesthetics and as a supplement to intravenous (IV) anesthetics further contributes to these impacts. At the same time, unscavenged WAGs can result in chronic occupational exposure of health care workers to potential associated adverse health effects. Few adverse effects associated with WAGs have been documented, however, when workplace exposure limits are implemented. Specific measures that can help reduce occupational exposure and the environmental impact of inhaled anesthetics include efficient ventilation and scavenging systems, regular monitoring of airborne concentrations of waste gases to remain below recommended limits, ensuring that anesthesia equipment is well maintained, avoiding desflurane and N2O if possible, and minimizing fresh gas flow rates (eg, use of low-flow anesthesia). One alternative to volatile anesthetics may be total intravenous anesthesia (TIVA). While TIVA is not associated with the risks of occupational exposure or atmospheric pollution that are inherent to volatile anesthetic gases, clinical considerations should be weighed in the choice of agent. Appropriate procedures for the disposal of IV anesthetics must be followed to minimize any potential for negative environmental effects. Overall, although their contributions are relatively low compared with those of other human-produced substances, inhaled anesthetics are intrinsically potent greenhouse gases and pose a risk to operating-room personnel if not properly managed and scavenged. Factors to reduce waste and minimize the future impact of these substances should be considered.
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Affiliation(s)
- Shane Varughese
- From the Global Medical Affairs, AbbVie Inc, North Chicago, Illinois
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18
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Kuvadia M, Cummis CE, Liguori G, Wu CL. 'Green-gional' anesthesia: further considerations. Reg Anesth Pain Med 2020; 46:554. [PMID: 32883716 DOI: 10.1136/rapm-2020-101946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Accepted: 07/21/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Mausam Kuvadia
- Anesthesiology, Hospital for Special Surgery, New York, New York, USA.,Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | | | - Gregory Liguori
- Anesthesiology, Hospital for Special Surgery, New York, New York, USA
| | - Christopher L Wu
- Anesthesiology, Hospital for Special Surgery, New York, New York, USA
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19
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Özelsel TJP, Ip VHY, Sondekoppam RV. "Green-gional" anesthesia: a lot greener than you think. Reg Anesth Pain Med 2020; 46:553-554. [PMID: 32883717 DOI: 10.1136/rapm-2020-101865] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/02/2020] [Accepted: 07/07/2020] [Indexed: 12/16/2022]
Affiliation(s)
- Timur J P Özelsel
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Vivian H Y Ip
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Rakesh V Sondekoppam
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Department of Anesthesia, University of Iowa Healthcare, Iowa City, Iowa, USA
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