Advances in vaporisation: A narrative review

Anesthesia and its environmental impact: approaches to minimize exposure to anesthetic gases and reduce waste

In today's era of modern healthcare, the intersection between medical practices and environmental responsibility has gained significant attention. One such area of focus is the practice of anesthesia, which plays a crucial role in various surgical procedures. Anesthetics such as nitrous oxide and volatile halogenated ethers (desflurane, isoflurane, sevoflurane) are examples of medical gases that are strong greenhouse gases that contribute to global warming. During medical procedures, most of these anesthetic agents are released into the atmosphere, which exacerbates their influence on the environment. Also anesthesia delivery systems have traditionally utilized high flow rates of gases, leading to not only excessive consumption but also a considerable environmental impact in terms of greenhouse gas emissions. However, the emergence of low-flow anesthesia (LFA) presents a promising solution for achieving emission reduction and cost savings, thereby aligning healthcare practices with sustainability goals. Understanding LFA involves the administration of anesthetic gases to patients at reduced flow rates compared to conventional high-flow methods. This practice requires precision in gas delivery, often incorporating advanced monitoring and control systems. By optimizing gas flow to match the patient's requirements, LFA minimizes wastage and excessive gas release into the environment, subsequently curbing the carbon footprint associated with healthcare operations. Decreasing volatile anesthetic delivery provides safe and effective strategies for anesthesia providers to decrease costs and reduce environmental pollution. Current literature support in favor of LFA represents an area of cost containment and an opportunity to lessen the environmental impact of anesthesia. This article will cover the concept of LFA, the distinctions between low flow and minimal flow, and the potential advantages of LFA, such as those related to patient safety, the environment, and the economy.

Volatile capture technology in sustainable anaesthetic practice: a narrative review

Anaesthetic practice contributes to climate change. Volatile capture technology, typically based on adsorption to a carbon- or silica-based substrate, has the potential to mitigate some of the harmful effects of using halogenated hydrocarbons. Anaesthetists have a professional responsibility to use anaesthetic agents which offer the greatest safety and clinical benefit with the lowest financial cost and environmental impacts. Inhalational anaesthetics should be used at an appropriate concentration with a minimal fresh gas flow via a circle system to minimise unnecessary waste. Once practice efficiencies have been maximised, only then should technical solutions such as volatile capture be employed. In this narrative review, we focus on the available literature relating to volatile capture technology, obtained via a targeted literature search and through contacting manufacturers and researchers. We found six studies focusing on the Blue-Zone Technologies Deltasorb®, SageTech Medical SID and Baxter/ZeoSys CONTRAfluran™ volatile capture systems. Though laboratory analyses of available systems suggest that > 95% in vitro mass transfer is possible for all three systems, the in vivo results for capture efficiency vary from 25% to 73%. Currently, there is no financial incentive for healthcare organisations to capture waste anaesthetic gases, and so the value of volatile capture technology requires quantification. System-level organisations, such as Greener NHS, are best positioned to commission such evaluations and make policy decisions to guide investment. Further research using volatile capture technology in real-world settings is necessary and we highlight some priority research questions to improve our understanding of the utility of this group of technologies.