A new role for anaesthetists in environmentally‐sustainable healthcare

Shelton, Cliff; McBain, Stuart C; Mortimer, Frances; White, Stuart

doi:10.1111/anae.14647

Cited by 28 publications

(37 citation statements)

References 14 publications

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“…USA, 146 UK, 147 France, 148 Canada, 149 Europe, 150 and Australia/ New Zealand. 43,151 Interest in environmental sustainability is also evident within anaesthesia editorials in British Journal of Anaestheisa, 35 Anesthesia and Analgesia, 152,153 Anaesthesia, 154,155 Canadian Journal of Anesthesia, 156 and Anaesthesia Critical Care and Pain Medicine. 157 Educational publications within anaesthesia journals, particularly describing climate change and the atmospheric effects of anaesthetic gases exist.…”

Section: Travelmentioning

confidence: 99%

Environmental sustainability in anaesthesia and critical care

McGain

Muret

Lawson

et al. 2020

British Journal of Anaesthesia

241

226

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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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Section: Travelmentioning

confidence: 99%

Environmental sustainability in anaesthesia and critical care

McGain

Muret

Lawson

et al. 2020

British Journal of Anaesthesia

241

226

View full text Add to dashboard Cite

show abstract

“…Beyond superior analgesia, the evidence for patient, surgical, institutional, and environmental benefits provided by regional anaesthesia is growing, with many of these benefits greatest when general anaesthesia can be avoided. 12,13 Benefits such as reduced postoperative complications, bypassing or reducing time in recovery, and earlier hospital discharge are particularly valuable. Avoiding a general anaesthetic in patients with active COVID-19 undergoing urgent surgery is likely to be beneficial, but there is also a suggestion that mortality rates of patients with undiagnosed COVID-19 who subsequently undergo surgery is higher.…”

Section: Other Potential Advantages Of Regional Anaesthesiamentioning

confidence: 99%

Regional anaesthesia and COVID-19: first choice at last?

Macfarlane

Harrop‐Griffiths

Pawa

2020

British Journal of Anaesthesia

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“…Analyses following propensity score matching, which were performed to account for the lack of random allocation of volatile agent and to address potential imbalances or residual confounding between study groups, remained robustly consistent with our primary findings. operating room altogether through the use of TIVA or the removal of desflurane[8,33,34]. However, the consideration of removal of desflurane from an organisation is typically driven by cost comparisons, operational efficiency and perceived clinical benefits.…”

mentioning

confidence: 99%

A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single‐centre cohort study

et al. 2020

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Sevoflurane and desflurane are the most commonly used volatile anaesthetics for maintenance of anaesthesia. In this study, we aimed to evaluate the relationship between choice of volatile anaesthetic and early postoperative respiratory complications, and to address a critical knowledge gap in safety outcomes between these two commonly used agents. We performed a retrospective analysis of adult (non-cardiac surgery) patients who received sevoflurane or desflurane for the maintenance of general anaesthesia at our institution between 2005 and 2018. We evaluated the association between desflurane exposure (when compared with sevoflurane) and the primary outcome of postoperative respiratory complications, defined by early post-extubation desaturation (S p O 2 < 90%) or re-intubation within 7 days postoperatively. Multivariable regression analyses were performed and adjusted for confounding factors, including patient, anaesthetic and surgical factors. Propensity matched, interaction and subgroup analyses were performed to assess outcomes in high-risk groups: morbidly obese (BMI > 35 kg.m À2); elderly (age > 65 years); and high risk of respiratory complications as well as the primary outcome at 24 h. Desflurane was used for 23,830 patients and sevoflurane for 84,608 patients. Patients exposed to desflurane did not demonstrate a reduced risk of postoperative respiratory complications when compared with sevoflurane (adjusted odds ratio 0.99, 95%CI 0.94-1.04, p = 0.598). These findings were consistent across all subgroups of high-risk patients and in the propensity score matched cohort. In summary, desflurane use was not associated with reduced postoperative respiratory complications when compared with sevoflurane. In the context of environmental and cost concerns with volatile anaesthetic agents, our study provides important data to support organisational decisions regarding the use of desflurane.

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A new role for anaesthetists in environmentally‐sustainable healthcare

Cited by 28 publications

References 14 publications

Environmental sustainability in anaesthesia and critical care

Environmental sustainability in anaesthesia and critical care

Regional anaesthesia and COVID-19: first choice at last?

A comparison of postoperative respiratory complications associated with the use of desflurane and sevoflurane: a single‐centre cohort study

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