Abandoning inhalational anaesthesia

Abandoning inhalational anaesthesia: a reply

“…We thank Tapley et al for their response [1] to our recent editorial [2]. We hoped that our work might give anaesthetists pause to consider, and take a more meticulous approach to quantifying, the environmental impacts of their practice; it is clear that Tapley et al have done so concerning total intravenous anaesthesia (TIVA).…”

“…Recent Difficult Airway Society (DAS) awake tracheal intubation (ATI) guidelines [1] recommend that 'effective (lidocaine) topicalisation must be established and tested' and that 'sedation must not be used as a substitute for inadequate airway topicalisation'. We are concerned this is a flawed approach that may, of itself, precipitate airway obstruction.…”

Greener ‘Gassers’: key challenges in anaesthesia and perioperative medicine related to the evolving climate crisis

“…33 TIVA worsens these statistics further: an average anaesthetist practicing solely TIVA will produce 4.6 metric tonnes of plastic waste during their career. 26 Though recycling single-use packaging helps minimise these effects, contaminated items are disposed of in yellow bags and sharps bins to be incinerated. This contamination effect was amplified during the COVID-19 pandemic when recycling was not possible in anaesthetic rooms and PPE consumption increased.…”

“…25 An average case using TIVA, with two IV infusion pumps and Bispectral Index monitoring uses 0.45 kWh of electricity, the equivalent of boiling a kettle 4.5 times. 26 However, even after factoring in these energy demands and the environmental effects of manufacturing, packaging, transportation, drug delivery, and waste collection, the CO 2 e for TIVA remains four orders of magnitude less than that of volatile anaesthesia. 25 Propofol consumption can be further reduced through the use of multiple adjuncts: dexmedetomidine (1 mg kg À1 bolus with a 0.5 mg kg À1 h À1 background dose) has been reported to reduce propofol requirements for anaesthetic maintenance by 29%.…”

Lighting a candle, or cursing the darkness? Delivering a climate friendly anaesthetic

“…Those who favour continued volatile anaesthesia use may mention propofol's moderate environmental persistence and unknown effects on the environment, plus the larger amount of plastic generated by its use, compared with volatiles. 22 Such arguments are offset by the life cycle analysis of these different approaches, which note that manufacturing impacts, and the additional overall packaging, weight and transport impacts of volatile anaesthesia still exceed these lesser issues. It's somewhat like worrying about getting your clothing wet as the Titanic is sinking.…”