Carbon footprinting of anaesthetic practice - the need to consider work as done

Carbon footprint of inhalational and total intravenous anaesthesia for paediatric anaesthesia: a modelling study

“…This and other data indicate that whilst low flow anaesthesia is recommended, it is seldom consistently achieved in practice. 29 This emphasises the potentially important role of technological solutions such as automated end-tidal control and electronic injection, which can optimise volatile agent use by reducing the influence of human factors. 30 As this technology becomes more widely established in practice, future research should evaluate its impact.…”

How should institutions help clinicians to practise greener anaesthesia: first-order and second-order responsibilities to practice sustainably

“…[27] In the absence  A peer reviewer raised a concern that minimal-flow anaesthesia, good agent husbandry and introduction of new technologies such as volatile capture technology, will bring a lifecycle analysis of inhalational anaesthesia with sevoflurane much closer to that of TIVA compared to that found by Sherman et al [6] It is possible to provide inhalational anaesthesia with sub-0.5l/min fresh gas flow rates, however this is rarely reflected in practice because of the need to use higher flows at induction of anaesthesia, and the potential to forget to reduce flows later. [22] The best available recent lifecycle analysis by Hu et al still favours TIVA over minimalflow volatile, but obviously this is by less of a margin than with a higher-flow of volatile anaesthetic. [11] The authors did find that volatile capture technology and minimal flow anaesthesia, used in combination, may push the carbon footprint of sevoflurane-based anaesthesia below that of TIVA and so Hu et al's work may be considered a best case scenario.…”

Efficiency of inhaled anaesthetic recapture in clinical practice. Comment on Br J Anaesth 2022; 129: e79–81

“…This means that in the experimental conditions described, a lower proportion of volatile agent may have been wasted (and therefore available for capture) than might be expected in 'real world' clinical practice, where average fresh gas flows of over 1 L.min -1 are frequently observed. 3,4 The sole use of 'recapture rate' as the performance metric for VCT has the potential to create some perverse incentives. For example, if the fresh gas flow were 10 times greater than necessary, 90% of the administered agent would pass out of the circuit and into the VCT device intra-operatively, potentially leading to a higher recapture rate despite a clearly wasteful technique.…”