Guidelines for reducing the environmental impact of general anaesthesia

Pauchard, Jean-Claude; Hafiani, El-Madhi; Pons, Stéphanie; Bonnet, Laure; Cabelguenne, Delphine; Carenco, Philipe; Cassier, Pierre; Garnier, Jérémie; Lallemant, Florence; Sautou, Valérie; De Jong, Audrey; Caillard, Anaïs

doi:10.1016/j.accpm.2023.101291

Cited by 14 publications

(3 citation statements)

References 123 publications

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“…Second, the anaesthetic practices in our organisation may not be reflective of other institutions and readers should be cautious when generalising the results of this study. In particular, the fresh gas flows typically used at our institutions at the time of data collection were higher than those advocated by many organisations [50], and are likely to have reduced since French professional guidelines advocating low flows (0.1–1 l.min ‐1 ) during inhalational anaesthesia were published in 2023 [51]. Third, the emissions factors and life‐cycle assessments are subject to inherent limitations and uncertainties, which may lead to an underestimation of the carbon footprint associated with sedation.…”

Section: Discussionmentioning

confidence: 99%

Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients

Bernat,

Boyer,

Roche

et al. 2024

Anaesthesia

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SummaryGlobal warming is a major public health concern. Volatile anaesthetics are greenhouse gases that increase the carbon footprint of healthcare. Modelling studies indicate that total intravenous anaesthesia is less carbon intensive than volatile anaesthesia, with equivalent quality of care. In this observational study, we aimed to apply the findings of previous modelling studies to compare the carbon footprint per general anaesthetic of an exclusive TIVA strategy vs. a mixed TIVA‐volatile strategy. This comparative retrospective study was conducted over 2 years in two French hospitals, one using total intravenous anaesthesia only and one using a mixed strategy including both intravenous and inhalation anaesthetic techniques. Based on pharmacy procurement records, the quantity of anaesthetic sedative drugs was converted to carbon dioxide equivalents. The primary outcome was the difference in carbon footprint of hypnotic drugs per intervention between the two strategies. From 1 January 2021 to 31 December 2022, 25,137 patients received general anaesthesia in the hospital using the total intravenous anaesthesia strategy and 22,020 in the hospital using the mixed strategy. The carbon dioxide equivalent footprint of hypnotic drugs per intervention in the hospital using the total intravenous anaesthesia strategy was 20 times lower than in the hospital using the mixed strategy (emissions of 2.42 kg vs. 48.85 kg carbon dioxide equivalent per intervention, respectively). The total intravenous anaesthesia strategy significantly reduces the carbon footprint of hypnotic drugs in general anaesthesia in adult patients compared with a mixed strategy. Further research is warranted to assess the risk–benefit ratio of the widespread adoption of total intravenous anaesthesia.

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Section: Discussionmentioning

confidence: 99%

Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients

Bernat,

Boyer,

Roche

et al. 2024

Anaesthesia

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“…Rescue medications are disposed of most often, with one study finding 85.7% of epinephrine was wasted. Prefilled syringes are a potential solution to mitigate medication waste, as this packaging has a longer shelf life and eliminates the need to prepare and dispose of the medication on a case-by-case basis [19,20 ▪▪ ]. Hospital systems should work to pair preparation and allotment of medications to actual use to decrease both healthcare costs and environmental impact [21].…”

Section: Environmental Impact Of Pharmaceuticals In Anesthesiamentioning

confidence: 99%

The environmental impacts of anesthesia

Grunert,

Hunt,

Decker

2024

Current Opinion in Urology

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Purpose of review The healthcare sector has a substantial environmental footprint, and the delivery of anesthesia contributes significantly. Inhaled anesthetics themselves are potent greenhouse gases, unused intravenous medication exert toxic effects on the environment, and the increasing reliance on single-use devices has led to an ever-growing amount of solid waste produced in operating rooms. This review discusses many of these environmental impacts and suggests practices to mitigate the environmental footprint of anesthetic practice. Recent findings The choice of anesthesia maintenance has significant environmental implications, with nitrous oxide and desflurane having the highest carbon footprint of all anesthetic agents. Using low fresh gas flows and supplementing or replacing inhalational agents with propofol leads to a significant reduction in emissions. Many intravenous anesthetic agents pose a risk of environmental toxicity, and efforts should be made to decrease medication waste and ensure appropriate disposal of unused medications to minimize their environmental impacts. Additionally, consideration should be given to replacing single-use devices in the operating rooms with reusable alternatives that are often both environmentally and economically superior. And solid waste generated in the operating room should be segregated thoughtfully, as processing regulated medical waste is a highly energy-intensive process. Summary Significant opportunities exist to improve the environmental footprint of anesthesia practice, and with the rapidly worsening climate crisis, the importance of implementing changes is greater than ever.

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“…Cost-reduction strategies have gained considerable significance due to rising anesthetic drug prices and health care costs, particularly in developing countries. Inferring that decreasing drug waste is a key area for lowering anesthetic costs without compromising the quality of care delivered [ 15 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Anesthetics drug wastage and preventive strategies: Systematic review

Habte,

Tegegne,

Alemayehu

2024

PLoS ONE

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Background Surgical Patients and hospitals are now facing financial strain due to direct anesthetic demand as a result of the development of new anesthetic drugs, equipment, and techniques. Up to 15% of a hospital’s pharmacy budget is currently allocated to anesthetic drug expenses. Drug wastage during anesthesia practice is a widespread hidden source of healthcare waste that leads to anesthetic drug shortages as well as poor operating room efficiency. On the other hand, despite the fact that it is preventable in the vast majority of cases, it is well described that drug wastage is routinely observed, including in developing countries where the consequences significantly affect both hospitals and patients. Methods This review aims to review the prevalence of anesthetic drug waste across the world and systematically formulate and describe preventive strategies. Relevant publications were identified using systematic searches on databases including Google Scholar, Medline (PubMed), the Cochrane Library, and Embase. In addition, papers were detected and then selected through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria guidelines and the inclusion and exclusion criteria. Using the predetermined terms and dates from the searching databases, a total of 504 articles were identified. Based on the screening criteria, 16 papers were considered eligible and included in the final review. In addition, the Joanna Briggs Institute (JBI) Manual for Evidence Synthesis was used for evaluating the quality of selected articles. This study is registered on PROSPERO, number CRD42024497044. Results Of the sixteen publications from eleven different nations that were considered suitable for inclusion, only two of them addressed the waste of inhalational anesthetics. In more than half of eligible articles, propofol was the frequently wasted drug that contributed to increased financial loss through drug waste. The first most significant factor contributing to the waste of intravenous and inhalational anesthetics was the disposal of multidrug vials following their use for a single patient and high fresh gas flow, respectively. Conclusion Anesthetic medication waste is a common occurrence worldwide, despite the fact that it is expensive and has a significant negative impact on operating room efficiency. Because the majority of drug waste is avoidable, preventive measures may lower drug waste and improve patient and hospital efficiency.

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Guidelines for reducing the environmental impact of general anaesthesia

Cited by 14 publications

References 123 publications

Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients

Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients

The environmental impacts of anesthesia

Anesthetics drug wastage and preventive strategies: Systematic review

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