New Method of Destroying Waste Anesthetic Gases Using Gas-Phase Photochemistry

Rauchenwald, Verena; Rollins, Mark D.; Ryan, Susan M.; Voronov, Alex; Feiner, John; Šarka, Karolis; Johnson, Matthew S.

doi:10.1213/ane.0000000000004119

Cited by 21 publications

(26 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…60 It is possible to destroy both volatile gases and N 2 O with a simple scavenging circuit UV lamp, although the efficiency of removing UV-resistant N 2 O is much less (<10% N 2 O destroyed). 64 Membrane technologies that filter through CO 2 , O 2 and N 2 into the scavenging interface, whilst preventing the larger volatile anaesthetics from escaping into the scavenging stream, are also being actively examined. 65 Anaesthesia scavenging interfaces continuously entrain large air volumes, diluting the WAGs and reducing suitability for effective volatile 'cold trap' condensation.…”

Section: Relevance To the Individual Anaesthetistmentioning

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

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.

show abstract

Section: Relevance To the Individual Anaesthetistmentioning

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

“… 54 A recent proof-of-concept study of a photochemical exhaust gas destruction system demonstrated efficient removal of desflurane and sevoflurane, although removal of N 2 O requires further optimization. 55 These and similar strategies provide valuable reductions in the environmental impact of volatile anesthetic gases that can often be implemented in a cost-neutral or even cost-saving fashion. 53 – 55 …”

Section: Strategies For Environmental and Occupational Improvement: Hospital Anesthesia And Minimization Of Waste And Exposurementioning

confidence: 99%

“… 55 These and similar strategies provide valuable reductions in the environmental impact of volatile anesthetic gases that can often be implemented in a cost-neutral or even cost-saving fashion. 53 – 55 …”

Section: Strategies For Environmental and Occupational Improvement: Hospital Anesthesia And Minimization Of Waste And Exposurementioning

confidence: 99%

Environmental and Occupational Considerations of Anesthesia: A Narrative Review and Update

Varughese

Ahmed

2021

Anesthesia &Amp; Analgesia

103

View full text Add to dashboard Cite

With an estimated worldwide volume of 266 million surgeries in 2015, the call for general inhalation anesthesia is considerable. However, widely used volatile anesthetics such as N 2 O and the highly fluorinated gases sevoflurane, desflurane, and isoflurane are greenhouse gases, ozone-depleting agents, or both. Because these agents undergo minimal metabolism in the body during clinical use and are primarily (≥95%) eliminated unchanged via exhalation, waste anesthetic gases (WAGs) in operating rooms and postanesthesia care units can pose a challenge for overall elimination and occupational exposure. The chemical properties and global warming impacts of these gases vary, with atmospheric lifetimes of 1−5 years for sevoflurane, 3−6 years for isoflurane, 9−21 years for desflurane, and 114 years for N 2 O. Additionally, the use of N 2 O as a carrier gas for the inhalation anesthetics and as a supplement to intravenous (IV) anesthetics further contributes to these impacts. At the same time, unscavenged WAGs can result in chronic occupational exposure of health care workers to potential associated adverse health effects. Few adverse effects associated with WAGs have been documented, however, when workplace exposure limits are implemented. Specific measures that can help reduce occupational exposure and the environmental impact of inhaled anesthetics include efficient ventilation and scavenging systems, regular monitoring of airborne concentrations of waste gases to remain below recommended limits, ensuring that anesthesia equipment is well maintained, avoiding desflurane and N 2 O if possible, and minimizing fresh gas flow rates (eg, use of low-flow anesthesia). One alternative to volatile anesthetics may be total intravenous anesthesia (TIVA). While TIVA is not associated with the risks of occupational exposure or atmospheric pollution that are inherent to volatile anesthetic gases, clinical considerations should be weighed in the choice of agent. Appropriate procedures for the disposal of IV anesthetics must be followed to minimize any potential for negative environmental effects. Overall, although their contributions are relatively low compared with those of other human-produced substances, inhaled anesthetics are intrinsically potent greenhouse gases and pose a risk to operating-room personnel if not properly managed and scavenged. Factors to reduce waste and minimize the future impact of these substances should be considered.

show abstract

“…Dots present the distribution of raw data for the fraction of time spent spontaneously breathing of even more efficient application systems as well as systems for elimination or recycling of volatile anesthetics may soon diminish ecological concerns. 34 Controlled mechanical ventilation with complete diaphragmatic inactivity for as little as 18-69 h results in marked atrophy of the diaphragm, 5 which impacts clinical outcomes. 6 In contrast, spontaneous breathing reduces dorso-caudal atelectasis and improves cardiac output.…”

Section: Discussionmentioning

confidence: 99%