Propofol Wastage in Anesthesia

Mankes, R.

doi:10.1213/ane.0b013e31824ea491

Cited by 94 publications

(122 citation statements)

References 8 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In previous studies [71,72], wasting of propofol, other injectable drugs, and controlled substances (CS) was generally higher (4.1%) at the same facilities as reported herein. For example; Mankes [71] found that 41 liters of propofol emulsion and other liquid injectable surgical drugs were wasted of 150 liters dispensed.…”

Section: Discussionsupporting

confidence: 69%

“…Sim et al [16] assayed twenty-four (24) different drugs in Korean wastewater finding ug/L levels of pharmaceuticals in hospital effluent. Olivera et al [71] measured 185 pharmaceutical and personal care products by liquid chromatographymass spectroscopy (LC-MS) in hospital effluent and wastewater in Suffolk County, USA finding very low levels ranging from undetectable (most) to 1.4 ug/L for erythromycin.…”

Section: Discussionmentioning

confidence: 99%

“…For example; Mankes [71] found that 41 liters of propofol emulsion and other liquid injectable surgical drugs were wasted of 150 liters dispensed. Mankes and Silver [72] reported that 8.5 kg of CS were wasted of 38 kg dispensed and 2.3 kg wasted of 56 kg dispensed in the present study.…”

Section: Discussionmentioning

confidence: 99%

“…In prior publications [71][72][73] the patterns of wasting and potential environmental effects of propofol and other surgical drugs (e.g., lidocaine, succinylcholine, bupivacaine, ephedrine, epinephrine, atracurium, proparacaine and atropine) were reported from a surgical care center in Albany, NY. Of interest was how a small change in availability (e.g., removal of 50 and 100 mL vials of propofol from automated dispensing machines in the operating rooms) reduced propofol wastage from 29.2 to 2.8 mL for each waste receptacle per day [71].…”

Section: Introductionmentioning

confidence: 99%

“…Of interest was how a small change in availability (e.g., removal of 50 and 100 mL vials of propofol from automated dispensing machines in the operating rooms) reduced propofol wastage from 29.2 to 2.8 mL for each waste receptacle per day [71]. In a second communication [72], wasting of 15 controlled substance from two hospitals in Albany, New York was evaluated over a two year period.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Pharmaceutical Dispensing and Wasting In Health Care Facilities, Amounts, Costs and Evaluation of Potential Ecologic Effects

Mankes¹,

Silver²

2017

SOJPPS

View full text Add to dashboard Cite

Drug waste from hospitals contributes to environmental contamination. Patient excreta, bathing or discarding of excess drugs are some sources of drug waste. We report on the wasting of 84 drugs of 14 therapeutic classes in two hospitals in Albany, NY. We consider drug metabolism, excretion, disposal and ecotoxicity in strategies for reducing drug waste, costs and potential environmental damage.Medication (12,345) and waste collection (199) records for: drugs dispensed, returned and wasted were examined. Of 2,700 drugs available, 84 drugs from 14 classes, weighing 56 kg were dispensed to patients, and 2.3 kg were wasted. Twelve drugs accounted for 80 percent of the drug waste and cost $111,000. Of the top wasted and dispensed drugs, all but ibuprofen are persistant and none were bioaccumulative. Ibuprofen, ipratropium ondansetron and oxymetazoline are "very highly toxic" or "highly toxic". Environmental Risk Ratio (PEC/PNEC) for the 20 top drugs were"Insignificant" or "Cannot Be Excluded".Acetazolamide is the most toxic to fish. Dexamethasone has the greatest chronic toxicity to Ceriodaphnia. Ibuprofen is predicted to be very highly toxic (acute and chronic) to zebra mussel, crab and fish. Neostigmine is the most acutely toxic (LC50<1 mg/L) to Daphnia. Ondansetron is the most acutely toxic to green algae. All but 2 of the drugs were 5 to 100% excreted. Fourteen were metabolised. Active metabolites were formed from 2 drugs. Nicardipine, ondansetron and prednisone formed drug conjugates which were excreted. Incineration was the manufacturer's recommended disposal method.We recommend excess drugs be returned to the hospital pharmacy for disposal by incineration. Drug use and disposal should be monitored by an expert committee according to recognized guidelines of pharmaceutical management. Knowledge of the adverse impacts from the release of highly toxic drugs into the environment must influence drug selection and disposal.Key words: Waste; Ecotoxicity; Wastewater; Abbreviations AMCH = Academic Medical Center Hospital; ASTER = Assessment Tools for the Evaluation of Risk. United States Environmental Protection Agency https://archive.epa.gov/med/med_archive_03/web/html/ aster.html Last accessed 6/4/17; B = Bioaccumulation is the general term describing a process by which chemicals are taken up by an organism either directly from exposure to a contaminated medium or by consumption of food containing the chemical; EC50 = Effective Concentration producing an adverse effect in 50% of a test species; EbC50 or ErC50 = EC50 in terms of reduction of growth rate; EyC50 = EC50 in terms of change in biomass yield; Ecosar = Ecologic Structure Activity Relationships is a computerized predictive system that estimates aquatic toxicity. The program estimates a chemical's acute (short-term) toxicity and chronic (long-term or delayed) toxicity to aquatic organisms such as fish, invertebrates, and plants by using computerized Structure Activity Relationships (SARs). https://www.epa.gov/tsca-screening-tools/ ecological-structure-...

show abstract

Section: Discussionsupporting

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Pharmaceutical Dispensing and Wasting In Health Care Facilities, Amounts, Costs and Evaluation of Potential Ecologic Effects

Mankes¹,

Silver²

2017

SOJPPS

View full text Add to dashboard Cite

show abstract

Neue Herausforderungen für die Anästhesie durch den Klimawandel

Koch

Pecher

2020

Anaesthesist

View full text Add to dashboard Cite

Zusammenfassung Hintergrund Die Klimakrise stellt die größte Bedrohung der globalen Gesundheit im 21. Jh. dar. Treibhausgasemissionen westlicher Länder sind zu 5–10 % dem Gesundheitssektor zuzurechnen; hierzu tragen energieintensive Abteilungen (Intensivmedizin, OP-Bereich und Rettungsdienst) maßgeblich bei. Ziel der Arbeit Ziel der Arbeit ist es, Hintergrundwissen und praktische Tipps zum Erreichen eines klimafreundlichen Krankenhauses zu geben. Material und Methoden Narrativer Review mit Hintergrundwissen zu den Themenfeldern: (I) inhalative Anästhetika als Treibhausgase, (II) Energieversorgung im Krankenhaus und (III) Abfallwirtschaft. Ergebnisse und Diskussion (I) Volatile Anästhetika sind hochpotente Treibhausgase; vor allem Desfluran sticht mit einer sehr hohen Global Warming Potenz (GWP) heraus. Einen geringeren Klimaeinfluss haben die totale intravenöse Anästhesie (TIVA) oder Regionalanästhesieverfahren. (II) Krankenhäuser sollten auf erneuerbare Energien umsteigen und gezielte Energiesparmaßnahmen (Leuchtdioden [LED], Bewegungssensoren etc.) implementieren. (III) Ein Abfallmanagement nach dem Konzept „Reduce, reuse, recycle, rethink, research“ kann die Müllproduktion im Krankenhaus reduzieren. Ärzte/Ärztinnen sollten aktiv dazu beitragen, die Klimaziele zu erreichen.

show abstract

Scoping review for the SAGES EAES joint collaborative on sustainability in surgical practice

Huo,

Eussen,

Marconi

et al. 2024

Surg Endosc

View full text Add to dashboard Cite

Background Surgical care in the operating room (OR) contributes one-third of the greenhouse gas (GHG) emissions in healthcare. The European Association of Endoscopic Surgery (EAES) and the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) initiated a joint Task Force to promote sustainability within minimally invasive gastrointestinal surgery. Methods A scoping review was conducted by searching MEDLINE via Ovid, Embase via Elsevier, Cochrane Central Register of Controlled Trials, and Scopus on August 25th, 2023 to identify articles reporting on the impact of gastrointestinal surgical care on the environment. The objectives were to establish the terminology, outcome measures, and scope associated with sustainable surgical practice. Quantitative data were summarized using descriptive statistics. Results We screened 22,439 articles to identify 85 articles relevant to anesthesia, general surgical practice, and gastrointestinal surgery. There were 58/85 (68.2%) cohort studies and 12/85 (14.1%) Life Cycle Assessment (LCA) studies. The most commonly measured outcomes were kilograms of carbon dioxide equivalents (kg CO2eq), cost of resource consumption in US dollars or euros, surgical waste in kg, water consumption in liters, and energy consumption in kilowatt-hours. Surgical waste production and the use of anesthetic gases were among the largest contributors to the climate impact of surgical practice. Educational initiatives to educate surgical staff on the climate impact of surgery, recycling programs, and strategies to restrict the use of noxious anesthetic gases had the highest impact in reducing the carbon footprint of surgical care. Establishing green teams with multidisciplinary champions is an effective strategy to initiate a sustainability program in gastrointestinal surgery. Conclusion This review establishes standard terminology and outcome measures used to define the environmental footprint of surgical practices. Impactful initiatives to achieve sustainability in surgical practice will require education and multidisciplinary collaborations among key stakeholders including surgeons, researchers, operating room staff, hospital managers, industry partners, and policymakers.

show abstract

Propofol Wastage in Anesthesia

Abstract: Propofol does not degrade in nature, accumulates in body fat, and is toxic to aquatic life. We reduced wastage by removing 50 and 100 mL vials of propofol from the pharmacy, retaining only the smallest size (20 mL).

Cited by 94 publications

References 8 publications

Pharmaceutical Dispensing and Wasting In Health Care Facilities, Amounts, Costs and Evaluation of Potential Ecologic Effects

Pharmaceutical Dispensing and Wasting In Health Care Facilities, Amounts, Costs and Evaluation of Potential Ecologic Effects

Neue Herausforderungen für die Anästhesie durch den Klimawandel

Scoping review for the SAGES EAES joint collaborative on sustainability in surgical practice

Contact Info

Product

Resources

About