The carbon footprint of general anaesthetics: A case study in the UK

Cu2O nanoparticles anchored on carbon for the efficient removal of propofol from operating room wastewater via peroxymonosulfate activation: efficiency, mechanism, and pathway

“…13,14 Simultaneously, propofol presents bioaccumulating properties in highly tolerant organisms due to its fat solubility and then reach the species at the top of food chain step by step. 15,16 Moreover, propofol also exhibits outstanding thermal stability. Only when the ambient temperature is higher than 1000 C for 2 seconds, the drug can be incinerated.…”

Operating in a Climate Crisis: A State-of-the-Science Review of Life Cycle Assessment within Surgical and Anesthetic Care

“…Most notably, 11% of studies (n = 5) did not clearly state their selected LCA methodology, and 23% (n = 10) did not report which, if any, LCA standard was followed. Furthermore, nearly one-third of studies (30%, n = 13) did not report numerical impact values, opting instead to report results either graphically (Hu et al 2021;Ibbotson et al 2013;Ison and Miller 2000;Schmutz et al 2020;Sherman et al 2012;Tan and Lim 2021;Unger and Landis 2016) or relative to the most or least impactful case study (Campion et al 2012;Leiden et al 2020;Liang 2019;Stripple et al 2008;Thiel et al 2015;Unger et al 2017).…”

“…Regarding the potential for bias, more than one-quarter of studies did not include a competing-interests statement (27%, n = 12) or funding declaration (30%, n = 13). Among those that did, authors of three studies reported having potential competing interests due to industry ties (McAlister et al 2016;McPherson et al 2019;) and nine studies received funding from industry groups (Carre 2008;Hu et al 2021;Leiden et al 2020;McAlister et al 2016;McPherson et al 2019;Stripple et al 2008;Van den Berghe and Zimmer 2011;Vozzola et al 2018. Although industry partnerships risk introducing bias into the Operating rooms (n = 1) analysis, in many cases they represent the only way researchers can obtain granular data that are otherwise inaccessible due to propriety interests (Weisz et al 2020).…”

“…Five studies assessed life cycle contributions arising from the provision and use of pharmaceuticals used in surgical settings. Sherman et al (2012) and Hu et al (2021) assessed climate impacts of four general anesthetic agents using maintenance of minimum alveolar concentration for one hour (1 MAC-h), or MAC-equivalent (MAC-e) for propofol, as the functional unit to compare systems. Both studies concluded that life cycle GHG emissions contributions from the intravenous agent propofol were considerably lower (0:01-1:01 kg CO 2 e=MAC-e) than commonly used inhalational agents (i.e., desflurane, isoflurane, and sevoflurane), whose impacts were found to vary according to synthesis method, carrier gas admixture, and flow rate utilization.…”

“…Both studies concluded that life cycle GHG emissions contributions from the intravenous agent propofol were considerably lower (0:01-1:01 kg CO 2 e=MAC-e) than commonly used inhalational agents (i.e., desflurane, isoflurane, and sevoflurane), whose impacts were found to vary according to synthesis method, carrier gas admixture, and flow rate utilization. For example, when the carrier gas admixture included nitrous oxide (60% N 2 O:40% O 2 ), the life cycle GHG emissions associated with the provision and use of isoflurane and desflurane ranged 19-24 and 48-56 kg CO 2 e=MAC-h, respectively (assuming a flow rate of 1 L=min), whereas sevoflurane's impact ranged 19-22 kg CO 2 e=MAC-h with a flow rate of 1 L=min and between 38 and 46 kg CO 2 e=MAC-h with a flow rate of 2 L=min (the regulated minimum gas flow rate for sevoflurane in the United States; Hu et al 2021;Sherman et al 2012). Conversely, when nitrous oxide was excluded from the carrier gas admixture, the per MAC-h climate impact associated with each of the inhaled agents ranged from 3 to 4, 3 to 11, 6 to 23, and 81 to 85 kg CO 2 e for isoflurane (1 L=min), sevoflurane (1 L=min), sevoflurane (2 L=min), and desflurane (1 L=min), respectively (Hu et al 2021).…”