Towards zero carbon healthcare: anaesthesia

Abstract

What you need to know• Sevoflurane and isoflurane have smaller atmospheric impacts than desflurane and nitrous oxide • Intravenous anaesthetic agents have minimal atmospheric impacts, but drug waste and urinary excretion of drugs and metabolites causes pollution in soil and ground water • Nitrous oxide is a common cause of medication waste and greenhouse gas emissions due to leaks in supply systems, over-ordering, and unused gas in cylinders returned to suppliers being vented to the atmosphere Case 1-A 30 year old woman attends the obstetric anaesthetic clinic at 36 weeks' gestation. This is her first pregnancy. The baby was in the breech position, and, after an unsuccessful attempt to turn the baby, she has been offered the option of planning for a vaginal delivery or a caesarean section. The anaesthetist discusses the anaesthetic and analgesic options for both and reassures the patient that all options appropriate to the mode of delivery are safe. Her priority is a safe delivery but she recently read online that both anaesthetic agents and "gas and air" contribute to global warming. Concern about the world in which her child will grow prompts her to ask which is the "greenest" option.Case 2-A 55 year old man is listed for total knee replacement for osteoarthritis, which is limiting his mobility and affecting his ability to pursue his passion for fell walking. When offered a choice of spinal or general anaesthesia, he says he has no preference providing both are safe, but he has noticed the enormity of hospital waste and asks which is the most sustainable option.

Patient characteristics, anaesthetic workload and techniques in the UK: an analysis from the 7th National Audit Project (NAP7) activity survey

“…The most striking change in behaviour is a three‐fold increase in the proportion of general anaesthetics given by TIVA from 8% during NAP5 to 26% in NAP7. The drivers of this are unknown but may include concerns over environmental impact [26], proposed benefits for cancer recurrence [27], increasing equipment availability and the technique now being embedded within the new UK postgraduate curriculum. The use of pEEG monitoring has also increased.…”

“…The most striking change in behaviour is a three-fold increase in the proportion of general anaesthetics given by TIVA from 8% during NAP5 to 26% in NAP7. The drivers of this are unknown but may include concerns over environmental impact [26], proposed benefits for cancer recurrence [27],…”

The green anaesthesia dilemma: to which extent is it important to preserve as many drugs available as possible

“…Therefore, more comprehensive studies on the environmental impact of propofol are still needed. Furthermore, the use of TIVA in institutions where it is not already widely used requires training and equipment procurement, which can be expensive [34 ▪ ].…”

“…Therefore, more comprehensive studies on the environmental impact of propofol are still needed. Furthermore, the use of TIVA in institutions where it is not already widely used requires training and equipment procurement, which can be expensive [34 ]. Unfortunately, propofol has been subjected to recurrent shortage waves during the last two decades [35][36][37][38][39][40], being the COVID-19 pandemic probably the most recent and best remembered.…”

Hope can bring solutions to climate despair

“…12 Two specific examples, with approaches to be followed in a clinical setting, are efforts to reduce the health effects of ambient air pollution (doi:10.1136/bmj-2021-069487) and to achieve net zero in anaesthesia (doi:10.1136/bmj-2021-069030). 1314 Another, the route to achieving a net zero carbon transport system, can be achieved with a shift away from private cars (doi:10.1136/bmj-2021-069688). 15…”