For the sake of climate change, researchers are urging surgeons to use less anesthetic on their surgical patients. Doctors at Henry Ford Health System in Detroit, Michigan, believe it has the potential to drastically cut the carbon footprint of hospitals in the United States.
An anaesthesiologist prepares to administer general anaesthesia to a patient before an open-heart surgery in a cardiac surgery unit at the CHU Angers teaching hospital in Angers, western France, on October 24, 2013.
Anesthesia Gases Contribute to Global Greenhouse Gas Emissions
According to a study, titled "Environmental Implications of Anesthetic Gases" published in Anesthesia Progress, inhalation anesthetic contributes to up to 0.1% of global carbon emissions.
Dr. Mohamed Fayed, a senior anesthetist at Henry Ford, said during the annual meeting of the American Society of Anesthesiologists that global warming is affecting lives every day, and reducing greenhouse gas emissions has become critical.
He noted that no matter how minor each consequence could be, they all add up. He urged anesthesiologists to make a big contribution to their cause by modifying their regular practice, like cutting back the flow of anesthetic gas without compromising the patient's care.
Based on the research, an hour of surgery with the inhaled anesthetic desflurane is comparable to driving up to 470 miles. Carbon dioxide is the major greenhouse gas that traps heat in the Earth's atmosphere and contributes to global warming.
While most general anesthetic operations need high fresh gas flow (FGF) at the start and finish of the surgery to obtain the desired effect rapidly, Dr. Fayed says it is safe and effective to reduce the flow for the duration of the process.
A 2022 article in the American Society of Anesthesiologists reports that anesthesiology is a carbon-intensive specialty that uses inhaled agents that contribute a lot of greenhouse gas emissions that in turn add to global warming. An atmospheric sampling of volatile anesthetics suggests that they are increasing and accounts for 5% of acute hospital carbon emissions.
Desflurane, sevoflurane, isoflurane, and halothane, which are used in general anesthesia, as well as nitrous oxide, are examples of relevant inhaled volatile anesthetics. Experts call on minimizing these agents' environmental consequences, especially desflurane which is substantially more expensive without evidence of therapeutic benefit of their use.
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Initiative in Reducing Carbon Footprint of Hospitals
According to the recent press release from the American Society of Anesthesiologists, researchers educated anesthesiologists at their institution on the benefits of reducing anesthetic gas flow during surgery, including through departmental lectures, newsletter articles, posters in work areas, and emails as part of the broader FGF reduction program.
They also withdrew desflurane from their operating rooms since it emits the highest carbon dioxide of any of the available inhalation anesthetics.
The authors established a goal of an average FGF of 3 liters per minute (L/min) or less for surgeries in their research of over 13,000 patients. Prior to the intervention, in March 2021, authors discovered that FGF was 5-6 L/min in many cases, with only 65% of patients achieving an FGF of 3 L/min or below. By July 2021, 93% of the patients had an average FGF of 3 L/min or less. The researchers are now seeking to lower FGF levels throughout the system to less than 2 L/min.
The program is part of the Multicenter Perioperative Outcome Group, a quality improvement collaboration involving more than 60 anesthetic offices. Dr. Fayed said their ultimate goal is to assess real carbon footprints from anesthetic chemical waste for each surgical case, but this will necessitate considerable changes and expenses.
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