Sustainable Anaesthesia is important to medical research and to climate change

In the May 2012 edition of the journal Anesthesia and Analgesia there are a number of “highly sustainable” articles to be read. I commend you to peruse this edition of the aforementioned journal neither because it’s interesting nor because Forbes McGain et al wrote 3 of the articles! Instead such publications in the mainstream, peer reviewed medical literature indicates that sustainability, resource use and climate change are attracting attention in the world of medical research and because such interest adds to advocacy efforts.

Forbes McGain, David Story, Simone Mossenson and Eugenie Kayak are all anaesthetists and members of the DEA and appear in this edition. For the vast majority of non-anaesthetic DEA members please take a squiz as such topics as greater hospital recycling apply to many!

1. Ryan and Sherman-Editorial (Anesth Analg 2012;114:921-923).
Two American anesthesiologists summarise the 9 articles on sustainable anesthesia and encourage greater advocacy towards a sustainable route. They also note that the American Society of Anesthesiologists recently established an Environmental Task Force within their equipment and facilities committee to advocate for more evidence-based enquiry. Such further enquiries would involve collaborations with environmental scientists et al to understand how the environmental consequences of our practice affect human health.

2. McGain, Story, Kayak, Kashima and McAlister (Anesth Analg 2012;114:1134-1139).
An “Open Mind” review of life cycle assessment- what it is, how it’s useful and applicable to medicine. The paper branches out to useful websites and resources for those wishing to recycle, reuse etc. within operating theatres.

3. Sherman, Le, Lamers, Eckelman. Life cycle greenhouse gas emissions of anesthetic drugs (Anesth Analg 2012;114:1086-90).
This life cycle assessment finds strongly in favour of using propofol for maintenance of general anaesthesia. For environmental reasons (CO2 emissions) desflurane and nitrous oxide should be strongly avoided.

4. Overcash. A comparison of reusable and disposable medical textiles: state of the art: 2012 (Anesth Analg 2012;114:1055-66). In this review of several life cycle assessments which have compared reusable gowns with disposable gowns the former have been found to have less CO2 emissions, water use etc.

5. Eckelman, Mosher, Gonzalez, Sherman. Comparative life cycle assessment of disposable and reusable laryngeal mask airways (Anesth Analg 2012;114:1067-72).
Reusable plastic laryngeal masks are found to have half the CO2 emissions of the disposable masks. The study was done at Yale, New Haven, Connecticut, USA with gas heat and electricity cogeneration as the source of energy.

6. McGain, McAlister, McGavin, Story. A life cycle assessment of reusable and single use central venous catheter (CVC) insertion kits (Anesth Analg 2012; 114: 1073-80).
This paper examined the life cycles of kits that are used to insert central venous catheters (i.e. a plastic kidney dish, two galley pots, scissors, needle holders and tissue forceps).

In contrast to the previous study the disposable kits were found to have three times the CO2 effects than the disposable kits. Why? Coal (specifically Eocene Victorian brown coal) was the source of the energy for the sterilisers used to reprocess the reusable kits. If hospital gas cogeneration was used in lieu of coal the difference in CO2 emissions between the two approaches would be insignificant. Further, a great deal was discovered about how inefficient sterilisers are, particularly when small, light items such as CVC kits were inserted.

7. Sulbaek Anderson, Nielsen, Wallington, Karpichev, Sander. Assessing the impact on global climate from general anesthetic gases (Anesth Analg 2012;114:1081-85).
A detailed description of the global warming potential of the anesthetic gases is revealed by folk from the Jet Propulsion Laboratory, California etc. Solid, but essential reading for anaesthetists! Desflurane and nitrous oxide are problematic…

8. Mankes. Propofol wastage in anesthesia (Anesth Analg 2012;114:1091-92).
A report on wastage of the intravenous agent propofol from the USA. Although interesting this article has perhaps less relevance to Australia where drug wastage from larger ampoules is less prevale nt.

9. McGain, White, Mossenson, Kayak, Story. A survey of anesthesiologists’ views of operating room recycling (Anesth Analg 2012;114: 1049-54).
This survey of approximately 900 Australian, NZ and English anaesthetists indicated: 1. recycling was occurring in only 11% of operating rooms, 2. inadequate facilities, incomplete education and negative staff attitudes were thought to be the main barriers to operating room recycling and 3. 95% of anaesthetists wanted to recycle.

10. Feldman. Managing fresh gas flows to reduce environmental contamination (Anesth Analg 2012;114:1093–101).
For those DEA members who deal daily with gases of the volatile kind this article may assist you to manage fresh gas flow with the aim of reducing atmospheric contamination.

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