Environmental sustainability - Revision history

Mitchel.DeVita: Added GA vs spinal

2022-02-27T22:09:32Z

Added GA vs spinal

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 The overall contribution to the greenhouse gas effect is quantified with the global warming potential which serves to compare the contribution of a greenhouse gas with the same mass of CO2 over a period of time. For context, this means that 1 hour of desflurane anesthesia is equivalent to driving 235-470 miles while 1 hour of sevoflurane anesthesia represents approximately 18 miles of driving (flows of .5-2l/min).<ref name=":0">Ryan SM, Nielsen CJ. Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg. 2010;111:92–98.</ref>
 ==Minimizing the Environmental Impact ==
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 *Utilizing closed circle systems further increases the efficiency of utilized anesthetic gases.
 *Minimizing nitrous and desflurane given their higher environmental impact is recommended, of course unless this will have negative outcomes on the patient.
 == Summary ==
-Modern health care has made considerable progress in improving human life, however this industry is also responsible for significant pollution and waste. Anesthetic gases represent overall a small but significant contributor to the growing crisis of global warming. When possible, taking patient safety into account, decreased use of nitrous oxide and desflurane as well as lower fresh gas flows will help to reduce anesthesia's role in the growing climate crisis.
+Modern health care has made considerable progress in improving human life, however this industry is also responsible for significant pollution and waste. Anesthetic gases, single use items, and reusable items represent an overall small but significant contributor to the growing crisis of global warming. When possible, taking patient safety into account, decreased use of nitrous oxide and desflurane as well as lower fresh gas flows will help to reduce anesthesia's role in the growing climate crisis.
 <references />

Chris.Rishel at 12:03, 12 November 2021

2021-11-12T12:03:11Z

← Older revision		Revision as of 05:03, 12 November 2021
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	== Introduction ==		== Introduction ==
	The climate crisis is quite possibly the largest and most protracted threat to human life yet described. Largely due to anthropogenic ~~green house~~ gas emissions the Earth's climate continues to warm, and modern medicine plays a nontrivial part in overall carbon emission. If global health care were a country, it would represent the fifth largest carbon emitter on the plant. <ref>Pichler P-P, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett 2019; 14, 064004</ref> ~~Green house~~ gas ~~(GHG)~~ emission represents a key contribution to global warming, and one important and relevant source of GHGs is anesthetic gases released into the environment.<ref>{{Cite journal\|last=Sherman\|first=Jodi D.\|last2=Sulbaek Andersen\|first2=Mads P.\|last3=Renwick\|first3=James\|last4=McGain\|first4=Forbes\|date=2021~~-06~~\|title=Environmental sustainability in anaesthesia and critical care. Response to Br J Anaesth 2021; 126: e195–e197\|url=http://dx.doi.org/10.1016/j.bja.2020.12.025\|journal=British Journal of Anaesthesia\|volume=126\|issue=6\|pages=e193–e195\|doi=10.1016/j.bja.2020.12.025\|issn=0007-0912}}</ref>		The climate crisis is quite possibly the largest and most protracted threat to human life yet described. Largely due to anthropogenic greenhouse gas emissions the Earth's climate continues to warm, and modern medicine plays a nontrivial part in overall carbon emission. If global health care were a country, it would represent the fifth largest carbon emitter on the plant.<ref>Pichler P-P, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett 2019; 14, 064004</ref> Greenhouse gas emission represents a key contribution to global warming, and one important and relevant source of GHGs is anesthetic gases released into the environment.<ref>{{Cite journal\|last=Sherman\|first=Jodi D.\|last2=Sulbaek Andersen\|first2=Mads P.\|last3=Renwick\|first3=James\|last4=McGain\|first4=Forbes\|date=2021\|title=Environmental sustainability in anaesthesia and critical care. Response to Br J Anaesth 2021; 126: e195–e197\|url=http://dx.doi.org/10.1016/j.bja.2020.12.025\|journal=British Journal of Anaesthesia\|volume=126\|issue=6\|pages=e193–e195\|doi=10.1016/j.bja.2020.12.025\|issn=0007-0912\|via=}}</ref>

	== Anesthetic Gases ==		==Anesthetic Gases==
	Commonly used modern anesthetic gases include nitrous oxide and fluorinated gases such as sevoflurane, isoflurane, and desflurane, all of which have been recognized as greenhouse gases.		Commonly used modern anesthetic gases include [[nitrous oxide]] and fluorinated gases such as [[sevoflurane]], [[isoflurane]], and [[desflurane]], all of which have been recognized as greenhouse gases. In clinical use, volatile anesthetics undergo minimal metabolism in the human body and are largely eliminated by exhalation unchanged (>95% unchanged). These gases are collected via a gas scavenging system, however this system then exhausts into the atmosphere with little to no further processing. There, these gases can absorb and reduce outbound infrared thermal energy and contribute to the increasing atmospheric temperatures.

	In clinical use, volatile anesthetics undergo minimal metabolism in the human body and are largely eliminated by exhalation unchanged (>95% unchanged). These gases are collected via a gas scavenging system, however this system then exhausts into the atmosphere with little to no further processing. There, these gases can absorb and reduce outbound infrared thermal energy and contribute to the increasing atmospheric temperatures. Halothane, and Isoflurane to a lesser extent, are halogenated chlorofluorocarbon that are known to both damage the ozone layer as well as function as a ~~GHG~~. Nitrous oxide also depletes the ozone layer and is reported to be the single most important ozone depleting substance currently emitted. <ref>Chipperfield M. Atmospheric science: nitrous oxide delays ozone recovery. ''Nat Geosci''. 2009;2:742–743</ref> Atmospheric lifetime ~~varies between the various volatiles~~, ~~and desflurane is reported to be the longest lived at~~ 9-21 years~~, followed by isoflurane at~~ 3-6 years ~~then sevoflurane with the shortest lifetime of~~ 1-5 years~~. Even worse, nitrous~~ oxide ~~has an atmospheric lifetime of~~ 114 years. The overall contribution to the ~~GHG~~ effect is quantified with the global warming potential which serves to compare the contribution of a ~~GHG~~ with the same mass of CO2 over a period of time. The 100 globing warming potential was 893 CO2 equivalents/kg for desflurane, 191 CO2 equivalents/kg for isoflurane, and 48 CO2 equivalents/kg for sevoflurane. <ref>Weinberg L, Tay S, Aykanat V, et al. Changing patterns in volatile anaesthetic agent consumption over seven years in Victorian public hospitals. Anaesth Intensive Care. 2014;42:579–583.</ref> For context, this means that 1 hour of desflurane anesthesia is equivalent to driving 235-470 miles while 1 hour of sevoflurane anesthesia represents approximately 18 miles of driving (flows of .5-2l/min). <ref name=":0">Ryan SM, Nielsen CJ. Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg. 2010;111:92–98.</ref>		Halothane, and Isoflurane to a lesser extent, are halogenated chlorofluorocarbon that are known to both damage the ozone layer as well as function as a greenhouse gas. Nitrous oxide also depletes the ozone layer and is reported to be the single most important ozone depleting substance currently emitted.<ref>Chipperfield M. Atmospheric science: nitrous oxide delays ozone recovery. ''Nat Geosci''. 2009;2:742–743</ref>
			{\| class="wikitable"
			!Anesthetic gas
			!Atmospheric lifetime
			!100-year global warming potential<ref>Weinberg L, Tay S, Aykanat V, et al. Changing patterns in volatile anaesthetic agent consumption over seven years in Victorian public hospitals. Anaesth Intensive Care. 2014;42:579–583.</ref>
			\|-
			\|Desflurane
			\|9-21 years
			\|893 CO<sub>2</sub> equivalents/kg
			\|-
			\| Isoflurane
			\|3-6 years
			\|191 CO<sub>2</sub> equivalents/kg
			\|-
			\|Sevoflurane
			\|1-5 years
			\|48 CO<sub>2</sub> equivalents/kg
			\|-
			\|Nitrous oxide
			\|114 years
			\|298 CO<sub>2</sub> equivalents/kg
			\|}
			The overall contribution to the greenhouse gas effect is quantified with the global warming potential which serves to compare the contribution of a greenhouse gas with the same mass of CO2 over a period of time. For context, this means that 1 hour of desflurane anesthesia is equivalent to driving 235-470 miles while 1 hour of sevoflurane anesthesia represents approximately 18 miles of driving (flows of .5-2l/min).<ref name=":0">Ryan SM, Nielsen CJ. Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg. 2010;111:92–98.</ref>

	== Minimizing the Environmental Impact ==		==Minimizing the Environmental Impact ==

	* The American Society of Anesthesiologists recommends avoiding nitrous oxide as a carrier gas and minimizing fresh gas flow rates while using nitrous.		*The American Society of Anesthesiologists recommends avoiding nitrous oxide as a carrier gas and minimizing fresh gas flow rates while using nitrous.
	* The best approximations of ideal FGF rates would be achieved by reducing FGF to 2 L/min with sevoflurane and to 0.5−1 L/min with desflurane and isoflurane. <ref name=":0" />		*The best approximations of ideal FGF rates would be achieved by reducing FGF to 2 L/min with sevoflurane and to 0.5−1 L/min with desflurane and isoflurane.<ref name=":0" />
	* Utilizing closed circle systems further increases the efficiency of utilized anesthetic gases.		*Utilizing closed circle systems further increases the efficiency of utilized anesthetic gases.
	* Minimizing nitrous and desflurane given their higher environmental impact is recommended, of course unless this will have negative outcomes on the patient.		*Minimizing nitrous and desflurane given their higher environmental impact is recommended, of course unless this will have negative outcomes on the patient.

	== Summary ==		== Summary ==
	Modern health care has made considerable progress in improving human life, however this industry is also responsible for significant pollution and waste. Anesthetic gases represent overall a small but significant contributor to the growing crisis of global warming. When possible, taking patient safety into account, decreased use of nitrous oxide and desflurane as well as lower fresh gas flows will help to reduce anesthesia's role in the growing climate crisis.		Modern health care has made considerable progress in improving human life, however this industry is also responsible for significant pollution and waste. Anesthetic gases represent overall a small but significant contributor to the growing crisis of global warming. When possible, taking patient safety into account, decreased use of nitrous oxide and desflurane as well as lower fresh gas flows will help to reduce anesthesia's role in the growing climate crisis.

			<references />

Mitchel.DeVita at 08:51, 16 August 2021

2021-08-16T08:51:52Z

← Older revision		Revision as of 01:51, 16 August 2021
Line 1:		Line 1:
	== Introduction ==		== Introduction ==
	The climate crisis is quite possibly the largest and most protracted threat to human life yet described. Largely due to anthropogenic green house gas emissions the Earth's climate continues to warm, and modern medicine plays a nontrivial part in overall carbon emission. If global health care were a country, it would represent the fifth largest carbon emitter on the plant. <ref>Pichler P-P, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett 2019; 14, 064004</ref> Green house gas (GHG) emission represents a key contribution to global warming, and one important and relevant source of GHGs is anesthetic gases released into the environment.		The climate crisis is quite possibly the largest and most protracted threat to human life yet described. Largely due to anthropogenic green house gas emissions the Earth's climate continues to warm, and modern medicine plays a nontrivial part in overall carbon emission. If global health care were a country, it would represent the fifth largest carbon emitter on the plant. <ref>Pichler P-P, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett 2019; 14, 064004</ref> Green house gas (GHG) emission represents a key contribution to global warming, and one important and relevant source of GHGs is anesthetic gases released into the environment.<ref>{{Cite journal\|last=Sherman\|first=Jodi D.\|last2=Sulbaek Andersen\|first2=Mads P.\|last3=Renwick\|first3=James\|last4=McGain\|first4=Forbes\|date=2021-06\|title=Environmental sustainability in anaesthesia and critical care. Response to Br J Anaesth 2021; 126: e195–e197\|url=http://dx.doi.org/10.1016/j.bja.2020.12.025\|journal=British Journal of Anaesthesia\|volume=126\|issue=6\|pages=e193–e195\|doi=10.1016/j.bja.2020.12.025\|issn=0007-0912}}</ref>

	== Anesthetic Gases ==		== Anesthetic Gases ==

Mitchel.DeVita: started page, added intro, gases, minimizing impact, and summary

2021-08-16T08:50:26Z

started page, added intro, gases, minimizing impact, and summary

New page

== Introduction ==
The climate crisis is quite possibly the largest and most protracted threat to human life yet described. Largely due to anthropogenic green house gas emissions the Earth's climate continues to warm, and modern medicine plays a nontrivial part in overall carbon emission. If global health care were a country, it would represent the fifth largest carbon emitter on the plant. <ref>Pichler P-P, Jaccard IS, Weisz U, Weisz H. International comparison of health care carbon footprints. Environ Res Lett 2019; 14, 064004</ref> Green house gas (GHG) emission represents a key contribution to global warming, and one important and relevant source of GHGs is anesthetic gases released into the environment.

== Anesthetic Gases ==
Commonly used modern anesthetic gases include nitrous oxide and fluorinated gases such as sevoflurane, isoflurane, and desflurane, all of which have been recognized as greenhouse gases.

In clinical use, volatile anesthetics undergo minimal metabolism in the human body and are largely eliminated by exhalation unchanged (>95% unchanged). These gases are collected via a gas scavenging system, however this system then exhausts into the atmosphere with little to no further processing. There, these gases can absorb and reduce outbound infrared thermal energy and contribute to the increasing atmospheric temperatures. Halothane, and Isoflurane to a lesser extent, are halogenated chlorofluorocarbon that are known to both damage the ozone layer as well as function as a GHG. Nitrous oxide also depletes the ozone layer and is reported to be the single most important ozone depleting substance currently emitted. <ref>Chipperfield M. Atmospheric science: nitrous oxide delays ozone recovery. ''Nat Geosci''. 2009;2:742–743</ref> Atmospheric lifetime varies between the various volatiles, and desflurane is reported to be the longest lived at 9-21 years, followed by isoflurane at 3-6 years then sevoflurane with the shortest lifetime of 1-5 years. Even worse, nitrous oxide has an atmospheric lifetime of 114 years. The overall contribution to the GHG effect is quantified with the global warming potential which serves to compare the contribution of a GHG with the same mass of CO2 over a period of time. The 100 globing warming potential was 893 CO2 equivalents/kg for desflurane, 191 CO2 equivalents/kg for isoflurane, and 48 CO2 equivalents/kg for sevoflurane. <ref>Weinberg L, Tay S, Aykanat V, et al. Changing patterns in volatile anaesthetic agent consumption over seven years in Victorian public hospitals. Anaesth Intensive Care. 2014;42:579–583.</ref> For context, this means that 1 hour of desflurane anesthesia is equivalent to driving 235-470 miles while 1 hour of sevoflurane anesthesia represents approximately 18 miles of driving (flows of .5-2l/min). <ref name=":0">Ryan SM, Nielsen CJ. Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg. 2010;111:92–98.</ref>

== Minimizing the Environmental Impact ==

* The American Society of Anesthesiologists recommends avoiding nitrous oxide as a carrier gas and minimizing fresh gas flow rates while using nitrous.
* The best approximations of ideal FGF rates would be achieved by reducing FGF to 2 L/min with sevoflurane and to 0.5−1 L/min with desflurane and isoflurane. <ref name=":0" />
* Utilizing closed circle systems further increases the efficiency of utilized anesthetic gases.
* Minimizing nitrous and desflurane given their higher environmental impact is recommended, of course unless this will have negative outcomes on the patient.

== Summary ==
Modern health care has made considerable progress in improving human life, however this industry is also responsible for significant pollution and waste. Anesthetic gases represent overall a small but significant contributor to the growing crisis of global warming. When possible, taking patient safety into account, decreased use of nitrous oxide and desflurane as well as lower fresh gas flows will help to reduce anesthesia's role in the growing climate crisis.