Inhaled Anesthetics: Environmental Role, Occupational Risk, and Clinical Use

Abstract

Inhaled anesthetics have been in clinical use for over 150 years and are still commonly used in daily practice. The initial view of inhaled anesthetics as indispensable for general anesthesia has evolved during the years and, currently, its general use has even been questioned. Beyond the traditional risks inherent to any drug in use, inhaled anesthetics are exceptionally strong greenhouse gases (GHG) and may pose considerable occupational risks. This emphasizes the importance of evaluating and considering its use in clinical practices. Despite the overwhelming scientific evidence of worsening climate changes, control measures are very slowly implemented. Therefore, it is the responsibility of all society sectors, including the health sector to maximally decrease GHG emissions where possible. Within the field of anesthesia, the potential to reduce GHG emissions can be briefly summarized as follows: Stop or avoid the use of nitrous oxide (N2O) and desflurane, consider the use of total intravenous or local-regional anesthesia, invest in the development of new technologies to minimize volatile anesthetics consumption, scavenging systems, and destruction of waste gas. The improved and sustained awareness of the medical community regarding the climate impact of inhaled anesthetics is mandatory to bring change in the current practice.

Absolute Differential Cross-Sections for Elastic Electron Scattering from Sevoflurane Molecule in the Energy Range from 50–300 eV

“…It is one of the most commonly used inhalational anaesthetics, and it has been widely investigated. The recent review on inhaled anaesthetics [ 2 ] covered their environmental role, occupational risk, and clinical use. Gaya da Costa and co-authors [ 2 ] extensively elaborated on the case of sevoflurane molecule and its contribution to the global warming effect as a volatile anaesthetic (especially in combination with the use with N 2 O), pointed out that its threshold has not yet been established in the workplace as waste anaesthetic gas, considering its side effects in a clinical context (epileptiform electroencephalogram patterns in both adults and paediatric populations; the cardio protective effect in patients with coronary artery disease undergoing vascular surgery, kidney transplantation or lung surgery).…”

Effects of Intravenous Versus Inhalational Anesthesia on Red Cell Distribution Width and Mean Platelet Volume in Patients Undergoing Coronary Artery Surgery

“…Sevoflurane has become the most widely used volatile agent in general anesthesia practice due to the disadvantages of isoflurane such as the stealing phenomenon, more reflex tachycardia, late onset, and late termination of the effect. In cardiac surgery, as compared to the TIVA techniques, the inhalation method is easy to apply, does not require dose adjustment according to body weight, is not affected by hemodilution, is cardioprotective, provides rapid recovery, and its elimination is independent of liver and kidney (9) .…”

Application of sevoflurane inhalation sedation in dental treatment: a mini review

“…Sevoflurane sedation has certain disadvantages. The characteristic smell may be difficult to tolerate in certain patients, possibly causing nausea, and leading to malignant hyperthermia [ 4 18 ]. It may be necessary to secure the airway due to excessive sedation.…”

“…However, the use of sevoflurane for inhalational sedation has recently increased [ 4 ]. Sevoflurane is suitable for outpatient dental treatment as it has low solubility in blood, with a fast induction and less recovery time.…”