Sustainability in the Operating Room

Gordon, Diane

doi:10.1016/j.anclin.2020.06.006

Cited by 49 publications

(43 citation statements)

References 20 publications

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“…Avoiding desflurane and nitrous oxide, using lower fresh gas flows (FGFs), total intravenous anesthesia (TIVA), and regional anesthesia techniques are recommended best practices. 9–11 However, because these practices have not been widely implemented, anesthetic gas emissions remain a significant source of health care pollution. Global warming potentials (GWPs) of GHGs are defined over a 100-year period (GWP 100 ) based on their impact with carbon dioxide as the reference (defined as GWP = 1).…”

Section: Available Knowledgementioning

confidence: 99%

Project SPRUCE: Saving Our Planet by Reducing Carbon Emissions, a Pediatric Anesthesia Sustainability Quality Improvement Initiative

Hansen

Chiem

Righter-Foss

et al. 2023

Anesthesia &Amp; Analgesia

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BACKGROUND: Children are particularly vulnerable to adverse health outcomes related to climate change. Inhalational anesthetics are potent greenhouse gasses (GHGs) and contribute significantly to health care–generated emissions. Desflurane and nitrous oxide have very high global warming potentials. Eliminating their use, as well as lowering fresh gas flows (FGFs), will lead to reduced emissions. METHODS: Using published calculations for converting volatile anesthetic concentrations to carbon dioxide equivalents (CO2e), we derived the average kilograms (kg) CO2e/min for every anesthetic administered in the operating rooms at our pediatric hospital and ambulatory surgical center between October 2017 and October 2022. We leveraged real-world data captured from our electronic medical record systems and used AdaptX to extract and present those data as statistical process control (SPC) charts. We implemented recommended strategies aimed at reducing emissions from inhalational anesthetics, including removing desflurane vaporizers, unplugging nitrous oxide hoses, decreasing the default anesthesia machine FGF, clinical decision support tools, and educational initiatives. Our primary outcome measure was average kg CO2e/min. RESULTS: A combination of educational initiatives, practice constraints, protocol changes, and access to real-world data were associated with an 87% reduction in measured GHG emissions from inhaled anesthesia agents used in the operating rooms over a 5-year period. Shorter cases (<30 minutes duration) had 3 times higher average CO2e, likely due to higher FGF and nitrous oxide use associated with inhalational inductions, and higher proportion of mask-only anesthetics. Removing desflurane vaporizers corresponded with a >50% reduction of CO2e. A subsequent decrease in anesthesia machine default FGF was associated with a similarly robust emissions reduction. Another significant decrease in emissions was noted with educational efforts, clinical decision support alerts, and feedback from real-time data. CONCLUSIONS: Providing environmentally responsible anesthesia in a pediatric setting is a challenging but achievable goal, and it is imperative to help mitigate the impact of climate change. Large systems changes, such as eliminating desflurane, limiting access to nitrous oxide, and changing default anesthesia machine FGF rates, were associated with rapid and lasting emissions reduction. Measuring and reporting GHG emissions from volatile anesthetics allows practitioners to explore and implement methods of decreasing the environmental impact of their individual anesthesia delivery practices.

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Section: Available Knowledgementioning

confidence: 99%

Project SPRUCE: Saving Our Planet by Reducing Carbon Emissions, a Pediatric Anesthesia Sustainability Quality Improvement Initiative

Hansen

Chiem

Righter-Foss

et al. 2023

Anesthesia &Amp; Analgesia

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“…According to Kennedy and Lindsey (2015), the planet has challenge with CC. CC is the defining health and environmental crisis of the twenty-first century (Gordon, 2020).…”

Section: Problem Statementmentioning

confidence: 99%

Tertiary Students’ Awareness of Climate Change: A Case Study of a Selected University of Technology

Dyani¹

2022

Preprint

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<div>Introduction: Climate change (CC) is harming the planet. All of society should be involved in managing climate changes or it will become uncontrollable. Students should not be left out as they are regarded as important to the society and in a good position to deal with the changes because they will become tomorrow’s decision makers and influencers.</div><div><br></div><div>Problem statement: It is unclear whether students at tertiary institutions are aware of climate change.</div><div><br></div><div>Aim of study: The aim of the research was to explore the level of climate change awareness of tertiary students.</div><div><br></div><div>Research methodology: The research adopted the objectivist ontology. A positivist approach was followed and the research approach was deductive. The intent of the study was to generalise what tertiary students think and know about climate change, therefore, the survey strategy was appropriate. Questionnaires were used to collect data from 603 students who participated in the study. The data were analysed using MS Excel and SPSS available at the university. A factors analysis was also performed. In total, 42 findings were identified.</div><div><br></div><div>Ethics: Participants were informed of the purpose of the study and their rights to privacy. No cultural or any other sensitive questions were asked, and participants had the option to participate in the study and withdraw at any time.</div><div><br></div><div>Finding: Students are aware of climate change, but more needs to be done to empower students to become advocates of climate change.</div>

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“…Не менее важным сегодня представляется эффективность снижения FGF в экологических це лях. В последнее время появилось много публикаций, посвященных влиянию на экологию ингаляционных анестетиков, обладающих парниковым эффектом, с доказательствами необходимости снижения их по требления именно за счет перехода на низкий и мини мальный поток свежего газа [60][61][62]. И эти публикации резонны.…”

Section: ингаляционная индукцияunclassified

Methodological aspects of desflurane application in modern anesthesiology. Review

Ovezov

Пивоварова

Halimov

2020

Annals of Critical Care

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Introduction. Desflurane is the last inhalational anesthetic approved for use in the Russian Federation. The experience of its use in the country in comparison with sevoflurane is still not great for a number of reasons, including the insufficient volume of methodological literature in Russian. Objectives. To highlight the methodological aspects of the use of desflurane in modern anesthesiology. Materials and methods. The search for sources was carried out using the resources of the Russian scientific electronic library (eLIBRARY.ru), the bibliographic database of articles from the US National Library of Medicine (NCBI), the ClinicalKey electronic library, and the Scopus abstract and citation database. The search depth is 7 years. Results. A review of publications in 2014-2020, devoted to the methodology of using modern vapor-generating anesthetics, has been performed. The methodological techniques of anesthesia with desflurane are described in detail: inhalation induction, maintenance of anesthesia using a low and minimal flow of fresh gas, the peculiarities of the period of awakening and post-anesthetic rehabilitation are given. Conclusion. Desflurane is not the drug of choice for inhalation induction of anesthesia, but has a number of distinctive feature: advantages for using with low or minimal fresh gas flow; superiority in speed and predictability of the period of early post-anesthetic rehabilitation; safety of use, both in elderly patients and in children; relevance for Outpatient anesthesiology, Bariatric surgery, and programs for Enhanced Recovery After Surgery.

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Sustainability in the Operating Room

Cited by 49 publications

References 20 publications

Project SPRUCE: Saving Our Planet by Reducing Carbon Emissions, a Pediatric Anesthesia Sustainability Quality Improvement Initiative

Project SPRUCE: Saving Our Planet by Reducing Carbon Emissions, a Pediatric Anesthesia Sustainability Quality Improvement Initiative

Tertiary Students’ Awareness of Climate Change: A Case Study of a Selected University of Technology

Methodological aspects of desflurane application in modern anesthesiology. Review

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