Is It Time to Say Goodbye to Inhaled Anesthesia? – Eurasian Review

A review presented at this year’s Euroanaesthesia Congress will discuss the environmental impact of inhaled anesthetic agents and how we can and should manage without them – or at least massively reduce their use. The presentation will be given by anesthesiologist Dr Niek Sperna Weiland, University of Amsterdam Medical Center, Netherlands, founder of the center’s Sustainable Health Care Team.

All volatile anesthetics (gases) are strong greenhouse gases, ranging in global warming potential (GWP) from 440 to 6810 relative to carbon dioxide (CO).2,) which has a reference GWP of 1. The anesthetic sevoflurane has a GWP of 440, isoflurane 1800, and desflurane 6810. These are all very high. Methane, emitted by livestock around the world and other processes, has a GWP of 86, and Nitrous oxide (emitted by agriculture, but also used in anesthesia) is 289, and this gas has a very long atmospheric lifetime (about 120 years).

“Reducing emissions of these gases is a quick win in the fight against climate change,” explains Dr Sperna Weiland. “After use, these substances are emitted into the atmosphere and increased concentrations have been noted even in very remote areas such as Antarctica and the high Alps.”

There are several ways to reduce emissions, including ending the use of nitrous oxide, desflurane and isoflurane immediately, despite the efficient combination use of the only other available alternative (sevoflurane), and switching to another anesthetic mode such as TIVA (total intravenous anesthesia) and general anesthesia. regional (spinal/epidural/nerve block); and also captures volatile anesthetics from exhaust pipes. “It is also hoped that a complete ban on desflurane is now being prepared by the European Commission*, which will come into effect on 1 January 2026,” explains Dr Sperna Weiland.

He will explain that while some indications for inhalation anesthesia will remain, there is no reason why patients should not be switched to TIVA or regional anesthesia in most cases. “There is no evidence that volatile anesthetics produce better outcomes for patients. That said, we can’t do it completely without this inhalation agent. The most common indication may be the continued need for induction of an anesthetic mask for children.”

He will also present a successful sevoflurane reduction campaign at UMC Amsterdam, which has seen annual tube usage drop 70% from above 2500 per year to below 1000. In line with previous recommendations, UMC Amsterdam is also completely eliminating nitrous oxide, desflurane and isoflurane. .

This success has come without hospitals not yet implementing capture and recycle technology. He explains: “In Amsterdam, we don’t capture and recycle, but we reduce emissions by 70%. This seems almost as low as you could get by using sevoflurane efficiently and switching to regional/TIVA. For the remaining 30%, capture and recycling will be the only options. While technologies that can do this are coming to market, there are several legal issues with the marketing of recycled materials that remain to be addressed before this can become a widespread practice.”

Dr Sperna Weiland will discuss overall energy use in operating theaters (OR), explaining “hospitals generally do not appear to have a clear policy on this, and indeed energy efficient technologies only tend to be introduced when operating theaters are refurbished, or hospitals that are completely new. new. built. But as we’ve shown ourselves, you can actually save a lot of energy by turning off most of the OR’s at night, all night and over the weekend. In Amsterdam, we save about 360,000 kWh per year by doing this.”

For waste materials, UMC Amsterdam applies the ‘reduce, reuse, recycle’ paradigm. A lot of material in the OR is discarded unused, simply because it was opened because of the protocol. Dr Sperna Weiland explained: “We are critically reviewing these protocols as well as the devices we use. In addition, we have developed a washable surgical head covering which was applied this year. We will go from 100,000 disposable headgear to just 500 per year, and save about 60% of our carbon footprint on headgear use. Lastly, we implemented a full recycling program of plastic packaging materials in all of our operations, recycling around 4000 kg per month.”

He concludes: “Climate change has really been high on the agenda in many countries, both developed and developing, especially in recent years. Each sector must play its part in reducing harmful gas emissions and overall energy use. It is clear that much can be achieved with relatively little effort, such as a major reduction in the use of inhalation anesthetics and general power saving techniques. Several national and international policies may be required to target remaining emissions, particularly those related to our supply chain, but at UMC Amsterdam we have shown what is possible with our own efforts first.”

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