Reviewed by Alex SmithJun 6 2022
The environmental impact of inhaled anesthetic agents will be addressed in a presentation that will be given at the 2022 Euroanaesthesia Congress. Also, a discussion will be held on how people can and should manage without anesthetic agents—or at least hugely decrease their use.
Image Credit: European Society of Anaesthesiology and Intensive Care.
Dr. Niek Sperna Weiland, an anesthesiologist from the Amsterdam University Medical Center, The Netherlands will be heading the presentation. Dr. Niek Sperna Weiland is also the founder of the center’s Sustainable Healthcare Team.
All unstable (gaseous) anesthetics are known to be potent greenhouse gases, varying in global warming potential (GWP) from 440 to 6810 compared to carbon dioxide (CO2,) with a reference GWP of 1.
The anesthetic sevoflurane consists of an isoflurane 1800, GWP of 440, and desflurane 6810. These are all extremely high. Methane, liberated by livestock throughout the world and other processes, consists of a GWP of 86, and Nitrous oxide (discharged by agriculture, but also utilized in anesthesia) is 289. Also, this gas has an extremely long atmospheric lifetime (nearly 120 years).
Reduction of emission of these gases is a quick win in combatting climate change. After use, these substances are emitted into the atmosphere and rising concentrations have been registered even in very remote areas such as Antarctica and high in the Alps.
Dr. Niek Sperna Weiland, Anesthesiologist, Amsterdam University
There are many ways to minimize emissions, including eliminating the use of nitrous oxide, isoflurane, and desflurane immediately, moving to other modes of anesthesia like TIVA (total intravenous anesthesia) and regional anesthesia (epidural/spinal/nerve blocks); and capturing volatile anesthetics from exhaust air piping.
It is also hopeful that a complete ban on desflurane is now being prepared by the European Commission, which would come into effect on 1 January 2026.
Dr. Niek Sperna Weiland, Anesthesiologist, Amsterdam University
Weiland describes that while few indications for inhaled anesthesia remain, there is no reason why a patient could not be changed to regional anesthesia or TIVA in the majority of the instances.
Weiland stated, “There is no evidence that volatile anesthesia results in more favorable patient outcomes. That said, we cannot do entirely without these inhaled agents. The most common indication may be the continued need for mask induction of anesthesia for children.”
Also, he will present the successful sevoflurane decrease campaign of Amsterdam UMC, which has noticed that the yearly canisters used fall by 70% from more than 2500 annually to below 1000. In accordance with earlier suggestions, Amsterdam UMC also entirely abolished isoflurane, desflurane, and nitrous oxide.
This success was achieved without the hospital even implementing capture and recycle technology.
Weiland explained, “In Amsterdam, we do not capture and recycle and yet we reduced our emissions by 70%. This seems almost as low as you can go with using sevoflurane efficiently and switching to regional/TIVA.”
Weiland added, “For the remaining 30%, capture and recycling will be the only option. While technology that can do this is coming onto the market, there are some legal issues with marketing the recycled substance which must still be overcome before this can become a widespread practice.”
Dr. Sperna Weiland addresses the energy use in operating rooms (ORs), stating that “Hospitals generally do not seem to have any clear policy on this, and indeed energy-saving technology only tends to be introduced when operating theatres are refurbished, or entirely new hospitals are built.
Weiland added, “But as we ourselves have demonstrated, you really can save a lot of energy by switching off most ORs during evenings, through the night and over weekends. In Amsterdam, we save around 360.000 kWh per annum by doing this.”
The “reduce, reuse, recycle” paradigm is applied to waste materials at Amsterdam UMC. Many materials in ORs are discarded unused simply because they were unwrapped due to protocol.
We are critically reviewing these protocols and also the sets that we use. Moreover, we have developed a washable surgical headcover that is being implemented this year. We will go from 100,000 disposable headcovers to just 500 per year, and save around 60% of our carbon footprint for headcover use. Lastly, we implemented a full recycling program of plastic packaging materials in all our operating rooms recycling around 4000 kg per month.
Dr. Niek Sperna Weiland, Anesthesiologist, Amsterdam University
Weiland added: “Climate change has really come to the top of the agenda in many countries, in both developed and developing countries, especially in the last couple of years. Every sector must play its part in reducing both emissions of harmful gases and overall energy use.”
“It is clear that much can be achieved with relatively little effort, such as massively reducing use of inhaled anesthesia and general power-saving techniques. Some national and international policies may be required to target remaining emissions, especially those associated with our supply chain, but at Amsterdam UMC we have shown what is possible with our own effort first,” concluded Weiland.