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.
Highlights
Inhaled anesthetics have been in clinical use since 1844 [1]
The clinical discussions presented in this review focus on evaluating the need for inhaled anesthetics
MacNeill et al demonstrated the impact of desflurane use in clinical practice in a well-designed report, in which huge—10 fold—disparities in greenhouse gases (GHG) emissions between hospitals could largely be accounted to the use of desflurane in comparison with less harmful gases [24]
Summary
Inhaled anesthetics have been in clinical use since 1844 [1]. Their discovery was a landmark as the first form of general anesthesia. Inhaled anesthetics are highly inert molecules, resulting in minimal to absent biotransformation—and virtually no production of toxic metabolites. This unique chemical property, results in exceptional atmospheric stability, causing these powerful greenhouse gases to have long-lasting ecological effects, requiring special attention from researchers, policymakers, and society in general. The clinical discussions presented in this review focus on evaluating the need for inhaled anesthetics They do not function as a pro–con comparison between the use of total intravenous anesthesia (TIVA) and inhaled anesthesia, but rather briefly show the available evidence from different areas where inhaled anesthetics are used
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