Prioritising source reduction over anaesthetic gas capture for sustainable practice.

Sevoflurane and desflurane are halogenated hydrocarbons with global warming potential. We examined the maximum potential benefit assuming 100% efficiency of waste gas capture technology used in operating rooms and recovery locations. We performed computer simulations of adult patients using the default settings of the Gas Man software program, including the desflurane vaporizer setting of 9% and the sevoflurane vaporizer setting of 3.7%. We performed 21 simulations with desflurane and 21 simulations with sevoflurane, the count of 21 = 1 simulation with 0-hour maintenance + (1, 2, 3, 4, or 5 hours of maintenance) × (0.5, 1, 2, or 4 L per minute fresh gas flow during maintenance). (1) A completely efficient gas capture system could recover a substantive amount of agent even when the case is managed with low flows. All simulations had at least 22 mL agent recovered per case, considerably greater than the 12 mL that we considered the minimum volume of economic and environmental importance. (2) All 42 simulations had at least 73% recovery of the total agent administered, considerably greater than the median 52% recovery measured during an experimental study with one gas capture technology and desflurane. (3) The maximum percentage desflurane (or sevoflurane) that could be captured decreased substantively with progressively longer duration anesthetics for low-flow anesthetics but not for higher-flow anesthetics. However, for all 8 combinations of drug and liters per minute simulated, there was a substantively greater recovery in milliliters of agent for longer duration anesthetics. In other words, if gas capture could be near perfectly efficient, it would have greater utility per case for longer duration anesthetics. (4) Even using a 100% efficient gas capture process, at most 6 mL liquid desflurane or 3 mL sevoflurane per case would be exhaled during the patient's stay in the postanesthesia care unit. Therefore, the volume of agent exhaled during the first 1 hour postoperatively is not a substantial amount from an environmental and economic perspective to warrant consideration of agent capture by having all these patients in the postanesthesia care unit, or equivalent locations, using the specialized anesthetic gas scavenging masks with access to the hospital scavenging system at each bed. Simulations with Gas Man show a strong rationale based on agent uptake and distribution for using volatile anesthetic agent capture in operating rooms if the technology can be highly efficient at volatile agent recovery.

#36915 D37 – the green footprint of regional anesthesia

The sustainability of the construction industry largely depends on effective waste management practices throughout both construction and demolition processes. Construction and demolition waste causes significant environmental degradation, resource depletion, and landfill overflow, making effective waste management an essential component of sustainable construction practices. As the construction industry is one of the biggest contributors of generated waste in today’s world, achieving sustainability in this industry is essential for overall sustainable development. This study aims to examine the sustainable approach to construction and demolition waste and develop strategies for the industry. Based on the evaluation of various waste management techniques, this study used a standard approach in examining existing literature available in renowned research databases and key concepts to develop strategies for future construction and demolition waste management. This included identifying appropriate keywords or combining multiple keywords during the search process. Waste reduction and protecting the planet’s precious natural resources have been the focus of this study. This research investigated strategies during the planning and design phases. Out of the three strategies tested; reduction at the source, recycling, and reuse, source reduction yields the best results. Selecting materials, optimizing designs, and improving processes are all essential techniques for source reduction. Additionally, it explores the role of policy interventions and regulatory frameworks in improving source reduction practices across the industry. However, as waste reduction may not always eliminate waste generation, especially during the demolition of buildings, it is important to supplement this with existing recycling and reuse approaches. With the use of alternative building materials, it is essential to reassess recycling and reuse options for innovative and sustainable construction materials. The findings illustrate that efficient waste reduction regulations, such as green building certifications and mandatory waste management plans, are critical to achieving sustainability. By incorporating source reduction measures in addition to recycling and reuse of waste management, the construction may drastically minimize its environmental effect while increasing cost efficiency and resource usage. This study emphasizes that source reduction should be mandatory for accomplishing sustainable construction and demolition waste management. Recycling and reuse should complement waste reduction efforts.

ABSTRACTOrganizations are increasingly engaging in socially and environmentally sustainable initiatives. This paper focuses on the institutional isomorphism mechanisms to analyse the organizational adoption of sustainable manufacturing practices like eco-design, source reduction, and environmental management practices. This paper empirically examines the role of institutional influence in the organizational adoption of sustainable manufacturing practices among firms in India. The results of this study confirm the significance of the three institutional isomorphism mechanisms in influencing sustainable responses, but not all mechanisms influence the organizational response equally. In particular, the results show a strong influence of self-regulatory normative isomorphism on the implementation.

Sustainable Anesthesia

As we write this editorial in early December 2023, the 28th United Nations (UN) Climate Change Conference (COP28), is underway. In the run-up to this event, the UN published its first Global Stocktake report [1]. This summarises the progress made towards the mitigation of global warming since the Paris Agreement of 2015 [2]. It tells us that while this international treaty has had positive impacts on the rate of greenhouse gas emissions, the rate of progress is likely insufficient to avoid global surface temperatures > 1.5°C above pre-industrial averages, at which point it is thought our capacity to adapt to climate change will be overwhelmed [3]. Many of the recommendations of the report describe various kinds of support that will be needed to further reduce greenhouse gas emissions, including increased financial investment; more transparent reporting of emissions; and measures to support transition away from fossil fuels [1]. Underpinning much of this transformation is a need for research. In some cases, this relates to the development of new solutions. In others, it relates to finding the best ways to implement existing solutions more widely, with particular attention drawn to the need to ensure that low- and middle-income countries are not left behind. Finally, there is a need to better understand the impacts of current practices and how these can be mitigated. In this environmental supplement of Anaesthesia, 11 commissioned articles offer readers an overview of the latest information about sustainable practices in peri-operative care. Two threads that bind these articles together are: an urgent need for action, considering that we are amid a worsening environmental crisis; and an acknowledgement that our understanding of sustainable peri-operative care remains limited. This puts colleagues in a difficult position; we don't have the option to do nothing, but in the absence of a more complete understanding – and given the complexity of healthcare systems – it is possible we may end up doing the wrong thing or missing an opportunity to do something better. Research into sustainable peri-operative care will reduce the risk of this occurring and given that the environmental crisis constitutes a health emergency [4], this should be a priority for researchers, healthcare professionals and broader society [5]. In this editorial, we summarise the research needs identified by the authors in our supplement, explain the factors that mark out high-quality sustainable healthcare research and direct readers to some of the resources and opportunities to support research in this area. We focus here on the UK, but many of the principles will be applicable worldwide. The environmental impacts of any item or process should be considered in terms of its entire 'life cycle', from extraction of raw materials through to disposal. In terms of the impacts on climate change, this is typically expressed in terms of greenhouse gas emissions, often converted into carbon dioxide equivalents (CO2e) using a metric called global warming potential (GWP) which integrates how much infrared radiation a gas absorbs and re-emits, and how long it persists in the atmosphere. As such, the GWP is expressed over a certain timeframe – usually 100 years (GWP100). Anaesthesia is one of a relatively small group of healthcare practices in which greenhouse gases are emitted at the point of use. In their articles on the climate science of anaesthesia, Nielsen and Sulbaek Andersen [6] and Slingo and Slingo [7] offer differing views on how we should assess the climate impacts of volatile agents, which are relatively short-lived greenhouse gases. Both articles acknowledge that volatile agents have very small overall climate impacts compared with carbon dioxide, but differ on whether GWP100 is a suitable metric to inform practice and whether choice of volatile agent is a worthwhile target for mitigation. This debate illustrates that there remains uncertainty about how to assess and report the climate impacts of anaesthesia and, perhaps, about where best to focus our efforts. Kanal and Fang remind us that climate change is not the only aspect of the ongoing environmental crisis that requires attention, noting, for example, that simply focusing on CO2e doesn't account for ecotoxicity or plastics pollution [8]. The Stockholm Resilience Centre defines nine 'Planetary Boundaries' (one of which is climate change), within which we must remain if humanity is to be able to meet the needs of generations to come (Fig. 1) [9]. While there are examples of assessments of the environmental impacts of anaesthesia that move beyond greenhouse gases [10], there is a clear need for research that acknowledges the complexity of the planet's systems and avoids so-called 'carbon tunnel vision', focusing only on greenhouse gas impacts because of their (relative) simplicity of quantification. While the environmental impacts of some industries (e.g. steel, aviation) are deemed 'hard to abate', meaning that environmentally responsible transformation would be prohibitively difficult or costly [1], healthcare is generally thought to be open to innovation. Perhaps the most obvious example of innovation is the development of new technologies which aim to reduce waste or improve efficiency. In their review, Ghandi et al. consider volatile capture technology [11], a group of devices that adsorb volatile agents from waste anaesthetic gases. The fluorinated compounds can then be desorbed, purified and (potentially) re-administered to patients. The obvious benefits of this approach include reduced material use to produce volatile anaesthetics and reduced greenhouse gas emissions, while the ability to deactivate energy intensive active scavenging systems may be less obvious but no less valuable [11]. But there may also be downsides; White and Montgomery raise the concern that volatile capture technology may be a distractive intervention that could promote maladaptive behaviours (e.g. if the volatile is being captured, why worry about low flows?) [12], and Ghandi et al. note that while volatile capture technologies all appear to perform efficiently in the laboratory setting, impacts in clinical practice are variable [11]. They outline the 'ideal characteristics' of a volatile capture technology system, and in doing so illustrate that the current technologies fall somewhat short of this aspirational standard. They also propose a series of research priorities which focus on investigating volatile capture technology in real-world scenarios, which would aid understanding of how these technologies could be deployed responsibly. Perhaps less controversial than the adoption of new technologies is optimising the use of established ones. Nitrous oxide has been part of the anaesthetic armamentarium since the mid 1800s, and its role in hastening the onset and offset of slow-acting volatile agents means that it was piped into many operating theatres built when these agents were commonplace. However, since the development of low-solubility volatile agents in the 1990s, and with the rising popularity of total intravenous anaesthesia [13], the clinical use of nitrous oxide has declined. This renders its delivery by complex (and often leaky) manifold and pipeline systems grossly inefficient, with portable cylinders more appropriate in many cases. Chakera et al. report the experiences and impacts of undertaking the Nitrous Oxide Project in three different institutions [14]. Discussion of the challenges encountered illustrates that even when the right thing to do is obvious, there is often a gap in understanding how to encourage individuals and institutions to use drugs, technologies and techniques more responsibly [15]. Perhaps the most positive aspect of making healthcare more environmentally sustainable is that it often results in superior (or, at least, no worse) outcomes for patients, and may also have financial advantages. The so-called 'triple bottom line', comprising environmental, social and financial considerations, is often used as a theoretical model to assess the value of interventions. For example, White and Montgomery point out that the most effective intervention would be to 'move medical funding away from reactive disease-care, towards personalised, preventative healthcare' [12]. If realised, this would result in fewer anaesthetics because healthier people need less surgical healthcare; this is clearly a 'win-win' but is also notoriously difficult to achieve. Perhaps more within our current capabilities is the call by van Hove et al. to invest in 'Getting It Right First Time' (GIRFT), and design out unwarranted variation in healthcare to reduce complications, cancellations and unexpected admissions to critical care, all of which are harmful to patients and the planet [16]. The authors note, however, that there is currently a dearth of information about 'carbon hotspots' in surgical procedures, which hampers our ability to standardise care in an environmentally responsible way. Considering the role of surgical teams in sustainable peri-operative practice, Ledda et al. use the Behaviour Change Wheel model to consider how teams respond to capabilities, opportunities and motivations [17, 18]. They note that behaviour is seldom simply a rational response to information and go on to describe a programme of research informed by behavioural change theory which will focus on three pillars: re-usable operating theatre textiles; anaesthesia; and waste reduction. The Behaviour Change Wheel model has been used recently to help understand why anaesthetists may adopt more sustainable practices, emphasising the growing research interest in the application of behavioural theories in accelerating change towards sustainable peri-operative care [15, 19, 20]. What do patients think about the ongoing efforts to promote sustainability in anaesthesia? In a review written by a team of patient representatives who draw on their own experiences in combination with key policy documents [21, 22], Knagg et al. explain that the sustainable healthcare agenda remains unknown to many patients and members of the public, who, quite understandably, tend to focus on getting better when they encounter healthcare services. But it is also clear that the environment matters to patients and the public, and leaves no doubt that patients expect to be represented in the processes (including the conduct of research) that may lead to changes in their healthcare [23]. A recent report from the World Health Organization highlights the urgent need for research to tackle unanswered questions in climate and health research and, given the required pace of change, to ensure that research carried out in this area is implemented into policy and practice [24]. For sustainability research to be implementable, it should take into consideration healthcare infrastructure and care pathways, as well as resource and logistical constraints [25]. The scalability of research and considering the potential for widespread adoption and application in diverse settings, populations and communities is also integral to the adoption of changing practice. Research conducted in sustainable healthcare should fully incorporate the principles of the triple bottom line. From an environmental perspective, it should reflect not only greenhouse gas emissions, but also the wider complexities of healthcare on the planet. From a social perspective, it should account for the well-documented intersectionality between environmental harms and other health inequalities [26, 27]. Designing research with equality and diversity at its heart is integral to developing meaningful outputs that can be translated to policy decisions and clinical practice. Bringing the patient and public voice into the sustainability agenda for clinical research is also vital in ensuring not only that interventions are acceptable, but that the public are empowered to engage on this topic and become drivers for positive change [5, 23, 28, 29]. There is increasing acknowledgement that the complexities of sustainable healthcare require research that transcends sectors and leverages expertise across disciplines. Interdisciplinary research is therefore a hallmark of quality [30, 31]. Engineering solutions, computer science and behavioural science are all examples of where engaging across sectors to deliver on new interventions in sustainable healthcare research has proven benefit. In addition to the above, the environmental cost of undertaking healthcare research is an important consideration. Adshead et al. estimated the carbon cost of clinical trials registered on the ClinicalTrials.gov database to be 27.5 million tCO2e, equivalent to just under one-third of the total annual carbon emissions of Bangladesh [32]. We must ensure that unnecessary environmental impact is not added through research which, like the rest of healthcare, must strike a balance between environmental responsibility, affordability and quality. General approaches to make research more sustainable include making efficient use of existing evidence and incorporating lower-carbon study design as described in the National Institute for Health and Care Research (NIHR) Carbon Reduction Guidelines [33]. There is a growing body of literature examining sustainability in specific types of research such as the work on low carbon clinical trials and laboratory sustainability [32, 34]. A comprehensive approach to environmentally responsible research would be akin to a life cycle assessment and should encompass the entire research pathway from concept to dissemination. A report commissioned by the Wellcome Trust shows the growing amount of resource and support available to researchers [35]. From communities and networks to carbon footprint calculators, there is a wealth of information for researchers to access. Major UK funders of health research are engaged in the topic and the Medical Research Council, Wellcome and NIHR, among others, have signalled their interest in this area through multiple calls and a desire to increase the knowledge base in this area [36-38]. There is no shortage of research gaps in sustainable anaesthesia research, and multiple resources exist to help researchers identify them. Specific to peri-operative care, the Greener Operations James Lind Alliance Priority Setting Partnership set out the top 10 questions according to patients, carers, the public and clinicians, and these have been highlighted and expanded in the recent Greener Surgery Report [5, 39]. Support exists too for specific research design queries. The new NIHR research support service provides advice to developing funding applications within the remit of the NIHR. In addition to general advice on study development and delivery, a new research support service hub delivered by Lancaster University and Partners offers specific advice on sustainable healthcare research and integrating sustainable healthcare principles into research practice. Support for researchers is summarised in Figure 2 (links to resources available in online Supporting Information, Appendix S1). It is clear from the articles in this special supplement that there is no shortage of passion among clinician-researchers, no shortage of opportunity to conduct research and no shortage of positive impacts that can be made. Nevertheless, there is much to do in sustainable peri-operative research with numerous challenges and contradictions: urgent action is needed but information is incomplete [6, 7, 11]; rapid progress has been made and yet operating theatres remain highly resource-intensive [8, 12]; implementation is challenging even when solutions are obvious [14, 16, 17]; 'easy' things can draw focus when sometimes 'difficult' things matter much more [7, 8, 12]; and all of this must be achieved without harming patient care [23]. The Global Stocktake report emphasises the need for investment in research [1] and it is heartening to see that taking place; not just in terms of funds, but in terms of development of expertise and sharing of resources through formal and informal networks. Closing the gaps in sustainable peri-operative research will rely on these collaborative efforts. It is increasingly recognised that sustainability is a 'core outcome' of everything that we do and we encourage researchers to consider the unmet research needs; collaborate across disciplines; and take the opportunities to undertake funded high-quality research in sustainable anaesthesia and peri-operative care. CS is Executive Editor of Anaesthesia Reports, a co-opted member of the Association of Anaesthetists Environment and Sustainability Committee, and the Sustainability Theme Lead for the NIHR Research Support Service Hub delivered by Lancaster University and Partners. SL was previously seconded to NHS England as Chief Sustainability Officer's Clinical Fellow. No external funding and no other competing interests to declare. Appendix S1. Links to online resources to support sustainable healthcare research. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Healthcare systems are a major source of greenhouse gas (GHG) emissions. In hospitals, the areas with the greatest environmental impact are anesthetic-surgical practice and intensive care. The aim of the study was to identify self-reported sustainable practices and attitudes of anesthesiologists at a public university hospital, their opinion on priority practices and barriers to their implementation. A cross-sectional study was carried out using an anonymous self-administered questionnaire adapted from an internationally validated instrument. All anesthesiology staff at the aforementioned hospital were invited to participate. Descriptive statistics and bivariate analysis using prevalence ratios were used. The participation rate was 71.6% (44 specialists and 4 residents). The most frequent sustainable practices were the choice of anesthetic gases according to their environmental impact and the use of prefilled drug syringes (58.3%). A total of 85.4% expressed a desire to recycle, although only 22.9% reported actually doing so. The majority (95.8%) considered that the environmental impact of products should be taken into account; however, 52.1% indicated that their knowledge to do so was insufficient. It was observed that women were less likely to consider carbon footprint when choosing inhalation anesthetics; this effect was statistically significant. For the rest of the factors analyzed, the variations did not reach statistical significance. Although there is a predisposition to consider sustainable practices in Anesthesiology, their implementation is scarce. This highlights the urgency of improving the environmental training of professionals, developing multilevel strategies to facilitate individual decisions, encouraging support of decision-makers, and creating participatory environmental hospital goals.

BackgroundOne of the most problems in developing countries is the integrated waste management and the effects on Greenhouse Gases (GHG) emission, Life Cycle Assessment (LCA) is used in this paper as a decision supporting tool in planning Municipal Solid Waste (MSW) managements.MethodsIn this paper the EPA’s Waste Reduction Model (WARM) that provide GHG emission factors for waste stream components that are based on life Cycle Inventory (LCI) framework were used and The MSW management methods comprised in seven scenarios.ResultsThe amount of GHG which was generated from Iran’s waste sector estimated about 17836079 Metric Tons of Carbon dioxide Equivalents (MT CO2e) in this study. The lowest amount of GHG was generated by LFG capture system with energy recovery (557635 MT CO2e), while Incineration of materials being sent to landfill (1756823 MT CO2e), Landfill Gas (LFG) capture system with flaring (2929150 MT CO2e) and Improved source reduction and recycling (4780278 MT CO2e) emitted fewer GHG than the other scenarios. Lowest levels of gross energy consumption occur in source reduction with recycling and composting (-89356240 Mega British Thermal Unit, M BTU), recycling and composting (-86772060 M BTU) as well as Improved source reduction with recycling and composting (-54794888 M BTU).ConclusionsIt appears that recycling and composting each offer significant GHG emissions and energy consumption reductions (scenarios 4, 5 and 6). Upon of the GHG emission and energy consumption results concluded that improved source reduction and recycling scenario has been the Balanced and appropriate technology for handling the solid waste streams in municipalities.

British Journal of Community NursingVol. 24, No. 5 TreatmentsGreener treatments: the NHS carbon footprintAysha MendesAysha MendesE-mail Address: [email protected]Freelance journalist specialising in psychology and healthcareSearch for more papers by this authorAysha MendesPublished Online:6 May 2019https://doi.org/10.12968/bjcn.2019.24.5.248AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References American Chemical Society. Greener drugs: benign by design strategies. 2011. https://tinyurl.com/y5c2lpsk (accessed 16 April 2019) Google ScholarCharlesworth M, Swinton F. Anaesthetic gases, climate change, and sustainable practice. Lancet Planet Health. 2017; 1(6):e216–e217. https://doi.org/10.1016/S2542-5196(17)30040-2 Crossref, Medline, Google ScholarKing's Fund. Sustainable services: future trends. 2019. https://tinyurl.com/y6qau78q (accessed 16 April 2019) Google ScholarKümmerer K, al-Ahmad A, Bertram B, Wiessler M. Biodegradability of antineoplastic compounds in screening tests: influence of glucosidation and of stereochemistry. Chemosphere. 2000; 40(7):767–773 Crossref, Medline, Google ScholarNational Institute for Health and Care Excellence. Patient decision aid: inhalers for asthma. 2019. https://tinyurl.com/y2ee7gws (accessed 16 April 2019) Google ScholarNHS. NHS long term plan. 2019. https://www.england.nhs.uk/long-term-plan/ (accessed 24 April 2019) Google ScholarNHS Digital. Core carbon footprint of NHS trusts and foundation trusts— emissions per full time equivalent. 2018. https://tinyurl.com/y6c9evnz (accessed 24 April 2019) Google ScholarRobinson J. NICE publishes patient decision aid to help patients choose greener asthma inhalers. 2019. https://tinyurl.com/y32m3qur (accessed 16 April 2019) Google ScholarRyan S, Nielsen C. Global warming potential of inhaled anaesthetics: application to clinical use. Anesthes Analges. 2010; 111(1):92–98. https://doi.org/10.1213/ANE.0b013e3181e058d7 Crossref, Medline, Google ScholarSustainable Development Unit. Natural resource footprint. 2019a. https://tinyurl.com/y8rps5a4 (accessed 16 April 2019) Google ScholarSustainable Development Unit. NHS carbon footprint. 2019b. https://tinyurl.com/y24xtdxy (accessed 16 April 2019) Google ScholarTuhus-Dubrow R. The little green pill. 2011. https://tinyurl.com/y3r4cg3g (accessed 16 April 2019) Google ScholarVollmer M, Rhee T, Rigby M et al.. Modern inhalation anesthetics: potent greenhouse gases in the global atmosphere. Geophys Res Lett. 2015; 42:1606–1611. https://doi.org/10.1002/2014GL062785 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 May 2019Volume 24Issue 5ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 6 May 2019 Published in print 2 May 2019 Information© MA Healthcare LimitedPDF download

This review aims to provide an update on the results of studies published in the last two years involving the development of sustainable practices in hospital and operating theaters (OT). Recently, many studies evaluated various initiatives to better understand the environmental impact of the OT but also to minimize its environmental impact. Many trials evidenced the positive impact of the instrument's reuse using an appropriate reprocessing procedure. Better waste segregation is associated with a reduction of produced waste and contributes to a significant reduction in CO 2 equivalent emissions. Regarding anaesthetic gas, Desflurane is known to have the worst environmental impact and the majority of the study evidenced that its reduction permits to drastically reduce greenhouse gas emission of the OT. Greening the OT necessitates climate-smart actions such as waste reduction, the improvement of reusable instruments, recycling of our waste and better anaesthetic gas management. Within the last two years, many efforts have been made to reduce and better segregate waste produced in the OT and also to better understand the environmental impact of disposable and reusable devices.

Journal of Prescribing PracticeVol. 1, No. 5 News AnalysisPrescribing green: reducing our carbon footprintAysha MendesAysha MendesFreelance Journalist, specialising in healthcare and psychologySearch for more papers by this authorAysha MendesPublished Online:8 May 2019https://doi.org/10.12968/jprp.2019.1.5.220AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail View article References American Chemical Society. Greener drugs: benign by design strategies. 2011. https://tinyurl.com/y5c2lpsk (accessed 16 April 2019) Google ScholarCardiff University. People outside the UK ‘more environmentally friendly’. Cardiff Wales: Cardiff University; 2017 Google ScholarCharlesworth M, Swinton F. Anaesthetic gases, climate change, and sustainable practice. Lancet Planet Health. 2017;1(6):216–217 Google ScholarKümmerer K, al-Ahmad A, Bertram B, Wiessler M. Biodegradability of antineoplastic compounds in screening tests: influence of glucosidation and of stereochemistry. Chemosphere. 2000;40:767–773 Google ScholarMendes A. From surviving to thriving: the ‘Goldilocks approach’ to prescribing. Nurs Presc. 2018;16(12):578–579 Abstract, Google ScholarNational Institute for Health and Care Excellence. Patient decision aid: inhalers for asthma. 2019. https://tinyurl.com/y2ee7gws (accessed 16 April 2019) Google ScholarNHS. The NHS Long Term Plan. 2019. https://tinyurl.com/ydh7y999 (accessed 17 April 2019) Google ScholarNHS Digital. Core carbon footprint of NHS trusts and foundation trusts—emissions per full time equivalent. 2018. https://tinyurl.com/y6c9evnz (accessed 17 April 2019) Google ScholarPharmaceutical technology. Green pharma: the growing demand for environmentally friendly drugs2017. https://tinyurl.com/y4rqfcdg (accessed 17 April 2019) Google ScholarRobinson J. NICE publishes patient decision aid to help patients choose greener asthma inhalers. 2019. https://tinyurl.com/y32m3qur (accessed 16 April 2019) Google ScholarRyan S, Nielsen C. Global warming potential of inhaled anaesthetics: application to clinical use. Anesthes Analges. 2010; 111(1):92–98. https://doi.org/10.1213/ANE.0b013e3181e058d7 Google ScholarScudellari M. Drugging the environment. 2015. https://www.the-scientist.com/features/drugging-the-environment-35077 (accessed 16 April 2019) Google ScholarSustainable Development Unit. NHS carbon footprint. 2019. https://www.sduhealth.org.uk/policy-strategy/reporting/nhs-carbon-footprint.aspx (accessed 16 April 2019) Google ScholarThe King's Fund. Sustainable services: Future trends. 2019. https://www.kingsfund.org.uk/projects/time-think-differently/trends-sustainable-services (accessed 16 April 2019) Google ScholarTuhus-Dubrow R. The little green pill. 2011. https://slate.com/technology/2011/01/how-can-we-make-pharmaceutical-drugs-less-toxic-to-the-environment.html (accessed 16 April 2019) Google ScholarUS Environmental Protection Agency. Contaminant Candidate List 5 (CCL 5). 2018.https://www.epa.gov/ccl/contaminant-candidate-list-5-ccl-5 (accessed 17 April 2019) Google ScholarVollmer M, Rhee T, Rigby M et al.. Modern inhalation anesthetics: potent greenhouse gases in the global atmosphere. Geophys Res Lett. 2015;42:1606–1611 Google ScholarXie Y. Green pharmaceutical supply chain in the UK: a cross boundary approach. 2012. https://tinyurl.com/yyvnvayg (accessed 17 April 2019) Google Scholar FiguresReferencesRelatedDetails 2 May 2019Volume 1Issue 5ISSN (print): 2631-8385ISSN (online): 2631-8393 Metrics History Published online 8 May 2019 Published in print 2 May 2019 Information© MA Healthcare LimitedPDF download

Anaesthetic gases, climate change, and sustainable practice

To determine the carbon footprint of various sustainability interventions used for laparoscopic hysterectomy. We designed interventions for laparoscopic hysterectomy from approaches that sustainable health care organizations advocate. We used a hybrid environmental life cycle assessment framework to estimate greenhouse gas emissions from the proposed interventions. We conducted the study from September 2015 to December 2016 at the University of Pittsburgh (Pittsburgh, Pennsylvania). The largest carbon footprint savings came from selecting specific anesthetic gases and minimizing the materials used in surgery. Energy-related interventions resulted in a 10% reduction in carbon footprint per case but would result in larger savings for the whole facility. Commonly implemented approaches, such as recycling surgical waste, resulted in less than a 5% reduction in greenhouse gases. To reduce the environmental emissions of surgeries, health care providers need to implement a combination of approaches, including minimizing materials, moving away from certain heat-trapping anesthetic gases, maximizing instrument reuse or single-use device reprocessing, and reducing off-hour energy use in the operating room. These strategies can reduce the carbon footprint of an average laparoscopic hysterectomy by up to 80%. Recycling alone does very little to reduce environmental footprint. Public Health Implications. Health care services are a major source of environmental emissions and reducing their carbon footprint would improve environmental and human health. Facilities seeking to reduce environmental footprint should take a comprehensive systems approach to find safe and effective interventions and should identify and address policy barriers to implementing more sustainable practices.

Anesthetic gases are potent greenhouse gases, which are currently released into the atmosphere where they remain for many years. Strategies to reduce the carbon footprint in anesthesiology without compromising patient safety are urgently needed. Since 2020 several departments of anesthesiology have installed anesthetic gas capture systems with which anesthetic gases can be collected. This article aims to describe the anesthetic gas capture system CONTRAfluran™ and to give an overview of the first experiences in four departments of anesthesiology working with the new device in the daily clinical routine. The CONTRAfluran™ system presents anew concept in the surgical setting that has the potential to reduce the carbon footprint in anesthesiology; however, in order to accurately estimate CO2 equivalent savings, more information concerning the reprocessing and data on the pharmacokinetics of anesthetic gases are needed. Application of the CONTRAfluran™ system in daily clinical routine is feasible when anesthesiologists are aware of specific issues. In order to minimize the carbon footprint, it remains essential to implement the specific recommendations in the position paper of the German Society of Anaesthesiology and Intensive Care medicine (DGAI) and the Professional Association of German Anaesthesiologists (BDA) on ecological sustainability in anesthesiology and intensive care medicine and to support further research.

Objective:In France, healthcare facilities account for 7% of greenhouse gas emissions and 3.5% of total waste generation. Operating rooms generate 30% of hospital waste and hence should be a primary focus of environmental sustainability initiatives. The aim of this study was to evaluate environmentally sustainable anaesthesiology practices in France in 2020 and understand the barriers to their adoption.Methods:An anonymous survey of 28 questions was published online. The website did not record participants’ IP addresses. The survey’s link was sent by email to anaesthesiologist and anaesthesia nurse members of the French Society of Anesthesia and Intensive Care Medecine (SFAR), in February and June 2020. The survey was closed in August 2020.Results:Of the 10 877 recipients, 1092 (10%) responded to the questionnaire. Waste sorting was organized in 69% of respondents’ workplaces (691/1007), and 90% (793/879) of respondents stated that they most often followed the instructions. Sixty-five percent (659/1007) of respondents avoided using the most polluting anaesthetic gases. Thirty-nine percent of respondents (417/1064) had already received environmental sustainability training and 73% (705/972) stated that they wanted more training. The main barriers to the adoption of recycling identified by respondents were staff training (by 70% of respondents, 691/993), budget constraints (66%, 652/993), and a lack of administrative support (60%, 602/993).Conclusion:French anaesthesiologists and anaesthesia nurses who responded to the survey are environmentally aware and want to improve sustainable practices in the operating room. More widespread adoption could be achieved by offering training to all healthcare professionals and administrative staff and by creating local environmental focus groups to coordinate actions.