Introduction
On a worldwide scale, healthcare contributes to nearly five percent of the total greenhouse gas emissions and corresponding proportions of detrimental air pollutants. While there is a lack of global data to estimate the emissions originating from anesthesia practices, a study conducted in the UK has indicated that inhalational anesthetic agents alone may account for approximately three percent of healthcare-related emissions within the NHS.
Despite uncertainties regarding the precise magnitude of anesthesia gasses' influence on individual nations, their cumulative worldwide impact on the environment is significant and should not be disregarded any longer.
What Did the WFSA Want to Achieve by Making Anesthesia More Eco-Friendly?
The WFSA (World Federation of Societies of Anesthesiologists) convened an international panel of experts with the goal of identifying practical recommendations that healthcare professionals worldwide can implement to reduce the ecological footprint of anesthesia services while maintaining positive patient outcomes. The WFSA Global Working Group on Environmental Sustainability in Anesthesia has established seven key principles that all anesthesia providers across the globe should strive to uphold:
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Minimize Environmental Impact: Efforts should be made to reduce the environmental impact of their clinical practices.
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Utilize Environmentally Preferred Resources: Whenever it is clinically safe to do so, healthcare providers should opt for medications and equipment that are environmentally preferable.
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Prevent Overuse and Waste: Healthcare providers should take measures to minimize the unnecessary overuse or wastage of medications, equipment, energy, and water resources.
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Integrate Sustainability into Education: Environmental sustainability principles should be integrated into formal anesthesia education programs to ensure that future practitioners are environmentally conscious.
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Incorporate Sustainability into Research and Quality Improvement: Environmental sustainability principles should be woven into anesthesia research and quality improvement initiatives.
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Champion Sustainability within Healthcare Organizations: Anesthesia providers should take a leadership role in promoting environmental sustainability within their healthcare organizations.
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Collaborate with Industry for Sustainability: Collaborative efforts with industry partners should be pursued to enhance environmental sustainability in the field of anesthesia.
These principles collectively represent a commitment to reducing the environmental impact of anesthesia services on a global scale while maintaining high standards of patient care.
What Are the Principles Emphasized by the WFSA to Align With the Goal of Reducing the Environmental Impact of Anesthesia?
The WFSA Working Group highlighted three core principles that must be in harmony with the objective of diminishing the environmental footprint of anesthesia:
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Preserving Patient Safety: Sustainable anesthesia practices should never compromise patient safety. Ensuring the well-being and safety of patients remains paramount, and sustainable practices must be aligned with this critical concern.
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Global Collaboration and Support: Countries of varying income levels, including high-, middle-, and low-income nations, should provide each other with suitable support to implement sustainable healthcare practices, including anesthesia. This collaborative approach ensures that sustainable healthcare is accessible and attainable worldwide.
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Mandatory Monitoring for Environmental Responsibility: Healthcare systems should be obligated to reduce their impact on global warming. Effective mandates and monitoring mechanisms should be established to ensure that healthcare institutions and providers actively work toward decreasing their environmental contributions.
What Are the Effects of Inhalational Anesthesia Agents on the Environment?
The influence of inhalational anesthetic agents on global climate change is relatively minor. However, anesthesiologists hold a unique position where the decisions they make in their professional roles can significantly impact their carbon footprint far more than their everyday activities.
The impact of each anesthetic agent depends on factors such as its capacity to absorb infrared radiation that would otherwise exit the Earth's lower atmosphere, the quantity utilized, and its atmospheric longevity. In clinical practice, desflurane and nitrous oxide are associated with a substantial inherent environmental impact, being at least ten times greater than that of Sevoflurane and Isoflurane.
What Can Be Done to Reduce Environmental Effects Through Anesthesia?
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Implementing Low-Flow Anesthesia: Utilizing low-flow anesthesia techniques.
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Choosing Environmentally Friendly Agents: Opting for anesthetic agents with lower environmental impact.
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Minimizing Inhalational Agents: Utilizing methods to decrease the reliance on inhalational agents, such as regional anesthesia and total intravenous anesthesia (TIVA). TIVA, in general anesthesia, has a significantly smaller carbon footprint compared to using volatile anesthetics. Moreover, considering other environmental effects associated with TIVA/volatile production and use, such as water and land pollution and solid waste generation.
What Are Some Examples of Anesthesia That Have an Impact on Environmental Sustainability?
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Nitrous Oxide (N2O): Nitrous oxide, commonly known as "laughing gas," is notorious for its potent greenhouse gas properties. When used as an inhalation anesthetic, nitrous oxide contributes substantially to global warming. It has a global warming potential approximately 300 times greater than carbon dioxide (CO2) over a 100-year period. Despite its known environmental harm, nitrous oxide has been widely used in anesthesia due to its effectiveness and low cost.
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Desflurane: Desflurane is another inhalation anesthetic with a high global warming potential. It has a significantly greater impact on global warming compared to other inhalation anesthetics like Sevoflurane. Desflurane's adverse environmental effects are primarily due to its inefficient metabolism within the body, leading to a higher percentage of the gas being exhaled unchanged.
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Single-Use Disposable Equipment: The pervasive use of single-use, disposable anesthesia equipment contributes to vast amounts of medical waste. Disposable breathing circuits, airway management devices, and intravenous tubing are examples of items that generate unnecessary waste and strain on resources.
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Waste Anesthetic Gas Scavenging Systems: While these systems are crucial for protecting healthcare workers from exposure to anesthetic gasses, they require significant energy consumption. The energy used to run these systems and maintain the necessary negative pressure in operating rooms adds to the overall carbon footprint of anesthesia.
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Inefficient Energy Use: Operating rooms and anesthesia machines consume large amounts of energy. The inefficient use of energy in healthcare facilities, including excessive lighting, HVAC systems, and the constant operation of anesthesia machines, exacerbates their environmental impact.
Conclusion
In conclusion, anesthesia's environmental impact, driven by gasses like nitrous oxide and desflurane, necessitates urgent attention. The WFSA's sustainability principles underscore the importance of reducing this footprint while ensuring patient safety. Implementing low-flow anesthesia, choosing eco-friendly agents, and minimizing inhalational agents are key steps healthcare professionals can take. Case studies demonstrate the successful adoption of sustainable anesthesia practices. Prioritizing these changes is crucial to mitigate anesthesia's adverse environmental effects and promote a greener healthcare system.
