TY - JOUR

T1 - Carbon footprint of inhalational and total intravenous anaesthesia for paediatric anaesthesia

T2 - a modelling study

AU - Narayanan, H.

AU - Raistrick, C.

AU - Tom Pierce, J.M.

AU - Shelton, C.

PY - 2022/8/31

Y1 - 2022/8/31

N2 - Background: Tackling the climate emergency is now a key target for the healthcare sector. Avoiding inhalational anaesthesia is often cited as an important element of reducing anaesthesia-related emissions. However, evidence supporting this is based on adult practice. The aim of this study was to identify the difference in carbon footprint of inhalational and i.v. anaesthesia when used in children. Methods: We used mathematical simulation models to compare general anaesthetic techniques in children weighing 5–50 kg for TIVA, i.v. induction then inhalational maintenance, inhalational induction then i.v. maintenance, and inhalational induction and maintenance. We simulated inhalational induction with sevoflurane alone, and co-induction with sevoflurane and nitrous oxide, and both remifentanil–propofol and propofol-only i.v. anaesthesia. For each technique, we drew on previously published life-cycle data to calculate carbon dioxide equivalents for anaesthetic durations up to 480 min. Results: TIVA with propofol and remifentanil had a smaller carbon footprint over a typical anaesthetic duration of 60 min (1.26 kg carbon dioxide equivalents [CO 2e] for a 20 kg child) than i.v. induction followed by inhalational maintenance (2.58 kg CO 2e) or inhalational induction and maintenance (2.98 kg CO 2e). Inhalational induction followed by i.v. maintenance only had a lower carbon footprint than inhalational induction and maintenance when used in longer procedures (>77 min for children 5–20 kg; >105 min for children 30–50 kg). Conclusions: In a simulation study, i.v. anaesthesia had climate benefits in paediatric anaesthesia. However, when used after inhalational induction, benefits were only achieved in longer procedures. These findings provide evidence-based guidance for reducing the environmental impact of paediatric anaesthesia, but these will require confirmation using real-world data.

AB - Background: Tackling the climate emergency is now a key target for the healthcare sector. Avoiding inhalational anaesthesia is often cited as an important element of reducing anaesthesia-related emissions. However, evidence supporting this is based on adult practice. The aim of this study was to identify the difference in carbon footprint of inhalational and i.v. anaesthesia when used in children. Methods: We used mathematical simulation models to compare general anaesthetic techniques in children weighing 5–50 kg for TIVA, i.v. induction then inhalational maintenance, inhalational induction then i.v. maintenance, and inhalational induction and maintenance. We simulated inhalational induction with sevoflurane alone, and co-induction with sevoflurane and nitrous oxide, and both remifentanil–propofol and propofol-only i.v. anaesthesia. For each technique, we drew on previously published life-cycle data to calculate carbon dioxide equivalents for anaesthetic durations up to 480 min. Results: TIVA with propofol and remifentanil had a smaller carbon footprint over a typical anaesthetic duration of 60 min (1.26 kg carbon dioxide equivalents [CO 2e] for a 20 kg child) than i.v. induction followed by inhalational maintenance (2.58 kg CO 2e) or inhalational induction and maintenance (2.98 kg CO 2e). Inhalational induction followed by i.v. maintenance only had a lower carbon footprint than inhalational induction and maintenance when used in longer procedures (>77 min for children 5–20 kg; >105 min for children 30–50 kg). Conclusions: In a simulation study, i.v. anaesthesia had climate benefits in paediatric anaesthesia. However, when used after inhalational induction, benefits were only achieved in longer procedures. These findings provide evidence-based guidance for reducing the environmental impact of paediatric anaesthesia, but these will require confirmation using real-world data.

KW - climate change

KW - inhalation anaesthesia

KW - intravenous anaesthesia

KW - paediatric anaesthesia

KW - sustainability

U2 - 10.1016/j.bja.2022.04.022

DO - 10.1016/j.bja.2022.04.022

M3 - Journal article

VL - 129

SP - 231

EP - 243

JO - British Journal of Anaesthesia

JF - British Journal of Anaesthesia

SN - 0007-0912

IS - 2

ER -