TY - JOUR

T1 - Inhalational anaesthetics, ozone depletion, and greenhouse warming

T2 - the basics and status of our efforts in environmental mitigation

AU - Lopes, R.

AU - Shelton, C.

AU - Charlesworth, Mike

N1 - This is a non-final version of an article published in final form in Lopes, Rita; Shelton, Cliff; Charlesworth, Mike Inhalational anaesthetics, ozone depletion, and greenhouse warming: the basics and status of our efforts in environmental mitigation, Current Opinion in Anaesthesiology: August 2021 - Volume 34 - Issue 4 - p 415-420 doi: 10.1097/ACO.0000000000001009

PY - 2021/8/1

Y1 - 2021/8/1

N2 - PURPOSE OF REVIEW: Following their use for medicinal purposes, volatile inhalational anaesthetic agents are expelled into the atmosphere where they contribute to anthropogenic climate change. We describe recent evidence examining the benefits and harms associated with their use. RECENT FINDINGS: The environmental harms associated with desflurane and nitrous oxide likely outweigh any purported clinical benefits. Life cycle analyses are beginning to address the many gaps in our understanding, and informing choices made on all aspects of anaesthetic care. There is, however, an urgent need to move beyond the debate about anaesthetic technique A vs. B and focus also on areas such as sustainable procurement, waste management, pharmacological stewardship and joined-up solutions. SUMMARY: There is now compelling evidence that anaesthetists, departments and hospitals should avoid desflurane completely, and limit nitrous oxide use to settings where there is no viable alternative, as their environmental harms outweigh any perceived clinical benefit. Life cycle analyses seem supportive of total intravenous and/or regional anaesthesia. There are many other areas where choices can be made by individual anaesthetists that contribute towards reducing the environmental burden of healthcare, such as prioritising the reduction of inappropriate resource use and over-treatment. However, this all requires joined up solutions where all parts of an organisation engage.

AB - PURPOSE OF REVIEW: Following their use for medicinal purposes, volatile inhalational anaesthetic agents are expelled into the atmosphere where they contribute to anthropogenic climate change. We describe recent evidence examining the benefits and harms associated with their use. RECENT FINDINGS: The environmental harms associated with desflurane and nitrous oxide likely outweigh any purported clinical benefits. Life cycle analyses are beginning to address the many gaps in our understanding, and informing choices made on all aspects of anaesthetic care. There is, however, an urgent need to move beyond the debate about anaesthetic technique A vs. B and focus also on areas such as sustainable procurement, waste management, pharmacological stewardship and joined-up solutions. SUMMARY: There is now compelling evidence that anaesthetists, departments and hospitals should avoid desflurane completely, and limit nitrous oxide use to settings where there is no viable alternative, as their environmental harms outweigh any perceived clinical benefit. Life cycle analyses seem supportive of total intravenous and/or regional anaesthesia. There are many other areas where choices can be made by individual anaesthetists that contribute towards reducing the environmental burden of healthcare, such as prioritising the reduction of inappropriate resource use and over-treatment. However, this all requires joined up solutions where all parts of an organisation engage.

KW - inhalation anesthetic agent

KW - nitrous oxide

KW - human

KW - ozone depletion

KW - Anesthetics, Inhalation

KW - Humans

KW - Nitrous Oxide

KW - Ozone Depletion

U2 - 10.1097/ACO.0000000000001009

DO - 10.1097/ACO.0000000000001009

M3 - Journal article

VL - 34

SP - 415

EP - 420

JO - Current Opinion in Anaesthesiology

JF - Current Opinion in Anaesthesiology

IS - 4

ER -