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Climate change – anaesthesia’s part in the problem. Dr Stuart White Royal Sussex County Hospital, Brighton. Climate change is a fact. Man is responsible for climate change. Why?. Less/more expensive food Fewer/more expensive car journeys No air travel Higher taxes and costs

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climate change anaesthesia s part in the problem

Climate change – anaesthesia’s part in the problem

Dr Stuart White

Royal Sussex County Hospital, Brighton

slide5
Why?
  • Less/more expensive food
  • Fewer/more expensive car journeys
  • No air travel
  • Higher taxes and costs
  • Less ‘stuff’
  • Population restriction
anaesthetists
Anaesthetists
  • Professional life
  • Personal life
professional life
Professional life
  • Do anaesthetic drugs harm the environment?
  • Does the conduct of anaesthesia harm the environment?
  • How can we minimise the impact of anaesthesia on the environment?
anaesthetic gasses
Anaesthetic gasses
  • Evidence limited
  • Langbein T et al. Volatile anaesthetics and the atmosphere: atmospheric lifetimes and atmospheric effects of halothane, enflurane, isoflurane, desflurane and sevoflurane. BJA 1999; 82: 66-73
  • IPCC
  • Summarised in

Axelson U. Climate impact of anaesthetic gases 2008.http://www.miljo.skane.se/eng/U2237_translation.pdf

langbein
Langbein

Inhalational anaesthetic agents contribute to two environmental problems

  • Direct depletion of the ozone layer
  • Infrared absorption and global warming
oxygen ozone cycle
Oxygen-ozone cycle

OO

O

O

O OO OOO

OO OOO OO OO

UV

UV

slide13

l

100

400

MESOSPHERE

STRATOSPHERE

TROPOSPHERE

ozone depletion potential
Ozone depletion potential

Ozone depletion dependent on:

  • chlorine and bromine content
  • amount of agent that reaches the stratosphere
  • longevity of agent remains in the stratosphere

Calculated contribution to stratospheric ozone depletion

    • halothane 1%,
    • isoflurane 0.02%
    • sevoflurane 0%
    • desflurane 0%
health effects of global warming
Health effects of global warming
  • Extreme weather
  • Rising sea levels
  • Drought
  • Crop failure
  • Resource conflict
  • Disease
  • Ozone depletion
greenhouse gasses
Greenhouse gasses

Global warming potentials (GWPs)

  • Measure of relative contribution to global warming of a mass of gas to equivalent mass of CO2 (GWP 1)
  • Calculated according to

- (high) absorption of infrared radiation

- (wide) spectral location of absorbing

wavelengths

- (long) atmospheric lifetime

  • Absorption not always linear
slide22
BUT ...

Axelson

so n 2 o is most pollutant but
So N2O is most pollutant, BUT

Greenhouse gasses

6%

Nitrous oxide

20%

Anthropogenic N2O

4%

Specific manufacture

90%

Medicinal N2O

so n 2 o is most pollutant but24
So N2O is most pollutant, BUT

Greenhouse gasses

6%

Nitrous oxide

20%

Anthropogenic N2O

4%

Specific manufacture

90%

  • ... equivalent to approximately
  • 1% atmospheric nitrous
  • 0.07% global warming

Medical N2O

so not much but
So not much, BUT ...
  • Avoidable
  • Secondary health benefits
  • I’ve stopped using it
  • BUT, have to use nasty gasses at higher MAC
  • + more oxygen/air
adapted from charlesworth m how green is your gas anaesthesia news 2009 267 22 23
Adapted from Charlesworth M. How green is your gas? Anaesthesia News 2009; 267: 22-23.
oxygen production
Oxygen production

CO2 cost of liquid oxygen

  • Air liquefaction
  • Cooling
  • Transport

= 0.4g CO2 per litre of oxygen

  • RAFT: Average amount of oxygen used per case is 594 litres = 238g CO2
  • Hip # (GA) = 340 L = 136g CO2
advice
Advice
  • Avoid nitrous oxide
  • Avoid desflurane (+ energy cost of warming)
  • Care prescribing oxygen
  • Active scavenging?
  • Low flow anaesthesia
  • TIVA
low flow anaesthesia
Low flow anaesthesia

Lockwood GG, White DC. Measuring the costs of inhaled anaesthetics. BJA 2001; 87: 559-63.

  • NARKUP
  • Hip#, 50kg, SV, CO 4.5, MV 4.5, FRC 1500ml
slide30
TIVA

Stockholm county council

  • janusinfo.se, pbtprofiler.net
ra v ga
RA v GA

Also cheaper! Hip #

medical waste
Medical waste
  • double/triple/quadruple packaging! Argh!
  • Costs of waste storage set to increase
  • Incinerator £753/tonne
  • Domestic £83/tonne
  • Recycled cardboard, plastic, glass +£17/tonne
some figures
Some figures
  • Europe 1.3 bn tonnes solid waste (3.5t/person)
  • UK 100 million tonnes solid waste
  • 85%  9901 landfill sites
  • Incineration limited by EU Directive
  • NHS waste 408,000t/year (4%)
  • 29% is clinical waste
  • < 10% of total NHS waste is recycled.
hutchins dcj white s coming round to recycling bmj 2009 338 609
Hutchins DCJ, White S. Coming round to recycling. BMJ 2009; 338: 609
  • 2300kg of anaesthetic waste/theatre/year
  • 40% of anaesthetic theatre waste is potentially recyclable
  • 4% of sharps bin waste was appropriate
barriers
Barriers

Social

Logistical

Legal

environment and wastes

health and safety

transport

slide40
6R
  • Responsibility
  • Reduce
  • Reuse
  • Recycle
  • Rethink
  • Research
responsibility
Responsibility

Central

Professional

Personal

travel
Travel

2010 update of NHS Carbon Reduction strategy (NHS SDU)

  • 2004 18.6Mt CO2 (25% public sector, 3% UK)
  • 2007 21 Mt CO2
  • 2008 Climate Change Act

- reduce by 10% 2015 (19Mt!)

- reduce by 80% 2050 (4.2Mt)

raft environmental audit
RAFT environmental audit

Patient + theatre staff + anaesthetists

=

108.7 miles of car usage

=

17.2kg CO2 (+ the rest!)

esa milan 2009
ESA Milan 2009
  • From LGW (BA)=

225kg CO2 (stratosphere)

  • Mean SE UK = 8.8t CO2/person @
  • ie 2.5% of @ production in 0.0006% of a year
  • ie 43 times the usual rate
research
Research
  • Update inhalational work
  • Evaluate inhalational vs TIVA vs regional
  • Life cycle analysis of anaesthetic equipment
  • Evaluate the monetary and environmental cost of recycling equipment
  • Fully calculate the carbon cost of oxygen/air
  • Green alternatives
  • Decontamination and sterilisation
slide49
BUT

1 year Brighton East REC paper audit

  • 68 REC applications + research conduct of successful 55
  • 176,150 sheets of A4 paper

- 879kg, £658, + £2078 PC

  • equivalent national annual estimate

- 11.5m sheets A4

- 88 tonnes

- 2100 trees

top tips
Top tips
  • Don’t use nitrous oxide
  • Use low flow anesthesia
  • Use regional anaesthesia
  • REDUCE, reuse, recycle, responsibility
  • Cycle to work
  • Stay informed
  • Agitate
slide52

igasbest@hotmail.com

stuart.white@bsuh.nhs.uk