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When we think about the frontline battles against climate change, operating rooms are seldom on the list. Yet, a lesser-known but significant contributor lurks within the medical practices we rely on for safety and healing: anesthetic gases. Anesthesia, critical for performing pain-free surgeries, has a hidden environmental cost that is drawing increasing concern among environmental scientists and healthcare professionals alike.



Anesthesia is an indispensable part of surgical procedures, rendering patients unconscious and insensitive to pain. It's administered in two main forms: inhalational, which includes gases and volatile liquids, and intravenous. The inhalational anesthetics, such as nitrous oxide, isoflurane, sevoflurane, and desflurane, are particularly potent as greenhouse gases (GHGs).


Unveiling the Environmental Impact


The environmental impact of these gases is alarming. For instance, desflurane, one of the most commonly used anesthetic gases, has a global warming potential (GWP) 2,500 times greater than carbon dioxide over a 100-year period. Nitrous oxide, another commonly used gas, not only has a GWP 298 times that of CO2 but also contributes to the depletion of the ozone layer. These gases escape into the atmosphere primarily through exhalation by patients and are vented out of facilities, mostly unchanged.



A typical mid-size hospital's use of desflurane, for example, contributes as much to climate change as the CO2 emissions from 1,200 cars annually. When we consider that millions of surgeries occur globally each year, the scale of these emissions becomes staggering.


Not only the ‘E’ aspect, the social implications, particularly on healthcare worker safety, are equally critical yet less discussed. In the United States alone, it's estimated that over 250,000 healthcare professionals are at risk of exposure to waste anesthetic gases (WAGs), with N2O being a primary component. These exposures not only threaten worker health but also reflect broader systemic issues within healthcare facilities related to workplace safety standards and environmental health practices.


Current Practices and Their Limitations


Current medical practices often prioritize efficacy and patient safety over environmental concerns, leading to the prevalent use of these high-GWP anesthetic gases. The Royal Brisbane and Women’s Hospital (RBWH) serves as a compelling example of how targeted efforts can significantly reduce the use of these gases. Over a five-year period, the hospital managed to reduce its use of desflurane by over 95%, cutting down its overall anesthetic gas emissions by approximately 88%. These efforts also resulted in a significant cost reduction, underscoring the financial benefits of sustainable practices. While safety should never be compromised, the environmental costs of such practices are now urging a reevaluation.


Exploring Sustainable Alternatives


Fortunately, there are sustainable alternatives and strategies that can minimize the environmental footprint of anesthetic practices:


1. Low-flow Anesthesia Techniques: By minimizing the flow rates of anesthetic gases, we can significantly reduce the quantity required for each surgery, thereby decreasing the emissions.

  

2. Anesthetic Gas Capture and Destruction: Emerging technologies are focusing on capturing these gases from patients' exhalation and either recycling them or safely destroying them. This technology, while still in developmental stages, promises a reduction in emissions.


3. Opting for Less Polluting Agents: Anesthesiologists can choose anesthetics with a lower GWP, such as isoflurane over desflurane, where clinically appropriate. Additionally, using intravenous anesthetics like propofol, which have no known environmental impact, can be an alternative in suitable cases.


4. Regulatory Actions and Guidelines: Healthcare systems and governments can develop and implement guidelines that promote the use of environmentally friendly anesthetic practices. Some countries have begun to recognize and address this issue through national health system policies.


The Role of Investment in Sustainable Healthcare


The transition to greener anesthetic practices also presents a unique opportunity for investors. By funding companies that are pioneering low-impact anesthetics or developing capture and recycling technologies, investors not only foster innovation in healthcare but also contribute to the broader goals of environmental sustainability. The growth potential for green technology in healthcare is substantial, as more facilities seek to reduce their carbon footprints.


In conclusion, while anesthetic gases play a crucial role in modern medicine, their environmental impact cannot be overlooked. By adopting new technologies, practices, and policies, we can mitigate their effects and help lead the way towards a more sustainable future in healthcare. Let us champion the cause where every breath taken in healing does not have to cost us the earth.


Reference:

Sherman, J., Le, C., Lamers, V., & Eckelman, M. (2012). Life cycle greenhouse gas emissions of anesthetic drugs. Anesthesia & Analgesia, 114(5), 1086-1090.

 

Gadani, H., & Vyas, A. (2011). Anesthetic gases and global warming: Potentials, prevention and future of anesthesia. Anesthesia Essays and Researches, 5(1), 5-10.

 

Alexander, R., Poznikoff, A., & Malherbe, S. (2018). Greenhouse gases: the choice of volatile anesthetic does matter. Canadian Journal of Anesthesia/Journal canadien d'anesthésie, 65, 221-222.


Author: Ms. Christine Huang, ESG Research Assistant of ICSD

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