Claim: Surgical General Anaesthetic is Contributing to Climate Change

Hospital for Special Surgery
Hospital for Special Surgery. By Ajay Suresh from New York, NY, USA – Hospital for Special Surgery, CC BY 2.0, Link

Guest essay by Eric Worrall

The Hospital for Special Surgery in New York is apparently cutting back on use of general anaesthesia for hip and knee replacement surgery, to minimise the impact of surgical procedures on global warming.

Gases used to knock patients out before they go under the knife are ‘fuelling climate change’ and should be replaced with ‘regional’ anaesthetics, scientists claim

By JONATHAN CHADWICK FOR MAILONLINE 

PUBLISHED: 08:30 AEST, 17 June 2020 | UPDATED: 08:30 AEST, 17 June 2020

Switching from general to regional anaesthetics may help cut greenhouse emissions and ultimately help reduce global warming, a new study claims.  

While regional anaesthetics numb a certain part of the body, general anaesthetics make patients totally unconscious for what tend to be more serious procedures. 

But unlike regional anaesthetics, generals use volatile and environmentally-unfriendly halogenated agents, such as desflurane, or nitrous oxide. 

‘Following general anesthetics, volatile halogenated agents and nitrous oxide are exhaled by the patient and are also often scavenged from the operating room and released into the atmosphere,’ the research team say in Regional Anesthesia & Pain Medicine

‘Very little – less than 5 per cent – of the volatile halogenated gases used during general anesthesia is metabolised by the patient.

‘The remainder is eventually vented into the atmosphere, and although each volatile gas used in anesthesia does differ in its global warming potential, all have some contribution to climate change. 

The Hospital for Special Surgery in New York therefore opted to carry out as many hip and knee replacements as possible using regional anaesthesia in 2019. 

Read more: https://www.dailymail.co.uk/sciencetech/article-8427763/General-anaesthetics-fuel-climate-change-scientists-warn.html

The abstract of the study;

‘Green-gional’ anesthesia: the non-polluting benefits of regional anesthesia to decrease greenhouse gases and attenuate climate change

Mausam Kuvadia, Cynthia Eden Cummis, Gregory Liguori and Christopher L Wu

Volatile halogenated gases and nitrous oxide used as part of a balanced general anesthetic may contribute to global warming. By avoiding volatile inhalational agent use, regional anesthesia may reduce greenhouse gas emissions and help prevent global warming. We present a theoretical calculation of the potential benefits and a real-life example of how much regional anesthesia may reduce greenhouse gas emissions.

Read more: https://rapm.bmj.com/content/early/2020/05/06/rapm-2020-101452

I’m a bit uncomfortable with the idea of climate change being used as a criterion for patient care decisions. Doctors should focus on what is best for the patient, not on what they think the weather will be like a hundred years from now.

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81 thoughts on “Claim: Surgical General Anaesthetic is Contributing to Climate Change

  1. ‘unlike regional anaesthetics, generals use volatile and environmentally-unfriendly halogenated agents, such as desflurane, or nitrous oxide. ‘
    saved by a comma?

    • Let’s just go back to Napoleonic times when you got a few swigs of whiskey and bit on a bullet when they amputated your leg. Much more “environmentally friendly”.

    • Try that on me, and I promise these wingnuts I will puke right in their faces. They should get it first. I won’t clean up after them, either.

      Hip joint replacement with a regional anesthetic? I can envision a lot of stomach contents on the floor of the OR. Let’s just go back to the mid-19th century, when a bottle of whiskey was about all the anesthetic a patient got, if that.

      Just curious: are they going to also demand that we ingest mold instead of penicillin or any of its derivatives? Should we just skip vaccinations and go to epidemics and plagues again? I mean, why not? If it takes those bozos out first, and the rest of us just watch, I’m all for it. /sarc

  2. Nitrous oxide is also used in dental work, obstetrics and for analgesia for minor injury manipulation; the reason being it is quickly cleared from the body once the mask is removed from the face. Halane is used for deeper anaesthesia. The alternatives, ether and chloroform are dangerous for the patient and may also be “green house gases”.
    We are being dragged back to pre industrial times with low CO2 and amputations being undertaken in 10 seconds without anaesthesia depending on alcohol to dull the pain.

    • Nitrous oxide is also used as the pressurant/propellant for expelling “whipped” dairy cream from those convenient flex-nozzle canisters sold in grocery stores . . . soon to be disappearing in order to save planet Earth.

      • gotta be THE dumbest product anyway
        real cream whips fast and its not hard to pipe if you really have to
        can stuff is additive central and a waste of money
        and?
        no one gets to lick the bowl or spoon;-(

        • And most importantly! When I whip my own cream … I get to control the amount of sugar added to the cream (I like a very light touch of sugar … very light). I always whip my own. No cans, plastic packaging and whatnot.

    • they were on about this years ago
      bloody idiocy because mst adult surgery is done with injectable anaesthesia
      why?
      because they dont like to talk about it but theres hefty later risks apparently, carcinogen etc
      oddly they still use inhalables for kids..
      and a curious factoid?
      it appears that quite a lot of A FIB cases apear within a month or 3 of surgery
      mine hit me almost exactly 4 weeks after surgery, and it took a year o r more browsing medical pages on afib to find it out. unfunnier still is to try n get some ease from afib?
      surgery and ablation;-/
      result for me was lessened events but not “cured”
      so upshot would be if at all possible but NOT for goofball climate reasons local injectables arent a bad way to go as an option.

    • The quantities of N2O cannot be anything else than negligible in view of total emissions, even in view of the CO2 emissions of the very patient during his hospitalization, N20 in the atmosphere is mainly a decay product of fertilizers plant decay caprolactam (nylon) production nitrous acid plants etc. It is not specifically to be made for medical purposes. I recon just captured before emission and maybe purified. As for the halogenated agents, the quantity should be equally negligible considering that in the 80-ies more than 1 kilogram of the stuff per capita per annum was sprayed. I think there are other areas where emissions can be cut more easily and more efficiently.

  3. This is evidence of the beginning of the end of climate scare combinations or the NY virus has mutated again.

  4. Yes, let’s stop single use plastics in medicine while we’re at it. There just seems to be no end of stupid gets klimate funding and publication.
    No, let’s not base patient care on climate- at the very least until we could actually have an adult conversation about climate and admit that models are currently vastly over rated and biased to AGW, and they could begin to hindcast climate change. Oh and that AGW is a political invention and we need to move on to reality.
    I’ll hold my breath for that level of adult dialogue (sarc).

  5. Building pictures was where Jason Bourne jumped into river in ‘The Bourne Ultimatum’ 2007.

  6. The current advise in the UK, Knee replacement surgery is usually performed either under general anaesthetic (you’re asleep throughout the procedure) or under spinal anaesthetic or epidural (you’re awake but have no feeling from the waist down). No mention of local anaesthetic I surpose it’s down to a patient’s individual needs.

    I had major surgery in 2019 I had epidural but was out completely, the benefit of general anaesthetic is pain can be controlled after the op ,in my case 5 days.

    Another climate issue in medicine is inhalers, they have become increasingly powders rather than using a propellant, I have complained many a time that because you cant inhale as well as you used too ,your not getting the full dose, the last time was 2 weeks ago, I had a phone consultation, were the doctor changed the prescription to a propellant inhaler, picked the prescription up Monday I did have a new inhaler but it was still a powder one. The doctor in the consultation assured me it would be a propellant type, lied to again in the name of the climate.

  7. Eventually the climate sensitivity of carbon dioxide will be found to be zero, or indistinguishable from zero. The sooner the better. Then the global warming potential – calculated as a multiple of that for carbon dioxide – of all the other greenhouse gases must also be zero.

    To illustrate the point, consider the graph at this link, in which I plot the “vertical integral of total energy,” expressed as Watt-hours, at a single gridpoint near where I live. This is from the reanalysis product ERA5 from the ECMWF, for every hour of 2019. The doubling of CO2 from preindustrial times is commonly accepted to have a static warming effect of 3.7 W/m^2, or 3.7 Watt-hours per hour per m^2. That is vanishingly thin on the vertical scale, and the magnitude of the rapid changes in both directions tells me that any effect of rising CO2 concentrations would be undetectable. Energy is easily transformed from latent heat to kinetic energy to potential energy to sensible heat and back again, so it is simply bonkers (a technical term) to claim that carbon dioxide has been found to be the cause of a trend or to claim that it can be modeled so as to project a future trend.

    https://www.dropbox.com/s/djnzrpfjo5raysv/ERA5_Wh_vitote_1hr_42.5N_73.5W_2019.jpeg?dl=0

  8. An important new paper by Richard Lindzen igonored on WUWT.
    WUWT?

    https://link.springer.com/article/10.1140/epjp/s13360-020-00471-z

    It would at least be a break from the endless recycled moronic mind-rotting media agitprop.
    It’s a drip-feed of Kafka-esque corrosive nonsense that’s designed to psycologically destabilise right-thinking citizens, and recycling it helps in that process.

    Realise that they are only screwing with your mind and just laugh it off.

  9. The Khmer-Vert Luddites are aiming for another pillar of the industrial scientific revolution – anaesthesia.
    For them the agenda is back to the jungle. Human population back to <100 million, life expectancy back to 20.

    • Oh, our leaders will still have access to the blessings of technology, don’t you worry.

  10. When a Green has to be under the knife, why not a strong punch on the chin, may be two if the first wasn’t strong enough, and go on.
    To discuss anaesthetics because of “climate change” asks just such a solution for such morons.
    SCNR 😀

  11. The surgeons could go back to just hitting the patient on the head with a mallet or getting them stinking drunk. That would really save on harmful gases, would it not? Possibly patient care and survival would suffer, but do we care about such mundane matters any more, in the Age of Stupid?

  12. From the article: “Switching from general to regional anaesthetics may help cut greenhouse emissions and ultimately help reduce global warming, a new study claims.”

    How absurd! It just keeps getting crazier and crazier. Alarmists have lost their minds.

  13. Surely we must be reaching the point where even the dumbest, most gullible greenie will say:

    “Wait a minute.. that just can’t be true..”

  14. Wow! We used lots of nitrous oxide over the years for in office sedation. That was before global warming (back in the 80’s and early 90’s) /sarc. Also we used Versed and fentanyl for IV sedation. Lots of addicts now(just kidding). All GA’s done in a surgicenter of hospital. Lots of gas passed. Anesthiology is 99% boredom and 1% panic as my anesthesiologist used to joke. A joke just like this article.

  15. Well, parakeets also breathe out CO2, so maybe if we kill all the parakeets, people that need knee surgeries can have them without resorting to booze and leather to endure the pain…

  16. Are there any surgeons on this list care to comment?

    I was under the impression that general anesthesia was done using only drugs supplied intra-venously these days. But then medicine is not my area of expertise, so what do I know? What’s the real answer?

    • Ding ding doing! When my wife had a c-section four years ago, I sat next to her and the anesthesiologist sat on the other side of her. He had a syringe s rewed into the IV line and was slowly (as in, another mL every few minutes) injecting her with it. The days of teasing the anesthesiologist as a “gas passer” appear to be over.

      • correct as I wrote above
        IV can also be reversed fast if needed too
        inhaleds not so much
        I travel a lot further to a vet who uses IV when my local young lasses insist on inhaleds for every procedure they do
        also a HUGE cost icrese in inhaled over IV
        so Id say that would be the BIGGIE for the hosp
        saying green
        but meaning greenbacks

  17. This is a very useful paper. I now know where NOT to go for surgery. I wouldn’t let anyone who puts the “environment” ahead of patient comfort and safety get near me with any sharp implement, not even a nose-hair-trimmer.

  18. Since I had both knees replaced 5 years ago I’m for the old bite the bullet because the infinitesimal amount of some gas being released that will break down in no time out weights the pain caused by not being properly sedated. Just when I don’t think these people can get any stupider they go and prove me wrong.

  19. How do they create the anaesthesia gases?
    Do they take greenhouse gases out of the air to make them?
    Are there natural processes to use or decompose them to something less harmful?
    How much gas are we talking about? Parts per million, billion or trillion in total atmosphere?
    Does 1 part per billion or less really matter?

    A small change in anaesthesia could be the difference between a fast and safe operation compared to patient distress and moving due to insufficient anaesthesia.

  20. “Gases used to knock patients out before they go under the knife are fuelling climate change”

    It just keeps getting weirder and weirder and more and more different professions want to play.

    Speaking of weird, there are a some strange but srangely credible alternative theories proposed for global warming. What makes them more credible is that they explain the whole of the Holocene, not just the post LIA warming. The one I studied is the so called tidal cycle. It shows a millennial scale pattern that looks a lot like the Holocene.

    What the Holocene looks like
    https://tambonthongchai.com/2019/06/11/chaoticholocene/

    What the tidal cycle theory says about that
    https://tambonthongchai.com/2018/08/05/tidalcyclesbiblio/ pp

  21. Great, well Alarmists can show their conviction and dedication to the cause
    by having operations using only local anaesthesia

  22. Jeezussss H. Keeeeeeerist, is there anything we’re not too stupid to swallow nowadays?

  23. Has the Hospital for Special Surgery thought to capture the exhausted gases from the A/C system and reusing them for future procedures? Isn’t that in line with service (gas) stations capturing vapour so it doesn’t go into the atmosphere? Imagine the savings on manufacturing new gases! Lefties don’t do maths or economics…..

  24. I have had 2 hernia repair surgeries to date. One was under general anesthesia a few years back, in which I was ‘out’ for the entire procedure. The more recent one, just 3 weeks ago, was initially general anesthesia, to apply extensive local numbing via injected lidocaine, after which I was brought back to consciousness for the remainder of the surgery. From a pain management perspective, they were basically equivalent in effectiveness, during and after the surgeries. Neither required more than simple acetaminophen for post op pain management.

    I will say that the 2nd one was entirely more entertaining, however! As the docs were working on me, they were talking among themselves, partly comparative training and partly telling jokes. As I was aware, I offered a joke or two of my own. “Did you hear about the cannibal that passed his mother-in-law in the woods?” cracked them up! I was asking them for a bit of description of what they were doing when one asked me “Do you want to see what it looks like right now?” I said “Sure!” One of them snapped a picture of the open incision with a camera and lifted the shroud over my head so I could view the display. Very interesting perspective, as the fellow described the visible features to me! I did feel a couple of needle ‘sticks’, as the docs were adding more lidocaine locally during the surgery, but nothing I would call painful. After returning home that afternoon from the surgery, it took about 5 hours post op for all of the local numbing to wear off.

    I don’t give a crap about any presumed effects on ‘climate change’, but from my limited experience, both methods were effective from a pain management and successful surgery perspective.

  25. I’ve had both hips replaced, one 10 years ago and one last year. An epidural was used in both cases. I was very lightly sedated for the first one so was awake for the whole procedure. The second one they sedated me so I slept through the procedure. The reason they told me was it is easier on the patient’s lungs and there is no need to intibate as you breath on your own. Less chance of infection that way. It’s got absolutely nothing to do with protecting the climate.

  26. I think this is something the climate virtuous/insane should have the chance to select.
    Show us their commitment
    I’ll take the general

    So much stupid in this world

  27. Hospital original post alludes to is for “special surgery” that use anesthesia for orthopedic surgery. Full knock out anaesthesia is still going to be used when surgery is agressively invasive, like for cancer I had cut out with attendant fiddling around inside involved.

  28. I hadn’t realised how behind times the American anaesthetists are. I stopped using nitrous oxide probably 3 decades ago, nobody uses halothane anymore because of some of its side effects and solubility – there are better volatile agents, and more importantly total intravenous anaesthesia without any volatile agents has a lower incidence of nausea and vomiting, the patients wake up more rapidly and feel just so much better. A combination of regional anaesthesia with sedation has been used since the beginning of anaesthesia while the techniques and drugs available have improved immensely. This also allows for the use of local anaesthetic agents and/or analgesics post operatively for excellent pain control. There are few indications for volatile general anaesthesia. Nitrous oxide and all the volatile agents are greenhouse gasses but how much effect they have on the atmosphere is debatable.

  29. As if they could not say something even more stupid than the last thing. I had general anesthetic twice in the past 10 days. Once for a TEE and the second time for a mitral valve repair. Both times it was a liquid via IV. The only gas that I had in 4 days of post op was O2.

    These people have lost it.

  30. Am I really the only one on this site to notice that this reported premise is utterly innumerate. Just how much of the exhaled anesthetic gasses reach a sensitive atmospheric locus and what will they adversely do there as long as they themselves survive decomposition? And then of course what is so far only vaguely intimated by handwaving implication, what is the ultimate contribution to global average temperature (routinely presumed to reflect an inexorable elevation in the daily highs that is nowhere in evidence) by the end of this century, in oh let’s say ten-thousands of a degree C.?

  31. …just had an idea for my new international climate scientific consensus article…….. for the Guardian…

    …just have to start up my new super duper computer™…. tap, tap, tap…the average person produces about a half a liter of flatus (farts) per day, containing around 10-30% CO²……tap, tap, tap…..and 10% methane….tap, tap, tap……earth population 7.8 billion……….. PRESS ENTER…..

    OMG!!!! IT’S WORSE THAN WE THOUGHT!!!

    • Someone beat me to it…..

      “World has six months to avert climate crisis”, says energy expert Fatih Birol in the Guardian.

      Blimey that escalated quick, what happened to 2030?

      • They keep saying that kind of thing – 18 months, now 6. Maybe by August it’ll be 3. The question this keeps raising is, WHAT IN HELL DO YOU WANT US TO DO ABOUT IT?

        And they never say. Not once. No “buy a Tesla” or “turn down your furnace/AC,” all those things so many of us are already doing just as a matter of common-sense frugality. They keep adding carbon taxes and plopping windmills all over, but apparently that must not doing the job. And still they say nothing about their plans for us. And WTF, aren’t we already in a “climate crisis” or even a “climate emergency”?

        What exactly is it we’ll avert if we do the things they haven’t yet described? Temperatures that won’t be happy temperatures 100 years from now? Or 50? More hurricanes, tornadoes, floods, droughts, fires? But everyone paying attention already knows those things aren’t increasing, so what should we expect? No answer.

        Here’s my answer: find real jobs that produce things of actual value, you lazy stupid bastards. Stop imagining that “adding to the fund of human knowledge” with your idiotic pointless blue-sky doomsday guesswork is worth the time of any human being with anything resembling a work ethic or a moral compass. Stop being parasites.

        In the absence of any transparency about your intentions, I’m also going to assume this is all leading to something Draconian, as do many others, and trust me: you’re tickling the dragon’s tail.

  32. It is worse than we thought
    gas scavenging pumps (centrifugal) run 24/7 in hospitals to pull waste anaesthetic gasses out of the operating environment, those pumps run HOT all the time, adding EVEN FURTHER to climate change. and the spare pump on the wall next to it just in case took a LOT OF ENERGY to make just to have it sit on a wall and (generally) not get used.
    on a more serious note ; the gaseous asthma inhalers have been a target for output reduction/ gas change for years and is built into a lot of NHS sustainability reports

    • on a more serious note ; the gaseous asthma inhalers have been a target for output reduction/ gas change for years and is built into a lot of NHS sustainability reports”

      So the end user suffers, on a sliding scale ,dependent on how much they can inhale , these powder inhalers are metered, for one month 60 shots that’s one puff twice a day , if you dont get enough of the metered dose,you either have to take another puff,which makes you short of medication by the end of the month,or you supplement by taking your rescuer more than you would otherwise have too,which is also not long lasting .

      Preventers are by there name necessary to prevent, be it asthma or COPD they are not fit for purpose if they only partially reach were the medication is needed, causing the patient discomfort and needing to take increased amounts of rescuer medication, which has cost implications for the patient and health implications ie more steroids ,

      Rescuers are forced by a propellant cfc free . Hfa 134a they get the job done in seconds,were as preventers only work partially at best , the whole idea of the propellant is to get the medication were its needed.

  33. As a retired UK consultant anaesthetist, I can assure you that this nonsense is not new. A generation ago, it was the effect of N2O and volatile halogenated anaesthetic agents on the ozone layer, now it’s global warming. Both claims are nonsensical, the amounts released are infinitesimal compared with natural emissions of methane and oxides of nitrogen.
    The problem is the pressure on trainees and academics to get published and the need for low interest, low impact journals to attract manuscripts and fill their pages. Hence the extraordinary number of “reviews”, “meta-analyses” and “audits” rather than proper research which takes time, effort and money.

  34. 330.000 gallons of gasoline out of the total USA consumption of 142,170,000,000 gallons makes 0,000232%

  35. One big blow by a volcano will put out more toxic gases than hospitals ever dreamed of. Maybe we need to put blankets over all the volcanoes of the world to stop this.

  36. Anaesthesia has come a very long way since the 1840’s. During the 19th C, hospital and individual surgeon’s records show that no one considered it necessary for all patients, and it was reserved for those with ‘high sensibility’ – women, educated men, sometimes children. During the Civil War, the surgeon general stated it was not necessary for soldiers who by their training did not need it. We now know that the huge stress response to amputation without anaesthesia contributes to the death rate. Anaesthesia in the mid-20th C is unrecognisable now – at least in the developed world. Noe only is it safer by nearly an order of magnitude, the focus on reducing stress leads to less secretion in lungs and lower rates of postoperative pneumonias.

    There is evidence that regional anaesthesia (from spinal/epidural blocks to blocks of regional nerve plexes) reduces the stress response by blocking neuronal afferents from the wound for surgeries for which it is possible. Its use for cesareans allows the couple to be present at the birth, but having the patient present in other types of surgery is still problematic, because it limits verbal communication in the surgical team – gone are the days when anyone in medicine would risk a dirty joke in front of the patient – indeed, even medical personnel are so sensitive that a ‘sexist’ remarks by anyone in an OR produces repremands. In addition, a large fraction of the population would rather not participate: they want it all wrapped up without knowing. There have also, over the past 20 years, been major changes in the pharmacological side of general anaesthesia that reduce stress and reduce the 3 day ‘hangover’ that used to follow general anaesthesia.

    It is hard for me to believe that the silly post about GG’s from anaesthesia was written by anaesthesiologists. As a group, they are one of the few specialities that actually know pharmacokinetics and gass pressures. Surely they can compute the total ppm of gaseous anaesthetics in relation to the atmosphere.

    PS. Nitrous oxide will always be great for those situations where pain is very severe – ie, pain completely blocks any attempt to communicate with or elicit cooperation from the patient – even if only to get an iv line in without having to use physical restraints. Its use is very limited now because scrubbing expired air is required in many jurisdictions.

  37. Articles such as this confirms brain rot is a deadly disease infecting CC pushers everywhere.

  38. I had arthroscopic surgery at HSS a few years ago and asked for local anesthesia so that I could watch the surgery instead of being knocked out. I had to convince the team I would not freak out if I were awake. I guess next time I won’t have to convince anyone of anything.

  39. From 2011

    Anesthetic agents used today are volatile halogenated ethers and the common carrier gas nitrous oxide known to be aggressive GHGs. With less than 5% of the total delivered halogenated anesthetic being metabolized by the patient, the vast majority of the anesthetic is routinely vented to the atmosphere through the operating room scavenging system. The global warming potential (GWP) of a halogenated anesthetic is up to 2,000 times greater than CO2.

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4173371/

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