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
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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.
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‘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.
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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.
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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.
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.
“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
greens have no sense of scale…………
Great, well Alarmists can show their conviction and dedication to the cause
by having operations using only local anaesthesia
Ban beans. They lead to climate-destroying gasses.
Jeezussss H. Keeeeeeerist, is there anything we’re not too stupid to swallow nowadays?
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…..
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.
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.
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
Still? I thought nitrous oxide was phased out of food products decades ago.
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.
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.
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.
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.?
The paper has ‘Idiots’ writ large over it.
…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.
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.
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.
330.000 gallons of gasoline out of the total USA consumption of 142,170,000,000 gallons makes 0,000232%
Contributing to Climate Change, which is not actually occurring.
Keep this in mind folks: someone was actually paid to produce this. Mind boggling.
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.
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.
Articles such as this confirms brain rot is a deadly disease infecting CC pushers everywhere.