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.
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.
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/