Comparing the environmental impact of anesthetic gases during transanal total mesorectal excision surgery at a tertiary
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CORRESPONDENCE
Comparing the environmental impact of anesthetic gases during transanal total mesorectal excision surgery at a tertiary healthcare centre Antonio Caycedo-Marulanda, MD, MSc Sanjiv Mathur, MD
. Joseph Caswell, PhD .
Received: 8 October 2019 / Revised: 2 November 2019 / Accepted: 4 November 2019 Ó Canadian Anesthesiologists’ Society 2019
To the Editor, The World Health Organization has identified climate change as the greatest threat to global health in this century.1 The Canadian Medical Association policy paper on climate change and human health states ‘‘the global community needs to act together to address the health and environmental impacts of climate change’’.A Volatile anesthetic agents have been identified as strong greenhouse gases.2 Anesthetic gases constitute one of the largest contributors to the carbon footprint of the operating room.3 The sustainable development unit of the National Health Services in the UK recommended that measuring, monitoring, and reporting the carbon dioxide equivalence (CDE) is crucial for reducing emissions of medical activity.B Recently, Hanna and Bryson graphically exemplified the significant differences in CDE among various anesthetic agents.4 We similarly calculated the CDE and kilometers driving equivalence (KmDE) of volatile anesthetics gases delivered during a novel surgical procedure (transanal total mesorectal excision [taTME]) over an 18-month period at Health Sciences North, a tertiary healthcare institution in Sudbury, Ontario.
A. Caycedo-Marulanda, MD, MSc (&) Surgery Department, Health Sciences North, Sudbury, ON, Canada e-mail: [email protected] J. Caswell, PhD ICES North, Sudbury, ON, Canada S. Mathur, MD Department of Anesthesia, Health Sciences North, Sudbury, ON, Canada
The electronic anesthetic records of all taTME procedures between 1 January 2017 to 30 June 2018 were analyzed for volatile concentration, fresh gas flow, and duration of anesthetic gas delivery. Institutional review board approval was obtained to conduct this retrospective study. The CDE was calculated using the Yale Gassing Greener program created by Yale Anesthesiology Media Lab.C The KmDE was calculated using the CDE produced and the assumption of driving a gas-powered vehicle with a fuel consumption of 28 mpg. We compared the CDE and KmDE in taTME procedures using sevoflurane (SEVO) or desflurane (DES). Values were compared using a t test. The time to reach Aldrete score of 9 (which is used to determine when patients can be safely discharged from the postanesthetic care unit [PACU]), the incidence of major perioperative morbidity events, and mortality rate were also compared. Sixty-three procedures were performed during the study period (five patients were excluded because of incomplete records and one because N2O was used). In 38 cases, SEVO was used as the anesthetic gas and the median [interquartile range (IQR)] CDE was 8.4 [7.4] kg of CO2 and the KmDE was 33.1 [29.0] km. Desflurane (DES) was the agent of choice for 19 cases. The median [IQR] CDE produced was 408.6
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