Inhaled Anesthetics: Environmental Role, Occupational Risk, and Clinical Use

Mariana Gaya da Costa, Alain F Kalmar, Michel M R F Struys, Mariana Gaya da Costa, Alain F Kalmar, Michel M R F Struys

Abstract

Inhaled anesthetics have been in clinical use for over 150 years and are still commonly used in daily practice. The initial view of inhaled anesthetics as indispensable for general anesthesia has evolved during the years and, currently, its general use has even been questioned. Beyond the traditional risks inherent to any drug in use, inhaled anesthetics are exceptionally strong greenhouse gases (GHG) and may pose considerable occupational risks. This emphasizes the importance of evaluating and considering its use in clinical practices. Despite the overwhelming scientific evidence of worsening climate changes, control measures are very slowly implemented. Therefore, it is the responsibility of all society sectors, including the health sector to maximally decrease GHG emissions where possible. Within the field of anesthesia, the potential to reduce GHG emissions can be briefly summarized as follows: Stop or avoid the use of nitrous oxide (N2O) and desflurane, consider the use of total intravenous or local-regional anesthesia, invest in the development of new technologies to minimize volatile anesthetics consumption, scavenging systems, and destruction of waste gas. The improved and sustained awareness of the medical community regarding the climate impact of inhaled anesthetics is mandatory to bring change in the current practice.

Keywords: climate change; environment; inhaled anesthetics; occupational health; patient risk.

Conflict of interest statement

Michel MRF Struys research group/department received (over the last 3 years) research grants and consultancy fees from The Medicines Company (Parsippany, NJ, USA), Masimo (Irvine, CA, USA), Becton Dickinson (Eysins, Switzerland), Fresenius (Bad Homburg, Germany), Dräger (Lübeck, Germany), Paion (Aachen, Germany), Medtronic (Dublin, Ireland), Medcaptain Europe (Andelst, The Netherlands). He receives royalties on intellectual property from Demed Medical (Temse, Belgium) and the Ghent University (Gent, Belgium), not related to the topic of this article.

Figures

Figure 1
Figure 1
Atmospheric absorption bands. Modified from an image obtained from the Wikimedia website, available under a CC-BY-SA 3.0 license, and included in this review on this basis.
Figure 2
Figure 2
Schematic view of the three different perspectives in choosing an anesthesia technique. Abbreviations: N2O: Nitrous oxide; TIVA: Total intravenous anesthesia; WAG: Waste anesthetic gas.

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