To the Editor
Recently I heard a local news report of a community anesthesiologist who worked within his hospital system to decrease the greenhouse gas effect of the volatile anesthetics used in his practice. The focus on decreasing the environmental impact of anesthetic gases has been published in peer-reviewed articles as well, and I was excited to see the article by Zuegge et al1 in the June 2019 issue of Anesthesia & Analgesia. As noted, in the accompanying editorial,2 climate change is a global threat. It is estimated that in 2014, the equivalent of approximately 3 million tons of carbon dioxide (CO2) was released into the atmosphere from anesthetic gases.3 While this is a small fraction of the approximate total 10 gigatons of CO2 emissions worldwide, any little bit may help when some large world governments refuse to address, or even acknowledge, the issue. The authors should be applauded for undertaking an environmental improvement project that not only decreased the environmental impact of anesthetic gases but also saved money.
The authors noted that the educational program included information to the anesthesia team about fresh gas flows (FGFs), but no data were provided on how FGF changed. Some newer ventilators allow the clinician to set flow digitally, and those flows are recorded and transferred to the electronic anesthesia record. Was the performance improvement intervention able to measure any decrease in FGF for any of the volatiles were used? Could the decrease in desflurane purchasing have been due to lower usage associated with lower FGF, or less usage overall? Sevoflurane use appears to have gone up, and as this volatile is often associated with 2 L/min of FGF, can the authors comment on any possible “increase” in sevoflurane scavenging/pollution due to the higher FGF used with this agent as well as its higher usage, as desflurane usage went down?
There are other ways anesthesia providers can help protect the environment. For example, at my institution, there is a robust recycling program in the operating room (OR), and articles on recycling have made appearances in Anesthesia & Analgesia and A & A Practice. Another crisis on this planet is of plastics. There is an estimated 268,940 tons of plastic floating in the ocean4 with millions more metric tons settling to the ocean floor “each year.”
In light of our specialty’s apparent focus on our own contributions to environmental damage, I was saddened to see yet another issue of Anesthesia & Analgesia show up to my door in a plastic bag. I understand that this wrapping helps to protect the contents within, and in some areas, these bags may be easily recyclable. However, I live in a quite environment-conscious city, and still this type of plastic is not accepted at curbside. Can the editors of Anesthesia & Analgesia please comment on the need for this plastic bag? Abandoning the plastic bag may be another small contribution to overall pollution on Planet Earth, but it would be consistent with the environmental values that seem to be expressed by those in our specialty.
Ryan J. Fink, MD
Department of Anesthesiology and Perioperative Medicine
Oregon Health and Science University
Portland, Oregon, [email protected]
1. Zuegge KL, Bunsen SK, Volz LM, et al. Provider education and vaporizer labeling lead to reduced anesthetic agent purchasing with cost savings and reduced greenhouse gas emissions. Anesth Analg. 2019;128:e97–e99.
2. Sherman JD, Berkow L. Scaling up inhaled anesthetic practice improvement: the role of environmental sustainability metrics. Anesth Analg. 2019;128:1060–1062.
3. Vollmer MK, Rhee TS, Rigby M, et al. Modern inhalation anesthetics: potent greenhouse gases in the global atmosphere. Geophys Res Lett. 2015;42:1606–1611.
4. Eriksen M, Lebreton LC, Carson HS, et al. Plastic pollution in the world’s oceans: more than 5 trillion plastic pieces weighing over 250,000 tons afloat at sea. PLoS One. 2014;9:e111913.