American Society of Regional Anesthesia and Pain Medicine May 2018 - 29
Green Anesthesia Special Interest Group: An Innovative Initiative
"O
ne touch of nature makes the whole world kin." Ulysses
expresses this in Shakespeare's Troilus and Cressida
to indicate that through a shared feeling or goal, we all
become siblings (in a sense of belonging). In contemporary medical
practice, our consideration for nature and the environment is
similarly necessary to make us feel like we belong to society.
The practice of medicine was borne out of compassion toward
those who are suffering and the constant desire to explore, explain,
and address various maladies. Pain and suffering had been a part
of humanity's story until the discovery of analgesic and anesthetic
agents. The development of the specialty of regional anesthesia
and acute pain medicine is a true testament to the human
effort to address the pain and suffering of humanity, leading to
unprecedented improvements in medical and surgical care. For the
first time, previously lethal maladies or afflictions could be easily
cured. Although advancements in medicine have basic tenets in
extending compassion to those in need, sadly, the greater good to
the society and the social responsibility of health care in terms of
environmental impact have been underrecognized.
The World Health Organization (WHO) constitution identifies the
enjoyment of the highest attainable standard of health as one of
the "fundamental rights of every human being without distinction,"1
and our role as physicians is to provide access to health-enabling
conditions. Unfortunately, the uphill task for us in the health
care field, as WHO duly acknowledged, is that climate change is
the greatest threat to global health in the 21st century2 and that
the provision of health care is one of the biggest contributors to
the problem. Recent studies have estimated that health care is
responsible for approximately 4-10% of the total United States
greenhouse gas (GHG) emissions and has increased 30% during the
past decade.3
It is the opinion of this special interest group (SIG) that
anesthesiologists should be on the correct side of this debate
and take measures to decrease the environmental impact of our
practice, hence reducing our indirect burden on health care. The
SIG plans to lead by example and to promote environmentally
friendly practices in anesthesia through education and generation
of evidence. The SIG's focus will be sufficiently broad so as to
encompass the full spectrum of "green anesthesia" and will not
be limited only to the environmental impact of regional anesthesia.
Through the creation of this SIG, we intend to encourage research,
publication, and education across the following fields.
GENERAL ANESTHESIA AND THE ENVIRONMENT
A recent study of operating room (OR) practices in three health
systems by MacNeill et al4 demonstrated how we can minimize
our GHG impact by simply changing to a volatile anesthetic with a
lesser carbon footprint. All inhaled anesthetics are potent GHGs of
varying degrees, and some, like nitrous oxide and isoflurane, also
Rakesh V. Sondekoppam, MD
Assistant Professor
Timur Ozelsel, MD
Associate Clinical Professor
University of Alberta
Edmonton, Alberta, Canada
Vivian Ip, MD
Associate Professor
University of Alberta
Edmonton, Alberta, Canada
Ban Tsui, MD
Professor of Anesthesiology,
Perioperative and Pain Medicine
Stanford Medicine
Stanford, California
"The provision of health care is one
of the biggest contributors to global
climate change. Regional anesthesia
can play a leading role in the
provision of 'Green Anesthesia.'"
destroy the ozone layer. Fortunately, the greenhouse impact of
volatile anesthetics varies greatly, with the least GHG effect coming
from sevoflurane and isoflurane and the maximal effect from
desflurane and nitrous oxide. Hence the adage "short-term gain
for long-term pain" aptly fits when one chooses to use desflurane
or nitrous oxide because they have higher carbon dioxide (CO2)
burdens and longer half-lives (Figure 1).
American Society of Regional Anesthesia and Pain Medicine
2018
29
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