Climate Alarmists: Volatile Anesthetics Must Be Abandoned

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Discuss? Basically some people in academia want to stake their claim and establish their niche on anesthesia and the environment in much the same way that a handful of academics have staked their careers on anesthesia and neurotoxicity.
 
It's definitely in line with all the other political crazies who think air travel should be abolished for everyone except rich liberals.

They need to mind their own business and let me do my job.
 
d9sccr said:
Also, we're talking about some anesthetic gasses being a problem.....anyone pay attention to how much plastic is thrown out every case?
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This is the real issue. When I was in residency I attempted to start a plastic recycling program but found our local companies wouldn’t accept anything that came even close to patients. A ridiculous amount of waste.
 
d9sccr said:
Someone smarter than myself is going to capitalize on this and retire off a product that re-captures those gasses


Also, we're talking about some anesthetic gasses being a problem.....anyone pay attention to how much plastic is thrown out every case?
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We attempted to separate the OR waste at my facility a couple years ago. It was comical how much there was and it became a full time job. Hospitals and their environment are some of the largest producers of waste.
I personally love DES but I will be cutting back.
 
d9sccr said:
Someone smarter than myself is going to capitalize on this and retire off a product that re-captures those gasses


Also, we're talking about some anesthetic gasses being a problem.....anyone pay attention to how much plastic is thrown out every case?
Click to expand...
I'm still wrapping my head out of having to drink something from a disposable plastic cup with a paper straw.
 
jwk said:
I'm still wrapping my head out of having to drink something from a disposable plastic cup with a paper straw.
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Starbucks is virtue signaling on the highest order with this crap. Their new lid design looks like it actually uses more plastic compared w the flat one they had before....maybe as much as a plastic straw
 
I’m pretty sure is joint commissions true goal to destroy the environment by forcing waste onto us. Single use laryngoscope handles, ridiculous. Plastic pieces to go onto the sides of my eyeglasses, insane. I’d love to help limit waste, but using Sevo instead of Des and using low gas flows might be as good as it gets. I’ll continue to oppose the single use handles as long as I can, but eventually I lose that fight as well. I’d like to see some news attention about waste in hospitals and see some positive change.
 
SaltyDog said:
I’m actually proud of the fact that I have no idea WTF this means.
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It's something you say or do in a religious context that indicates you belong to that specific religious group.
 
Waste anesthesia gases rise up to the troposphere, remain nondegraded for extended periods (sevoflurane - 1.1 years, isoflurane - 3.2 years, desflurane - 14 years, and nitrous oxide - 114 years), and tend to trap the earth's radiant heat. (Sherman J, McGain F. Environmental sustainability in anesthesia pollution prevention and patient safety. Adv Anesth. 2016;34:47–61).
 
algosdoc said:
Waste anesthesia gases rise up to the troposphere, remain nondegraded for extended periods (sevoflurane - 1.1 years, isoflurane - 3.2 years, desflurane - 14 years, and nitrous oxide - 114 years), and tend to trap the earth's radiant heat. (Sherman J, McGain F. Environmental sustainability in anesthesia pollution prevention and patient safety. Adv Anesth. 2016;34:47–61).
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This is only what the liberal, lamestream physician scientists believe about halogenated ethers and the atmosphere. Please post the right-wing, conservative physician scientist take on halogenated ethers so I can have a fair and balanced view.
 
vector2 said:
This is only what the liberal, lamestream physician scientists believe about halogenated ethers and the atmosphere. Please post the right-wing, conservative physician scientist take on halogenated ethers so I can have a fair and balanced view.
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The conservative might say that the contribution of the gases is 0.0001% and thus insignificant.
 
Pharmado said:
I’m pretty sure is joint commissions true goal to destroy the environment by forcing waste onto us. Single use laryngoscope handles, ridiculous. Plastic pieces to go onto the sides of my eyeglasses, insane. I’d love to help limit waste, but using Sevo instead of Des and using low gas flows might be as good as it gets. I’ll continue to oppose the single use handles as long as I can, but eventually I lose that fight as well. I’d like to see some news attention about waste in hospitals and see some positive change.
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But the light is so much better. I’m not saying that I do this but the handle is reusable. 😵
I was in a third world country last January and I left my disposable blades and handles with them. They are still using them as of two weeks ago.
 
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SaltyDog said:
I’m actually proud of the fact that I have no idea WTF this means.
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I view it as "I'm better than you, because my morals are better than yours" and the evidence is just them saying so.
 
Regardless of whether you care about this stuff or not, there is no reason to use high flows with the anesthesia machine.

0.5 LPM flows every case, every day, sevo or iso, cost effective and good for the environment, takes no effort at all. I personally like iso for any case that’s longer than a couple hours.
 
jwk said:
I'm still wrapping my head out of having to drink something from a disposable plastic cup with a paper straw.
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It’s marketing. What is there to wrap your head around? Some Madison Avenue firm made a few million for that idea. It actually reminds me of when Nike ran the Colin Kaepernick ad and a bunch of chubby old dudes at work were swearing off wearing Nike stuff ever again...like they were Nike’s core market.
 
d9sccr said:
Starbucks is virtue signaling on the highest order with this crap. Their new lid design looks like it actually uses more plastic compared w the flat one they had before....maybe as much as a plastic straw
Click to expand...


Starbucks is one of the few coffee shops that uses exclusively disposable cups. Most other coffee shops have reusable mugs for customers who consume their beverage in the store. Starbucks cares about the environment so long as they don’t have to wash dishes.
 
nimbus said:
Starbucks is one of the few coffee shops that uses exclusively disposable cups. Most other coffee shops have reusable mugs for customers who consume their beverage in the store. Starbucks cares about the environment so long as they don’t have to wash dishes.
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Starbucks is a company that sells a hot liquid made from burned coffee beans.
Amazingly people line up to buy at premium prices such a low quality product!
 
I relieved a colleague's ASA1 lap chole today.

Des and N2O running at 2L/min. If one of my other colleagues had walked in on that we would've been calling the police.
 
woopedazz said:
I relieved a colleague's ASA1 lap chole today.

Des and N2O running at 2L/min. If one of my other colleagues had walked in on that we would've been calling the police.
Click to expand...

I interviewed for a job in PP awhile ago where the interviews were with MDs in the room while doing cases (all solo MD group). One of the cases was like a vag hyst or something and the physician had the patient on like 8% des at 4L/min (to say nothing of huge tidal volumes and no PEEP). It took everything I had within me not bring it up.
 
cchoukal said:
the physician had the patient on like 8% des at 4L/min
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tenor.gif
 
cchoukal said:
I interviewed for a job in PP awhile ago where the interviews were with MDs in the room while doing cases (all solo MD group). One of the cases was like a vag hyst or something and the physician had the patient on like 8% des at 4L/min (to say nothing of huge tidal volumes and no PEEP). It took everything I had within me not bring it up.
Click to expand...
You would think he'd get worn out refilling the vaporizer.
 
d9sccr said:
Someone smarter than myself is going to capitalize on this and retire off a product that re-captures those gasses
Click to expand...

I was thinking about this today. I agree that is a great idea, but I'm imagining that actually re-capturing them would be technically challenging. Perhaps a more realistic device would be something like a catalytic converter on a car or a scrubber on a power plant that fits onto the scavenger/waste gas side of the machine (or OR exhaust) and chemically converts the volatiles into a more benign non-greenhouse gas before releasing them into the atmosphere.

Who wants to contribute to my Kickstarter?
 
woopedazz said:
I relieved a colleague's ASA1 lap chole today.

Des and N2O running at 2L/min. If one of my other colleagues had walked in on that we would've been calling the police.
Click to expand...
If your surgeons are fast enough do you really need more than a propofol bolus.
 
SaltyDog said:
I was thinking about this today. I agree that is a great idea, but I'm imagining that actually re-capturing them would be technically challenging. Perhaps a more realistic device would be something like a catalytic converter on a car or a scrubber on a power plant that fits onto the scavenger/waste gas side of the machine (or OR exhaust) and chemically converts the volatiles into a more benign non-greenhouse gas before releasing them into the atmosphere.

Who wants to contribute to my Kickstarter?
Click to expand...
This is old news and been done. We have the little charcoal absorber on every machine. They issue is getting a license to reuse the exhaled gas on a new patient. It's not as lucrative as it seems
 
Usually the method for dehalogenating hydrocarbons is catalytic hydrodechlorination using hydrogen gas as a dechlorinating agent. This can be done pretty quickly at lowish temperatures but obviously you need H2 gas which introduces some issues if you want to slap such a device on the back of every anesthesia machine.

An ordinary catalytic converter from your car would work ... assuming you heated it to a few hundred degrees. In your car the exhaust gas provides the heat and the exothermic oxidative reactions to convert CO and NOx species and partially burned hydrocarbons to CO2 and N2. There isn't really anything special about similar platinum/palladium/rhodium catalysts burning chlorinated and fluorinated hydrocarbons. The temperature required is going to be the dealkiller for a per-machine solution. If you wanted to plumb a hospital with a second vacuum scavenging system for just anesthesia machines, it could probably be done reasonably efficiently with one big catalytic converter elsewhere in the hospital.

Of course, TIVA'ing everyone is probably the answer if you care that much.
 
Newtwo said:
This is old news and been done. We have the little charcoal absorber on every machine. They issue is getting a license to reuse the exhaled gas on a new patient. It's not as lucrative as it seems
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He's talking about something completely different. An activated charcoal absorber used to de-volatilize a machine to prep it for a MH susceptible patient is something else entirely. It's not a solution for preventing the release of waste volatiles into the environment. The stuff has to be burned in an incinerator or differently-burned in a catalytic converter to get rid of it on a bulk scale.

Edit - If you really are using charcoal absorbers on every machine instead of waste gas vacuum scavenging, you're just making the environmental problem worse. The saturated absorbers will eventually make their way to a landfill where the gas will eventually be released anyway.
 
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I'm not in the equipment side of the house discussions but yes I believe all 90 odd ors in my hospital group have a charcoal scavenger, nothing to do with MH. Purpose is to recycle volatiles
 
FYI, in the late 1980's/early 90's 4 liter gas flows were the norm. In the mid 1990s many/most began to shift to 2 liter flows as the norm (SEVO was just released). These days it is rare to see more than 2 liters of flow especially with Desflurane. Old habits die hard and for some they never die at all.
 
BLADEMDA said:
FYI, in the late 1980's/early 90's 4 liter gas flows were the norm. In the mid 1990s many/most began to shift to 2 liter flows as the norm (SEVO was just released). These days it is rare to see more than 2 liters of flow especially with Desflurane. Old habits die hard and for some they never die at all.
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As a current resident, it baffles me why anyone would run anything more than the minimum required for flows (0.5 - 1 LPM), I suppose it’s just habit.
 
dipriMAN said:
As a current resident, it baffles me why anyone would run anything more than the minimum required for flows (0.5 - 1 LPM), I suppose it’s just habit.
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Speed? Higher FGF gives faster wash in, wash out, and achievement of steady state. Try a mask induction with low vs high FGF.
 
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nimbus said:
Speed? Higher FGF gives faster wash in, wash out, and achievement of steady state. Try a mask induction with low vs high FGF.
Click to expand...
I imagine (s)he is referring to during maintenance period.
 
nimbus said:
Speed? Higher FGF gives faster wash in, wash out, and achievement of steady state. Try a mask induction with low vs high FGF.
Click to expand...
That only applies with low concentration at high flow, like 6% at 3L.

Increase the concentration to 18%, and you can run 1L but same speed as above.

Of course 18% is the max on Des, but Sevo lets you have a 4x difference.


Wash in is determined by how many molecules of agent are in stream, free gas flow is only a partial determinant of that.
 
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