Sustainability for anaesthetists – from everyday practice to the big picture webinar

This webinar will move from low carbon anaesthetic techniques and carbon calculators through QI recipes and building networks to the impact of global supply chains and COP26 in Glasgow next year.

Dr Tom Pierce - Capturing our carbon footprint presentation

You can also access environmentally sustainable anaesthetic practice e-learning here.

FAQ's

How should we safely dispose of waste propofol – I’ve heard it’s toxic to aquatic life?

The effects of anaesthetic drugs and their metabolites on the marine environment is unknown but unlikely to be positive. Hospital wastewater and sewage systems do not undergo any special treatment before joining the municipal sewage system. Drugs and their metabolites can enter the aquatic environment if disposed of into the sink or sluice. All unused drugs must be disposed of into the appropriate containers for incineration (eLfH module - Waste).

7.6% CO2e from NHSE is electricity supply - switch to totally renewable generation would cost 0.4% extra. Is this a public health win-win?

Yes - all NHS organisations should move to purchasing 100% renewable electricity from their energy suppliers by April 2021 (NHS Operational Planning and Contracting Guidance 2020/21, p19).

Newcastle stepped up to the fellowship as they had an interest in sustainability. But surely there are larger gains in other trusts currently ignoring sustainability?

Ignoring sustainability is no longer an option with the NHS Net Zero report clearly mandating a board-level net zero lead. Engaged and informed employees can press for action. There is however a need for our regulator to include sustainability in it's 2021 inspection strategy to ensure even intransigent boards engage with the agenda.

We are drowning in single use PPE at the moment. Is there any hope for a better option than a plastic apron? We’re using 1000s a day. I loved the GOSH plastic glove campaign but we are using masses of them now. How can we reduce stuff and waste in Covid t

Dr Chantelle Rizan has undertaken a study looking at the environmental impact of our PPE use during the first 6 months of COVID-19 (link to article here). Where aprons are truly necessary the biggest thing we can do to reduce the impact is to use those manufactured in the UK, or shipped (rather than air-freighted).

Where can we make most energy savings in theatres?

Scavenging systems uses a lot of electricity but is usually left running for 24 hours rather than just the time the theatre is used. Engage with ODP colleagues to see if they can be switched off at the end of the day and switched on again in the morning.

Use natural light if the theatre has windows – leave the blinds up unless low light is needed for the surgical procedure. LED lights are low energy and will pay for themselves very quickly.

Is there any College guidance on single use equipment such as laryngoscopes and Waters circuits?

Guidance from the College would have to take into account all guidance from other bodies such as PHE and MHRA as well as relevant legislation. This paper may help build your case for reusable laryngoscopes (link to paper is here).

Certain types of surgery have a bigger carbon footprint. Which are the worst?

The types of operations with the highest carbon footprint are likely to be those which use the most consumables (such as those using robotics, orthopaedics, cardiothoracic surgery). By volume the biggest culprits will of course be those which are most common in the UK (and hence good ones to tackle). These are lap chole, inguinal hernia repair, knee replacement, carpal tunnel decompression and tonsillectomy.

If we still use volatiles, how can we minimise the carbon impact?

Use low flow circle systems. Some modern machines have end tidal control software systems and there is some evidence that this is better - see the paper by NICE here.

Anaesthetic gas capture and reuse is mentioned as something we should be doing in the NHS Net Zero report but is still quite limited in availability. They can capture 60-70% of volatile used.

Is TIVA really better than volatile with all the disposables?

We don’t know for sure. A common method used within environmental accounting is life cycle assessment (LCA), which measures multiple elements of the environmental impact, which may include, for example, marine ecotoxicity and marine eutrophication. However, the direct impact from plastic accumulation is not adequately captured, and methods are currently being developed to address this. Pharma companies have not been forthcoming in sharing LCA data on the manufacture of anaesthetic drugs such as propofol. Volatiles and nitrous oxide have such a big impact that we believe TIVA is better. Dr Jodi Sherman is a lead researcher in this field and has published multiple papers on this subject including 'Life cycle greenhouse gas emissions of anesthetic drugs' and 'Greenhouse Gas Emissions for Twenty Anesthetic Active Pharmaceutical Ingredients...' notably.

Is there information for patients to make informed choices based on the environmental impact of different anaesthetic techniques?

The College recently published information on its website.

I really want to do something but I’m not sure where to start...?

Find out who your Trust Sustainability Lead is. if you cannot find one, approach the Trust Board with copies of the Net Zero Plan and ask to speak to the NZ lead
Look at the NHS Sustainable Development Unit for resources
Look at eLA modules and sustainability chapters from new RCoA QI Compendium
Set up a Green Theatre Users Group
Join the Association Environmental Champions network.