Anesthesia and analgesia
-
Anesthetic drugs have the potential to contribute to global warming. There is some debate about the overall impact of anesthetic drugs relative to carbon dioxide, but there is no question that practice patterns can limit the degree of environmental contamination. In particular, careful attention to managing fresh gas flow can use anesthetic drugs more efficiently--reducing waste while achieving the same effect on the patient. ⋯ This article provides background information and discusses strategies for managing fresh gas flow during each phase of anesthesia with the goal of reducing waste when using a circle anesthesia system. Monitoring oxygen and anesthetic gas concentrations is essential to implementing these strategies safely and effectively. Future technological advances in anesthetic delivery systems are needed to make it less challenging to manage fresh gas flow.
-
Anesthesia and analgesia · May 2012
Comparative StudyComparative life cycle assessment of disposable and reusable laryngeal mask airways.
Growing awareness of the negative impacts from the practice of health care on the environment and public health calls for the routine inclusion of life cycle criteria into the decision-making process of device selection. Here we present a life cycle assessment of 2 laryngeal mask airways (LMAs), a one-time-use disposable Unique™ LMA and a 40-time-use reusable Classic™ LMA. ⋯ The differences in environmental impacts between these devices strongly favor reusable devices. These benefits must be weighed against concerns regarding transmission of infection. Health care facilities can decrease their environmental impacts by using reusable LMAs, to a lesser extent by selecting disposable LMA models that are not made of certain plastics, and by ordering in bulk from local distributors. Certain practices would further reduce the environmental impacts of reusable LMAs, such as increasing the number of devices autoclaved in a single cycle to 10 (-25% GHG emissions) and improving the energy efficiency of the autoclaving machines by 10% (-8% GHG emissions). For both environmental and cost considerations, management and operating procedures should be put in place to ensure that reusable LMAs are not discarded prematurely.
-
Anesthesia and analgesia · May 2012
Hemoglobin desaturation after propofol/remifentanil-induced apnea: a study of the recovery of spontaneous ventilation in healthy volunteers.
In an earlier study investigating the "can't ventilate/can't intubate" clinical scenario, induction of anesthesia with thiopental 5 mg/kg and succinylcholine 1.0 mg/kg was associated with a significant risk of hemoglobin desaturation. It appeared that succinylcholine-induced apnea was responsible for the prolonged apnea. Our hypothesis was that using propofol and remifentanil for tracheal intubation might avoid prolonged apnea and subsequent desaturation attributable to muscle relaxation. ⋯ Administered with propofol 2 mg/kg, the remifentanil dose necessary to produce acceptable intubating conditions, 2 mcg/kg, produces apnea that carries a significant risk of desaturation, whereas a remifentanil dose of 1.5 mcg/kg does not reliably produce acceptable intubating conditions and does not eliminate the risk of desaturation.