Anesthetic Types for Carbon Footprint Reduction

Recruiting at 1 trial location

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Alberta

Disqualifiers: General anesthetic contraindications, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 1

90 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine which type of anesthesia is more environmentally friendly by examining the waste produced during wrist surgery. It compares three types: regional anesthesia (numbing a specific area), general anesthesia (inducing sleep), and a combination of both. The trial involves adults undergoing wrist surgery to repair a fracture. This research seeks to identify the most eco-friendly method for managing pain during surgery. As an unphased trial, it provides an opportunity to contribute to environmental sustainability in medical practices.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It's best to discuss this with the trial coordinators or your doctor.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that anesthetics used in surgeries are generally safe for patients, but they can affect the environment differently. Here's a simple breakdown of the safety for each type of anesthetic used in this study:

1. **Regional Anesthetic**: Studies indicate that regional anesthesia, like nerve blocks, is well-tolerated. It is often chosen to avoid the side effects of inhaled anesthetics, which are gases with a larger environmental impact. This type of anesthesia usually has fewer side effects because it targets a specific area of the body.

2. **General Anesthetic**: This type is commonly used and involves putting the patient to sleep for surgery. While generally safe, it can have more side effects than regional anesthesia, such as nausea or grogginess. However, these side effects are well-known and are usually managed effectively.

3. **Combined General and Regional Anesthetic**: Using both types together is also considered safe and combines the benefits of both methods. It can help manage pain better while reducing the amount of inhaled anesthetics needed, which may be better for the environment.

In summary, while each type of anesthetic is considered safe, they have different environmental impacts. Patients usually tolerate these anesthetics well, and any side effects are typically manageable. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores how different anesthetic techniques can reduce the carbon footprint in medical procedures. Unlike traditional care that often relies heavily on general anesthetics, this trial evaluates the environmental impact of using regional anesthetics alone and in combination with general anesthetics. By potentially lowering greenhouse gas emissions associated with anesthesia, these methods could make surgeries more environmentally friendly without compromising patient care. This could represent a significant step forward in sustainable healthcare practices.

What evidence suggests that this trial's anesthetic methods could be effective in reducing the carbon footprint?

This trial will compare the environmental impact of different anesthesia options. Research has shown that regional anesthesia, which participants in one arm of this trial will receive, can reduce the negative effects of inhaled anesthetics and offers benefits during surgery. Participants in another arm will receive general anesthesia, which studies indicate can have a significant carbon footprint, though certain methods can greatly reduce these emissions. In the third arm, participants will receive a combination of general and regional anesthesia, where inhaled anesthetics are still used, and their impact depends on the specific gases involved. Overall, regional anesthesia alone is often considered more environmentally friendly because it produces fewer emissions. This study aims to better understand the environmental impact of these anesthesia options. ^{1 2 6 7 8}

Are You a Good Fit for This Trial?

This trial is for adult patients with a wrist fracture who are undergoing surgery and fall within the ASA physical status classification of 1-3, indicating they're fit for anesthesia. Patients must not have any contraindications to the type of anesthetic they would receive.

Inclusion Criteria

I am an adult having surgery to fix a broken wrist with plates and screws.

My health is good to moderately impaired.

Exclusion Criteria

I can safely receive general anesthesia.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Surgical Intervention

Participants undergo wrist surgery with either regional anesthetic, general anesthetic, or a combination of both. Waste generated from the anesthetic process is collected and analyzed.

1 day

1 visit (in-person)

Follow-up

Participants are monitored for any post-surgical complications and the effectiveness of anesthetic waste management is evaluated.

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Combined general anesthetic and regional anesthetic
• General anesthetic
• Regional anesthetic

Trial Overview

The study compares environmental impacts by measuring waste from three types of anesthesia: regional, general, and a combination of both. It aims to determine which method produces less waste and is more sustainable for surgeries like wrist fracture repairs.

How Is the Trial Designed?

Group I: Regional anesthetic Experimental Treatment 1 Intervention

Patients only have nerve block with or without sedation

Group II: General anesthetic Experimental Treatment 1 Intervention

Patients only have general anesthetic

Group III: Combined general anesthetic and regional anesthetic Experimental Treatment 1 Intervention

Patients have both general anesthetic and regional anesthetic together

Who Is Running the Clinical Trial?

University of Alberta

Lead Sponsor

Trials

957

Recruited

437,000+

Published Research Related to This Trial

The low-volume anesthesia machine (Maquet Flow-i C20) delivered approximately 20% less sevoflurane compared to the traditional anesthesia machine (GE Aisys CS2), indicating greater efficiency in volatile anesthetic delivery during surgery.

Using the MQ machine not only reduces anesthetic costs, potentially saving around $239,440 over 10 years, but also significantly lowers CO2 emissions by 201 metric tons, highlighting its environmental benefits.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Environmental and Economic Impact of Using a Higher Efficiency Ventilator and Vaporizer During Surgery Under General Anesthesia: A Randomized Controlled Prospective Cohort. Field, RR., Calderon, MC., Ronilo, SM., et al.[2023]

In a study of 27 patients undergoing major abdominal surgery, a combination of general anesthesia and epidural block provided optimal protection against surgical stress, regardless of whether inhalational or intravenous anesthetics were used to induce unconsciousness.

The study suggests that blood loss during surgery is not a strict contraindication for using epidural anesthesia, and emphasizes the importance of monitoring and adhering to protocols to enhance the safety and effectiveness of combined anesthesia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Epidural block as a component of anesthesiological provision during abdominal operations]. Stamov, VI., Kozlov, SP., Deshko, IuV., et al.[2006]

Recent advancements in upper-limb regional anesthesia have significantly reduced postoperative pain and improved safety and outcomes for patients undergoing surgery.

Techniques such as ultrasound-guided anesthesia and wide-awake local anesthesia have expanded the use of regional anesthesia, allowing for procedures in outpatient settings and enhancing the overall effectiveness of pain management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Regional Anesthesia in Upper-Limb Surgery. McLennan, L., Haines, M., Graham, D., et al.[2023]

Human activities are a major cause of rapid climate change, and volatile anesthetics used in medical practices contribute significantly to greenhouse gas emissions, being up to 2,000 times more potent than carbon dioxide.

Reducing the use of volatile anesthetics through low-flow techniques or total intravenous anesthesia can not only lower the carbon footprint but also decrease costs and reduce postoperative complications like nausea and the risk of malignant hyperthermia.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reducing the Carbon Footprint of Anesthesia: Low-Flow Anesthesia and Other Techniques. McGowan, LS., Macksey, LF.[2022]

In a study of 3675 general anaesthesia cases, automated control of end-tidal gases significantly reduced the cost of volatile agents by 27%, from $18.87/hour to $13.82/hour.

The use of automated control also led to a 44% decrease in greenhouse gas emissions, reducing the global warming potential from 23.2 kg/hour to 13.0 kg/hour, primarily due to lower desflurane consumption.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Financial and environmental costs of manual versus automated control of end-tidal gas concentrations. Tay, S., Weinberg, L., Peyton, P., et al.[2019]

The establishment of sustainable anesthesia groups in four hospitals led to a significant reduction in the carbon footprint from inhaled halogenated anesthetics, with a dramatic decrease from -0.27 tons/month to -14.16 tons/month after the intervention.

An information campaign about the carbon footprint further contributed to the reduction, maintaining a negative slope of -7.58 tons/month, highlighting the importance of educating anesthesia providers on the environmental impact of their drug choices.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Association Between Anesthesia Provider Education and Carbon Footprint Related to the Use of Inhaled Halogenated Anesthetics. Chambrin, C., de Souza, S., Gariel, C., et al.[2023]

The addition of fentanyl to hyperbaric bupivacaine significantly enhances the onset and duration of sensory and motor block in patients undergoing lower abdominal and limb surgeries, with the highest efficacy observed in the group receiving 50 μg of fentanyl.

While the combination of bupivacaine and fentanyl provides effective analgesia, the higher dose of fentanyl (50 μg) was associated with a greater incidence of side effects like hypotension and nausea, indicating a trade-off between efficacy and safety.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Fentanyl on Block Characteristics as Adjuvant to Intrathecal Bupivacaine for Lower Limb Surgeries. Abbi, P., Kumari, A., Gupta, R., et al.[2022]

Halogenated inhalation anesthetics in Sweden contributed approximately 5000 tons of CO2 equivalents to the climate footprint, accounting for 0.005% of the country's total emissions.

Switching from desflurane to sevoflurane can reduce the climate impact by 73%, and further replacing sevoflurane with intravenous propofol can decrease the environmental effect by at least 100 times.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Climate footprint of halogenated inhalation anesthetics]. Lindén-Søndersø, A., Nielsen, N., Bentzer, P.[2020]

In a study of 114 patients undergoing prostate needle biopsy, the combination of 40% dimethyl sulfoxide (DMSO) with lidocaine significantly reduced pain during probe insertion compared to standard local anesthesia techniques, with the lowest pain scores recorded for this method.

The DMSO/lidocaine method was as effective as perianal and periprostatic nerve blocks in minimizing discomfort, suggesting it could be a preferable option for patients due to its non-invasive nature.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Comparison of different local anesthesia techniques during TRUS-guided biopsies: a prospective pilot study. Kravchick, S., Peled, R., Ben-Dor, D., et al.[2022]

Using regional anesthesia instead of volatile halogenated gases and nitrous oxide during surgeries can significantly reduce greenhouse gas emissions, contributing to efforts against global warming.

The study provides a theoretical calculation and a real-life example demonstrating the environmental benefits of choosing regional anesthesia over traditional inhalational anesthetics.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

'Green-gional' anesthesia: the non-polluting benefits of regional anesthesia to decrease greenhouse gases and attenuate climate change. Kuvadia, M., Cummis, CE., Liguori, G., et al.[2021]

Combining general anesthesia with thoracic epidural anesthesia (TEA) can improve patient outcomes by enhancing hemodynamics, respiratory function, and postoperative pain management, particularly in high-risk patients.

Despite these benefits, there is currently no evidence that this combination reduces overall perioperative morbidity and mortality, highlighting the need for careful evaluation of risks versus benefits by anesthesiologists.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Combined anesthesia procedures]. Litz, RJ., Bleyl, JU., Frank, M., et al.[2006]

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This study aims to evaluate the environmental benefits of using regional anaesthesia over general anaesthesia and to compare the associated complication rates.

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For the general anesthesia and combined groups, sevoflurane contributed an average 4.7 kg carbon dioxide equivalent (35% total) and 3.1 kg ...

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Carbon footprint and sustainable development in anesthesia

Notably, the prohibition and substantial restriction of desflurane could result in a reduction of approximately 80% in the carbon footprint associated with ...

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Carbon Footprint of General, Regional, and Combined ...

emissions for general anesthesia were an average 14.9 (95% CI, 9.7 to 22.5) kg carbon dioxide equivalent emissions; spinal anesthesia, 16.9 (95% CI, 13.2 to 20 ...

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sciencedirect.com

sciencedirect.com/science/article/pii/S2957391224000834

The environmental effects of anesthetic agents and ...

Regional anesthesia reduces the harmful effects of inhaled anesthetics and has shown to have positive perioperative effects in certain patient populations.

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signavitae.com/articles/10.22514/sv.2025.123

Carbon footprint and sustainable development in anesthesia

The primary objective of applying LCA to anesthesiology is to assess the carbon footprint and environmental impact of different anesthesia modalities under the ...

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thelancet.com/journals/lanplh/article/PIIS2542-5196(23)00084-0/fulltext

Assessing the potential climate impact of anaesthetic gases

We review the current literature on the environmental impact and the estimation of the potential climate forcing of common inhaled anaesthetic drugs.

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The carbon footprint of general anaesthesia in adult patients

A recent study suggested a 98% reduction in GHG emissions from anaesthetic gases through three simple measures: discontinuing N2O use, drastically reducing or ...