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

Trial Summary

What is the purpose of this trial?

Following Ethics approval, all adult patients undergoing surgery to fix the wrist fracture will be approached and consent to undergo this study. The amount of waste generated from general anesthetic, regional anesthetic and regional+general anesthetic will be collected and weighed. Patients undergoing this type of wrist surgery have only regional anesthetic, or general anesthetic, or both ie. regional anesthetic and general anesthetic. The aim of the study is to compare the amount of waste generated from each type of anesthetic and this will give us a better idea of which anesthetic is more environmentally sustainable.

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.

What data supports the effectiveness of the treatment Combined general anesthetic and regional anesthetic, General anesthetic, Regional anesthetic for reducing carbon footprint?

Research shows that using automated control of anesthetic gases and low-flow anesthesia techniques can significantly reduce greenhouse gas emissions and costs associated with general anesthesia. These methods decrease the use of volatile anesthetics, which are known to have a high environmental impact. ^{1 2 3 4 5}

Is the use of combined general and regional anesthetics safe for humans?

The research articles provided focus on the environmental impact of anesthetic choices rather than their safety in humans. However, general and regional anesthetics are commonly used in medical practice, suggesting a general acceptance of their safety when administered by trained professionals. ^{1 2 4 5 6}

How does the treatment of combined general and regional anesthetic differ from other treatments for reducing carbon footprint?

The combined use of general and regional anesthesia is unique because it aims to minimize the side effects of each technique when used alone, potentially offering better protection from surgical stress and improved postoperative pain management. This combination may also have beneficial effects on respiratory function and recovery, making it a novel approach compared to using either technique individually. ^{7 8 9 10 11}

Eligibility Criteria

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

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

Treatment Details

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.

Participant Groups

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+

Findings from Research

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

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]

References

1. United States pubmed.ncbi.nlm.nih.gov

Financial and environmental costs of manual versus automated control of end-tidal gas concentrations. [2019]

2. Sweden pubmed.ncbi.nlm.nih.gov

[Climate footprint of halogenated inhalation anesthetics]. [2020]

3. United States 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. [2023]

4. United States pubmed.ncbi.nlm.nih.gov

Association Between Anesthesia Provider Education and Carbon Footprint Related to the Use of Inhaled Halogenated Anesthetics. [2023]

5. United States pubmed.ncbi.nlm.nih.gov

Reducing the Carbon Footprint of Anesthesia: Low-Flow Anesthesia and Other Techniques. [2022]

6. England pubmed.ncbi.nlm.nih.gov

'Green-gional' anesthesia: the non-polluting benefits of regional anesthesia to decrease greenhouse gases and attenuate climate change. [2021]

7. United States pubmed.ncbi.nlm.nih.gov

Regional Anesthesia in Upper-Limb Surgery. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Comparison of different local anesthesia techniques during TRUS-guided biopsies: a prospective pilot study. [2022]

9. India pubmed.ncbi.nlm.nih.gov

Effect of Fentanyl on Block Characteristics as Adjuvant to Intrathecal Bupivacaine for Lower Limb Surgeries. [2022]

10. Germany pubmed.ncbi.nlm.nih.gov

[Combined anesthesia procedures]. [2006]

11. Russia (Federation) pubmed.ncbi.nlm.nih.gov

[Epidural block as a component of anesthesiological provision during abdominal operations]. [2006]