In the operating room, a fight against GHGs

The Association des anesthesiologistes du Québec calls on the Quebec government to reduce greenhouse gas (GHG) emissions in hospital operating rooms. The group collected data from 25 hospitals: four had “very significant leaks” of nitrous oxide (N₂O, or laughing gas). GHG emissions ranged from 1.1 to 231 kg CO equivalent₂ per operative hour, based on the anesthetic gas usage of the facilities surveyed.

“To compensate for one hour of anesthesia at 200 kg of CO equivalent₂ per hour, it would be necessary to plant 3.3 trees”, illustrates the D^r Stephan Williams, president of the carbon neutrality committee of the Association des anesthesiologistes du Québec (AAQ). “It’s unsustainable. »

The AAQ conducted its investigation in 2020-2021 with anesthesiology services located throughout Quebec. It will discuss the issue this week with the Ministry of Health and Social Services (MSSS), indicates its president, Dr.^r Nikola Joly. “We need the collaboration of the MSSS to achieve carbon neutrality in health and reduce the production of waste from Quebec’s operating rooms,” he says. By wasting fewer resources, the public network will also save money, he argues.

According to the D.^r Joly, hospitals are still operating “on autopilot”, without really analyzing their consumption of anesthetic gases or medical supplies. “The bottle of nitrous oxide is empty, we fill it,” he cites as an example. But was the gas used by clinicians or did it simply leak out of a pipe?

During its investigation, the AAQ reported to four hospitals the existence of “very significant” leaks of nitrous oxide in their facilities, specifies the D^r Williams. “When we saw [dans nos données] consumption of this gas which was completely disproportionate to the quantity of anesthetic treatment given, we knew that there was a leak”, he explains.

The Cité-de-la-Santé wants to reduce its footprint

Even in the absence of a leak, operated patients exhale some of the anesthetic gases they inhale. Since operating rooms are ventilated, these powerful GHGs are expelled into the atmosphere through hospital chimneys. A reality that has preoccupied anesthesiologists for ten years.

In its 2023 revised practice guide, the Canadian Anesthesiologists’ Society recommends that the use of desflurane and nitrous oxide — potent GHGs — be “eliminated or minimized, where possible, taking into account local resources, location and clinical context”.

At Cité-de-la-Santé, in Laval, anesthesiologists have abandoned nitrous oxide and practically no longer use desflurane, according to D^D Marie-Pierre Huot, head of the anesthesiology department. Instead, specialists administer propofol intravenously to patients. “We put them to sleep and we keep them asleep with that,” she explains.

Patients do not lose out, she says. “Studies show that they have less heartache with the use of propofol than with the volatile agents,” she says. The awakenings are better. They are more awake. »

In children under 10, sleep is always induced using a gas, sevoflurane, which is less polluting than desflurane and nitrous oxide. Doctors want to avoid “an injection” to young awakes, specifies the D^D Huot. Once asleep, the little patients are given medication intravenously.

Cité-de-la-Santé respiratory therapists are also trying to reduce the carbon footprint of the operating room. “Before, we used disposable pads each time we performed spinal anesthesia,” says the coordinator of respiratory therapists, Tanya Thibeault. We could use 30 a day. We now take washable towels. Professionals are now swapping needles for plastic tips when withdrawing drugs from vials.

Asthma “pumps” are in the crosshairs of the Éco-CPDP committee (Council of Physicians, Dentists and Pharmacists) of the CISSS de Laval. Metered-dose inhalers, which squirt puffs of medicine into patients’ throats, contain powerful GHGs. The committee wants to develop a protocol to avoid waste, especially in the emergency department.

Waste production is a problem in the health network, according to the D^r Williams. In the operating room, for example, the teams must unwrap – “like Christmas presents” – a tray of instruments when they perform anesthesia. “To do an epidural, you don’t need that many things, but over time, product vendors have managed to wrap a lot of stuff in little gifts,” he notes. Unnecessary material is thrown in the trash. “All that is cost, waste, and there are no benefits for the patient,” he laments.

According to the D^r Williams, suppliers will have to be “carbon-friendly” in the future. “They will have to adapt to the fact that we are in a climate crisis. It is the main threat to human health in the 21st century.^e century. »

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