MSA applauds the work anesthesiologists are doing in this field
Anesthesiologists in Michigan are leading the way to increase patient safety through innovative methods that also decrease the use of greenhouse gases.
In cases where there is a choice between anesthetics, many anesthesiologists in Michigan are choosing to use an anesthetic called sevoflurane. It is one of the more modern anesthetics available and has many benefits over other anesthetics, including improving how patients wake up after surgery and reducing greenhouse gas emissions from anesthetics by 50%.
“We are massively reducing the amount of greenhouse gases used by employing a more modern drug without decreasing the amount of anesthetic a patient receives,” said Dr. David Hovord, University of Michigan Medical School clinical assistant professor of anesthesiology and co-leader of Michigan Medicine‘s Green Anesthesia Initiative. “When we have a choice of the gas we can use, we go with the far more environmentally friendly one.”
Many anesthesiologists in the state have reduced or stopped using certain inhaled anesthetics that do the most damage to the environment. Michigan Medicine and Henry Ford Health have eliminated desflurane, which is approximately 40 to 50 times more detrimental to the environment than sevoflurane and isoflurane, significantly more expensive and has little evidence of clinical benefit justifying its use. Michigan Medicine and Henry Ford Health have greatly reduced the use of nitrous oxide (known commonly as laughing gas). Nitrous oxide persists in the atmosphere for more than 100 years and breaks down the ozone layer.
Tailoring fresh gas flows for patients is another new way Michigan Medicine and Henry Ford Health are reducing greenhouse gases while delivering the same amount of anesthesia that the patient needs. Their anesthesiologists set patient-specific targets for nitrogen, oxygen and the anesthetic agent, resulting in less anesthesia being wasted. Additionally, new software by GE Healthcare is helping Michigan Medicine automatically adjust the fresh gas concentrations to quickly achieve and maintain those targets.
“Fine-tuning the amount of gas delivered to the patient, calculated specifically to a patient’s needs, improves patient care and reduces greenhouse gases, while still ensuring the safest and most comfortable experience for the patient,” said Dr. Carlos Guerra Londono, an anesthesiologist at Henry Ford Health. “Anything above the amount a patient needs is wasted to the environment.”
The Multicenter Perioperative Outcomes Group (MPOG), based at the University of Michigan, is a consortium of 70 hospitals in Michigan and around the country tasked with promoting safe and evidence-based surgery and anesthetic care for patients. The organization has been gathering research and offering quality-improvement feedback around sustainable measures for several years. These include advising anesthesiologists on their choice of anesthetic agent and tailoring fresh gas flows for patients. MPOG also collects data across partner organizations and then gives feedback on the quality of patient care and the global-warming footprint of anesthetics.
“MPOG’s sustainability dashboard offers a suite of measures that help anesthesiologists maintain or improve their quality of patient care while also reducing greenhouse gas emissions and costs,” said Dr. Nirav Shah, MPOG quality improvement director. “It’s a triple win. We are also proud to launch a sustainability toolkit for hospitals this week focused on quality improvement.”
There is a range of other initiatives taking place across the state. Michigan Medicine is expanding the use of a brain monitoring device while administering total intravenous anesthesia (TIVA) so that anesthesiologists can see the effects of the drug and don’t need to supplement with any gas. Henry Ford Health is studying the behavior of anesthesiologists after receiving education and feedback on the environmental impact of different types of anesthesia.
Michigan Society of Anesthesiologists president Dr. Neeju Ravikant said that the organization applauds anesthesiologists working in this area.
“As physician anesthesiologists, we have a responsibility to help ensure patient safety, and this includes how our field impacts the air we all breathe,” Ravikant said. “Anesthesiologists across Michigan are making great advances in sustainability that will improve patient care and lower greenhouse gas emissions.”
Read Lester Graham’s piece for Michigan Radio at https://www.michiganradio.org/environment-climate-change/2023-04-24/laughing-gas-is-no-laughing-matter-when-it-comes-to-greenhouse-gas-emissions.
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