Sustainability in veterinary anaesthesia
In 2010, The Lancet called climate change “potentially the biggest global health threat of the 21st century” (Costello et al. 2009). It has been widely understood that climate change will have significant adverse effects on global health. What is now becoming clear is the contribution of healthcare systems in causing climate change, and this includes the practice of veterinary anaesthesia. It is essential that veterinary anaesthetists also commit to reducing our impacts on global health.
WHAT DO VETERINARY ANAESTHETISTS NEED TO DO?
Sustainable development has been defined by the UN Brundtland Commission as “development that meets the needs of the present without compromising the ability of future generations to meet their own needs”. A recent review published in Veterinary Anaesthesia and Analgesia by Jones & West (2019) provides further detail on sustainable options in veterinary anaesthesia. The role of veterinary anaesthetists is likely to include:
EDUCATION
- Informing ourselves about the basic science of climate change, the likely impacts, and the urgent need to take action
- Educating our wider community about the disproportionately potent greenhouse gas effects of inhalational anaesthetic agents, due to their action in ‘plugging’ the atmospheric window by which the planet cools itself (see Table 1)
| Atmospheric characteristics | Nitrous oxide | Desflurane | Isoflurane | Sevoflurane | Carbon dioxide |
|---|---|---|---|---|---|
| Atmospheric lifetime (years) | 110 | 14 | 3.2 | 1.1 | 74 |
| Radiative efficiency (W m-2 ppb-1) | 0.003 | 0.469 | 0.453 | 0.351 | 0.676 |
| Global warming potential over 100 years | 310 | 2540 | 510 | 130 | 1 |
- Supporting anaesthesia providers in minimising inhalational anaesthetic gas use during anaesthesia, including using the lowest safe fresh gas flows, rebreathing systems and appropriate monitoring
- Including sustainability principles into undergraduate and postgraduate curricula
PRACTICE
- Discussing reducing, or eliminating, the use of nitrous oxide in clinical veterinary practice due to its potent greenhouse gas effect and ozone depleting effects, and desflurane due to its potent greenhouse gas effects
- Promoting sustainable conferencing
- Following ethical procurement guidelines (BMA 2017 SDU – Ethical Procurement for Health: Workbook)
- Incorporating sustainability principles into our own decisions regarding procurement, equipment use, waste management, energy and resource use (see Table 2)
| Reduce volatile anaesthetic atmospheric waste | Low fresh gas flow Monitoring of inspired oxygen and end-tidal anaesthetic agent concentrations Avoid high impact agents (desflurane, nitrous oxide) Consider intravenous and regional techniques Invest in waste anaesthetic recycling or destruction |
| Reduce pharmaceutical waste | Use prefilled syringes or pre-packed kits Use appropriate sized vials Dispose of pharmaceuticals appropriately Replace perioperative injectable with oral medications |
| Reduce equipment waste | Only open equipment intended for immediate use Purchase reusable or reprocessed equipment Adjust stock levels to minimise discard beyond expiry dates eliminate unnecessary items |
| Waste segregation | Evaluate waste handling to move up the waste hierarchy Segregate waste strictly, according to legal frameworks Recycle where possible, in clinical and non-clinical streams Use reusable or non-plastic waste containers Minimise packaging |
| Textiles | Use reusable textiles Use towels and blankets efficiently |
| Electronics | Do not use unless proven benefit Use certified recycling site for disposal |
| Leadership | Develop a sustainability plan and committee, with advocates at local level Procure sustainably where possible Promote staff engagement with sustainability Evaluate travel within your organisation Promote research into sustainability |
RESEARCH
- Life cycle analysis (cradle-to-grave carbon emissions) for alternative systems e.g. intravenous anaesthesia for maintenance of anaesthesia, or anaesthetic gas reclamation techniques
- Incorporating guidelines to reduce carbon emissions in research e.g. NIHR Carbon Reduction Guidelines
WHAT IS AVA DOING?
The UN has produced Sustainable Development Goals, and it is imperative that organisations align themselves with these goals. Specifically, the AVA has taken the following actions:
- The majority of committee meetings are held electronically
- We are supporting migration of membership from paper to electronic journals
- We encourage sustainable conferencing at our biannual conferences, including plans for recording of conference streams
- Our investments are consistent with our aim to be a socially and environmentally responsible organisation
- We are developing a sustainability strategy which will be reviewed every 2 years, and a nominated committee member will retain responsibility for this strategy
WHERE CAN I FIND MORE INFORMATION?
Published papers
- Jones RS & West E (2019) Environmental sustainability in veterinary anaesthesia. Veterinary Anaesthesia and Analgesia 46, 409-420. Click here to access article, or click here to access the VAA podcast accompanying this article (episode 5)
- Association of Anaesthetists – Environment section
- The Lancet Planetary Health series
Sustainable healthcare organisations
- Vet Sustain A voluntary collaboration of veterinary professionals who are championing sustainability in the veterinary profession
- Sustainable Development Unit The SDU is funded by, and accountable to, NHS England and Public Health England to work across the NHS, public health and social care system.
- The UK Health Alliance on Climate Change
- The Centre for Sustainable Healthcare
- Healthcare Without Harm Leading the global movement for environmentally responsible healthcare
National Healthcare Associations
- American Society of Anesthesiologists
- Royal College of Anaesthetists
- Association of Anaesthetists
Last edit: Feb 2020