Articles: anesthetics.
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Life cycle assessment is increasingly used in the healthcare sector to facilitate more environmentally informed supply and medication use. A thorough life cycle assessment comparing the carbon impacts of 10 different single-use anaesthetic drug trays yielded surprising findings. Although life cycle assessment can guide decision-making, results must be interpreted clinically and in light of all available options, including eliminating unnecessary consumption altogether. Effective life cycle assessment in healthcare that is clinically applicable requires expertise from both environmental scientists and clinicians.
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Etomidate, an intravenous hypnotic used for anaesthesia and critical care, is known for its undesirable side effects, including pain on injection, myoclonus, and adrenocortical depression. Despite its continued clinical use because of its haemodynamic stability and rapid onset and offset of effect, alternatives like propofol, ketamine, and remimazolam offer fewer drawbacks. Recent efforts to improve etomidate through chemical modifications, such as methoxyethyl etomidate hydrochloride (ET-26), have shown limited success, with persistent issues like involuntary muscle movements and adrenocortical suppression. We suggest that it might be time to move on from etomidate and focus on developing new anaesthetic agents.
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Editorial Review
The safety of nitrous oxide: glass half-full or half-empty?
A systematic review of clinical trials confirms that including nitrous oxide in the gas mixture for general anaesthesia has minor short-term benefits and does not impact most patient safety outcomes. However, no risk-benefit analysis of nitrous oxide should ignore its known environmental effects. If continued nitrous oxide use is supported, strategies to minimise and monitor the contribution of medical nitrous oxide to global warming are vital.
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Editorial Review
Towards sustainability of volatile anaesthetics: capture and beyond.
The first measures to reduce the environmental harm from volatile anaesthetics are implementation of minimal fresh gas flow strategies and avoidance of desflurane. Although anaesthetic waste gas capture systems generally exert high capturing efficiencies, only about half of volatile anaesthetics used in the operating room are accessible for capture. Industry-sponsored reports promise a reduction of the global warming potential by both incineration and recycling of captured volatile anaesthetics. However, independent high-quality peer-reviewed studies are needed to confirm these findings.