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Global Warming: A Universal Problem

In this article, our educators discusses the global impact of climate change and the role we can play in anaesthesia to reduce our carbon footprint.

Carbon Footprint of Healthcare

  • Medical care accounts for a large proportion of emissions
  • Carbon footprints stemming from healthcare are variable between countries
  • Equivalent emissions as % of national emissions of CO2
    • NHS (UK) ~ 3%
    • Australia ~ 7%
    • US ~ 10 %
  • Anaesthetic gases contribute to the greenhouse effect as they influence radiative forcing

Radiative Forcing

  • Radiative forcing is the change in energy flux in the atmosphere caused by natural and/or anthropogenic factors of climate change
  • Radiative forcing is measured in watts/metre 2
  • Energy is constantly flowing in, some is reflected back and the rest is absorbed by the earth
  • The earth’s energy budget (inflow-outflow) largely determines climate
  • There are 3 main factors for the earth’s energy budget
    • Solar irradiance (sunlight)
    • Albedo (indication of how well a surface reflects solar energy varies between 0-1)
    • Atmospheric composition (greenhouse gas, aerosols)
  • Natural factors (climate cycles have occurred throughout Earth’s history)
    • changes in the sun’s energy output
    • changes in Earth’s orbital cycle
    • large volcanic eruptions (light-reflecting particles expelled into the upper atmosphere)
  • Anthropogenic factors (human impact on Earth’s climate). Various components of the atmosphere have the effect of absorbing the reflected radiation
    • Carbon Dioxide
    • Methane
    • Halogens
    • Nitrous Oxide
    • Other gases
  • Human expansion of the greenhouse effect is the principal cause of the current global warming trend

F-gases (Fluorocarbons)

  • HFCs are members of a family of gases known as the F-gases (Fluorocarbons) along with CFCs and HCFCs
  • HFCs have high global warming potential (GWP), raising concern about their impact as they become increasingly used as replacements for ozone-depleting substances (ODS)
  • Regulation of F-gases is achieved with various international protocols and agreements

The Montreal Protocol 1987

  • Agreement ratified by 197 parties has been in effect since 1989
  • Aims to reduce the consumption of substances that deplete the ozone layer
  • The Kigali agreement is the latest revision (in effect since 2021) that focuses on reducing Hydrofluorocarbons (HFCs) use by 85%
  • Anaesthetic gases which are HFCs are currently not prescribed based on their medical necessity
  • The Montreal Protocol has undergone 9 revisions since its implementation

Kyoto Protocol 1997

  • This agreement ratified by 192 parties has been in effect since 2005
  • Aims to reduce global warming by lowering greenhouse gas concentrations in the atmosphere
  • Kyoto Protocol covers emissions of the six main greenhouse gases, namely:
    • Carbon dioxide
    • Methane
    • Nitrous oxide
    • Hydrofluorocarbons
    • Perfluorocarbons
    • Sulfur hexafluoride

Paris Agreement 2015

  • This United Nations Climate Change Conference agreement between 196 parties has been in effect since 2016
  • Aims to
    • Hold the increase in global average temperature to below 2 °C above pre-industrial levels and pursue efforts to limit the temperature increase to 1.5 °C above pre-industrial levels
    • Increase the ability to adapt to the adverse impacts of climate change and foster climate resilience and low greenhouse gas emissions development
    • Make finance flows consistent with a pathway towards low greenhouse gas emissions and climate-resilient development

Alternative to HFCs in anaesthesia

  • TIVA
  • Regional Anaesthesia
  • Xenon

We will focus on the environmental benefits of TIVA

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Introduction to Using Total Intravenous Anaesthesia (TIVA)

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