We should consider the effect of gas anaesthetics at two levels-
- At the working environment in the operation theatre .
- The environmental changes outside the operation theatre .
Nitrous oxide we release today pollutes the operation theatre and finally it destroys ozone layer in the stratosphere for 114 years. Modern anaesthetics like isoflurane, sevoflurane, desflurane are halogen compounds pollute the operating theatre and recovery room area (8% of total}and destroy the ozone layer causing green house effect. The sevoflurane you release today remains 46 years in the stratosphere and destroy ozone layer for 46 years. It is estimated that 1 kilo of desflurane is equivalent to 2.5 tonnes of CO2 in terms of the amount of green house potential. According to the study from university of Chicago, the healthcare sector accounts for 8% of the United States total greenhouse emissions. The environmental impact of operating theatre in three academic centres in Canada , United States and United Kingdom over 1 year period in 2011. The green house estimate the carbon footprints of the surgery in the three centres at 9.7 million tonnes of carbon dioxide emitted per year. The use of desflurane or sevoflurane from modern anaesthetics machine for 1 hour is same as 230 or 30 miles travelled in a modern car respectively. As we grow older our cognitive function decline gradually. Interestingly, there are reports of steep decline of the memory- cognition after consecutive exposure of the anaesthetic gases and such condition is termed Post-Operative Cognition Dysfunction (POCD). However, there are solutions in the management of general anaesthetics by not using gas anaesthetics and replacing it by total intravenous anaesthetics.
Total Intravenous Anaesthesia (TIVA)
- The discovery of Propofol (half life of 6-8 minutes ) and remifentanil of comparable half life has found intertwined combination have found the main stay of TIVA during last decade.
- The pharmacological property of propofol has established attractive evidences against the inhalational anaesthetics as far as post operative nausea and vomiting are concerned.( 3-5% against 25-30% of inhalant anaesthetics).
- Post operative delirium, POCD has decreased significantly with TIVA as compare to gas anesthetic.
- TIVA with voltage gated calcium broker enhances rapid recovery from the anaesthesia with excellent cognition.
- TIVA do not pollute OR environment nor GHG effect.
- The Euphoric effect of propofol is very significant- smooth landing of the anaesthesia.
- Reduction body metabolism by TIVA with adjuvant is very valuable during preoperative period.
Conclusively, TIVA is very relevant and should be adopted in all.
