The science of climate change and the effect of anaesthetic gas emissions: a reply
Notice bibliographique
Résumé
Physicians are not climate scientists and are not trained in the intricacies of how greenhouse gases affect climate change. Hence it is refreshing to read the thought-provoking review article by Slingo and Slingo on the impact of volatile anaesthetic gas emissions on climate change [1]. They have suggested that only desflurane will have full radiative effect on global warming due to its longer atmospheric lifetime of 14 years compared with others. Another key message for us practitioners is the caution against the simplistic use of global warming potential (GWP) to calculate the carbon footprint of volatile agents. While many, including us, have used GWP in the past, we agree with their call for caution in translating GWP to miles driven. Yet, we contend that, even if our contribution to greenhouse gases is not significant, choosing volatile agents with shorter life times seems common sense and aligns with the recommendations of the AR-6 report of the Intergovernmental Panel on Climate Change to curb the use of near-term climate forcers. Additionally, such choices also align with the principles of ‘choosing wisely’ where resource consciousness is taken into consideration. We must refine our practice by both choosing the anaesthetic agent with the most favourable profile and the ideal way to use that agent. Environmental sustainability aside, there are a multitude of reasons to refrain from using desflurane, which is far from an ideal anaesthetic agent. First, it has lower potency requiring approximately three times more mass of agent for the same clinical effect compared with sevoflurane. Second, its pungency may cause bronchial reactivity, and increase cerebral blood flow and cerebral spinal fluid pressure, causing sympathetic stimulation [2]. These undesirable effects outweigh the marginal clinical benefit of earlier recovery [3]. With a better understanding of the pharmacokinetic properties of sevoflurane, adjustment of the sevoflurane dosage towards the end of surgery negates the latter perceived advantage. Third, the costs of desflurane remain significantly higher than sevoflurane, especially given its reduced potency. Institutions have demonstrated significant cost savings with reduced desflurane use [4]. Moreover, low fresh gas flows should be employed using automated fresh gas flow control, which is lacking in even highly resourced countries such as the USA, one of the highest emitters of healthcare-related greenhouse gases. Irrespective of our total contribution to climate change, the fact remains that desflurane is more harmful to the environment compared with sevoflurane. Desflurane has significantly higher atmospheric concentrations than sevoflurane and isoflurane, contributing 81% of the radiative forcing of the halogenated anaesthetic agents [5]. Taking the economic and perhaps environmental considerations, all healthcare sectors are beginning to remove desflurane from clinical practice. This is much needed considering the growing surgical burden and the future need to improve access to surgeries in low-income countries. We agree with the statement by Slingo and Slingo [1] that selecting a volatile agent should be based on clinical judgement; however, even with that in mind, desflurane is disadvantageous from a value-based perspective for both patients and institutions. Further, even if the impact of volatile agents on the environment may seem minimal, action is better than inaction, and small actions in the right direction are to be encouraged to combat the climate emergency. Choosing sevoflurane on the grounds of clinical, economic and environmental reasons aligns with the triple bottom line. Refining practice with automated fresh gas flow or closed circuits to minimise usage is necessary. There are many more strategies anaesthetists need to focus on for combating the climate crisis; choosing anaesthetic agents is only one component. We must keep moving and not get distracted.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,013 | 0,058 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,004 | 0,003 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,003 | 0,008 |
| Communication savante | 0,005 | 0,021 |
| Science ouverte | 0,005 | 0,005 |
| Intégrité de la recherche | 0,045 | 0,085 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,011 | 0,009 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».