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D3 – General Anesthetic Controversies: TIVA or Gas?

Meeting Rooms

Anesthesiologists seek to provide safe and comfortable patient experiences, and have many approaches to achieve these goals. The topic of TIVA vs inhalational anesthetic has received attention over the past few years in regards to outcomes such as POCD, cost, length of stay, and patient satisfaction.  A new discussion point has emerged in this debate on anesthetic choice within the context of sustainability — which is better for environmental health? Inhaled anesthetics are potent greenhouse gases, yet IV drugs are concerning water toxicants. As anesthesiologists we are rarely exposed to this literature or discussion of the impact of our practice on public health.  This session will create awareness in the gap of knowledge we as providers have, of the anesthetic contributions to environmental health.

In this point-counterpoint session, the presenters will take opposing viewpoints.  One will argue that IV anesthetics are more sustainable and have less environmental impact than inhalational agents.  The other will argue that IV anesthetics are no more sustainable than inhaled anesthetics. The speakers will review the current literature to support these arguments and offer clinical applications to make either anesthetic more environmentally conscious.

  • Ryan SM, Nielsen CJ. Global warming potential of inhaled anesthetics: application to clinical use. Anesth Analg 2010; 111:92-8.
  • Eckelman MJ, Sherman JD. Estimated Global Disease Burden From US Health Care Sector Greeenhouse Gas Emissions.  American Journal of Public Health, 2017.
  • der Beek T, et al. Pharmaceuticals in the environment-Global occurrences and perspectives. Environ Toxicol Chem 2016; 35(4):823-3.
  • Mankes RF.  Propofol wastage in anesthesia. Anesth Analg .2012; 114(5):1091-2.
  • Sulbaek Andersen, et al. Medical intelligence article: assessing the impact on global climate from general anesthetic gases.  Anesth Analg. 2012; 114(5):1081-5.
  • Sherman, JD, et al. Life Cycle Greenhouse Gas Emissions of Anesthetic Drugs.  Anesth Analg. 2012;114(5):1086-90.
  • Mychaskiw G. Anesthesia and global warming: the real hazards of theoretic science. Med Gas Res. 2012; 2:7.
Clinical advocacy Greening the OR Sustainable procurement