North West School of Anaesthesia, Health Education England North West, Manchester, UK.
Department of Anaesthesia, Royal Manchester Children's Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
Br J Anaesth. 2022 Aug;129(2):231-243. doi: 10.1016/j.bja.2022.04.022. Epub 2022 Jun 18.
Tackling the climate emergency is now a key target for the healthcare sector. Avoiding inhalational anaesthesia is often cited as an important element of reducing anaesthesia-related emissions. However, evidence supporting this is based on adult practice. The aim of this study was to identify the difference in carbon footprint of inhalational and i.v. anaesthesia when used in children.
We used mathematical simulation models to compare general anaesthetic techniques in children weighing 5-50 kg for TIVA, i.v. induction then inhalational maintenance, inhalational induction then i.v. maintenance, and inhalational induction and maintenance. We simulated inhalational induction with sevoflurane alone, and co-induction with sevoflurane and nitrous oxide, and both remifentanil-propofol and propofol-only i.v. anaesthesia. For each technique, we drew on previously published life-cycle data to calculate carbon dioxide equivalents for anaesthetic durations up to 480 min.
TIVA with propofol and remifentanil had a smaller carbon footprint over a typical anaesthetic duration of 60 min (1.26 kg carbon dioxide equivalents [COe] for a 20 kg child) than i.v. induction followed by inhalational maintenance (2.58 kg COe) or inhalational induction and maintenance (2.98 kg COe). Inhalational induction followed by i.v. maintenance only had a lower carbon footprint than inhalational induction and maintenance when used in longer procedures (>77 min for children 5-20 kg; >105 min for children 30-50 kg).
In a simulation study, i.v. anaesthesia had climate benefits in paediatric anaesthesia. However, when used after inhalational induction, benefits were only achieved in longer procedures. These findings provide evidence-based guidance for reducing the environmental impact of paediatric anaesthesia, but these will require confirmation using real-world data.
应对气候紧急情况现在是医疗保健部门的一个关键目标。避免吸入性麻醉通常被认为是减少麻醉相关排放的一个重要因素。然而，支持这一观点的证据是基于成人实践的。本研究的目的是确定在儿童中使用吸入性和静脉麻醉时，其对碳足迹的影响差异。
我们使用数学模拟模型来比较 5-50 公斤重的儿童使用全凭静脉麻醉、静脉诱导后吸入维持、吸入诱导后静脉维持、吸入诱导和维持的全身麻醉技术。我们模拟了单独使用七氟醚的吸入诱导，以及七氟醚和一氧化二氮的联合诱导，以及瑞芬太尼-丙泊酚和仅丙泊酚的静脉麻醉。对于每种技术，我们借鉴了先前发表的生命周期数据，以计算麻醉时间长达 480 分钟的二氧化碳当量。
在典型的 60 分钟麻醉时间内，丙泊酚和瑞芬太尼的全凭静脉麻醉的碳足迹小于静脉诱导后吸入维持（20 公斤儿童为 2.58 千克二氧化碳当量）或吸入诱导和维持（2.98 千克二氧化碳当量）。在更长的手术中（5-20 公斤儿童>77 分钟；30-50 公斤儿童>105 分钟），吸入诱导后静脉维持的碳足迹仅低于吸入诱导和维持，才具有较低的碳足迹。
在模拟研究中，静脉麻醉在儿科麻醉中有气候效益。然而，在吸入诱导后使用时，仅在较长的手术中才能获得效益。这些发现为减少儿科麻醉对环境的影响提供了循证指导，但这些发现需要使用真实数据进行证实。
