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What is this nonsense going on about removing desflurane and nitrous to save the environment. Are you all doing this?
What is this nonsense going on about removing desflurane and nitrous to save the environment. Are you all doing this?
I guess for academics nitrous doesn’t really matter cause things move slower, but for private practice those quicker wake times = more $$$. Turn and burn baby.Honestly do u think des and nitrous really make your anesthetic that much better?
Do you think removing them has any meaningful affect on the environment?Honestly do u think des and nitrous really make your anesthetic that much better?
I mean if you consider how much is used worldwide ya it probably would have a meaningful impact. That being said I love my nitrous. Take the Des, never understood the appeal. I don’t think there is anything wrong with trying to reduce waste. But, it is laughable to focus on the gas without addressing the sickening amount of hospital waste we produce everyday.Do you think removing them has any meaningful affect on the environment?
I never use them, but I'm about to start
I miss having desflurane available, but I got over it.Honestly do u think des and nitrous really make your anesthetic that much better?
I miss having desflurane available, but I got over it.
For fast wakeups now, I just do a rocuronium + esmolol TIVA, and when the dressing goes on I give sugammadex and wow are those patients motivated to GTFO of the hospital. You have to hold them down so they won't leave the OR under their own power.
I miss having desflurane available, but I got over it.
For fast wakeups now, I just do a rocuronium + esmolol TIVA, and when the dressing goes on I give sugammadex and wow are those patients motivated to GTFO of the hospital. You have to hold them down so they won't leave the OR under their own power.
For most of what I do, no. However I use Des maybe 5-10% of the time in specific situations, but ALWAYS with low fresh gas flows. It is a fact that it’s “global warming” potential is MUCH higher than that of sevo.Honestly do u think des and nitrous really make your anesthetic that much better?
Propofol works just as well and less nausea.I guess for academics nitrous doesn’t really matter cause things move slower, but for private practice those quicker wake times = more $$$. Turn and burn baby.
I miss having desflurane available, but I got over it.
For fast wakeups now, I just do a rocuronium + esmolol TIVA, and when the dressing goes on I give sugammadex and wow are those patients motivated to GTFO of the hospital. You have to hold them down so they won't leave the OR under their own power.
If you need Des and/or nitrous for a “fast wake up” then you are doing it wrong. If using a volatile such as sevo/iso, simply turn your flows down to aalmost nothing and pay F-ing attention, you can get a smooth wake up. Last sutures going in then crank the flows up to 11. Reverse muscle relaxant with suggamadex and boom. Alternatively, use a propofol TIVA, turn it down at the appropriate time and get them breathing, pull LMA or tube. Also, the idea that the vast majority of our patients need to be awake and doing higher level math prior to removing a tube is garbage.I guess for academics nitrous doesn’t really matter cause things move slower, but for private practice those quicker wake times = more $$$. Turn and burn baby.
I’d rather not pay attention to the resident/PA closing and just use nitrous.If you need Des and/or nitrous for a “fast wake up” then you are doing it wrong. If using a volatile such as sevo/iso, simply turn your flows down to aalmost nothing and pay F-ing attention, you can get a smooth wake up. Last sutures going in then crank the flows up to 11. Reverse muscle relaxant with suggamadex and boom. Alternatively, use a propofol TIVA, turn it down at the appropriate time and get them breathing, pull LMA or tube. Also, the idea that the vast majority of our patients need to be awake and doing higher level math prior to removing a tube is garbage.
If you talk to an actual climate scientist they will tell you Des doesn’t stick around in the atmosphere and therefore has no contribution to climate change
I guess for academics nitrous doesn’t really matter cause things move slower, but for private practice those quicker wake times = more $$$. Turn and burn baby.
Propofol works just as well and less nausea.
If LMA, you just leave it in and pull out in pacu. No real need to do a complex wean from sevo to nitrous
If intubated, keep them paralyzed and breath off most of the gas and then reverse with sugammadex and extubated 15 seconds later. No real need for nitrous or des.
Maybe only need for nitrous is the old, unstable patients?
If the energy and motivation to take on projects designed to eliminate waste or pollution were infinite, sure focus on reducing a 1-ish-percent GHG contributor. But since they're not, effort to make large reductions in a small contributor are extraordinarily less efficient than making smaller reductions in large contributors. This is an academic QI project in search of a problem. But no, I never use Des, and, yes, the pharmacy costs are high, so whatever.
This was a hot topic on the ASA Community a month or two ago. Supposedly the major cause of nitrous pollution is actually leaks in the system itself, not it's actual use. Several contributors noted that they have switched to tank N2O only (the ones on the back of the anesthesia machine) and stopped using the piped-in N2O altogether.leakage from nitrous lines results in a considerable loss and limiting leaking gas is something more of us can do.
Speaking of waste - what would y'all say if I told you that a desflurane-free hospital put one too many bloody sponges in the regular trash, one too many times, and now they have to truck all of their trash to another state because the local landfill won't take their garbage any more?
Honestly do u think des and nitrous really make your anesthetic that much better?
Responses like that are exactly why we are doomed.Do you really think using sea and nitrous is what’s going to kill the planet?
Do you really think using sea and nitrous is what’s going to kill the planet?
I haven’t use sevo for years until very recently. Forgot how fast the patients can wake up….
It’s like driving an EV. It won’t make a huge difference, but some people like the technology and the idea of helping the planet.
I use low flow iso. I like the predictability. Nitrous sticks around in the atmosphere for 100 years and there's really no need for it. You can have quick predictable wakeups with anything if you know how to use it. Our wanton use of chemicals, particularly fossil fuels, is greatly detrimental to the environment. I try to limit my unnecessary overuse of materials. I only use one syringe for a case, I reuse syringes for the cuff, I try not to open twenty vials of stuff I don't need. I mean really how long does it take to draw up and dilute down some ephedrine?
The real question is why we are doing so many unnecessary procedures for people who have low or zero quality of life?
I like EVs because the acceleration is fun and there's no cloud of gas when you pull out of the driveway. Maintenance is better. The major issue is that the price tends to be high and if you're not on the tesla supercharger network, it's way harder to find a charger in a timely fashion than it is to pump gas. Less relevant if you have a home charger.
I'm hoping that the batteries become as recyclable as lead and am looking forward to solid state batteries (estimated 2026 by toyota and bmw).
So they can use up valuable resources for a few more days /s
I was trying to get one earlier this year…. Both for the fun factor and tax deduction. Won’t qualify (which I imagining is true for most attending here….). Decided just keep on driving my SO’s hand me down…. Maybe I’ll wait until 2026.
I see where you're coming from - small efforts matter. Except for the most part they really don't.This whataboutism is quite a way to distract from the topic. I don't label and truck away the garbage (And you are correct that someone screwed up with that). But I can control the use of my anesthetics.
So you see the negligible effect a one-syringe anesthetic has in the shadow of an ICU's consumption for an end-of-life hospitalization ... but you still do it. Tthis perplexes me.I use low flow iso. I like the predictability. Nitrous sticks around in the atmosphere for 100 years and there's really no need for it. You can have quick predictable wakeups with anything if you know how to use it. Our wanton use of chemicals, particularly fossil fuels, is greatly detrimental to the environment. I try to limit my unnecessary overuse of materials. I only use one syringe for a case, I reuse syringes for the cuff, I try not to open twenty vials of stuff I don't need. I mean really how long does it take to draw up and dilute down some ephedrine?
The real question is why we are doing so many unnecessary procedures for people who have low or zero quality of life?
All of those are poor examples and you know itI see where you're coming from - small efforts matter. Except for the most part they really don't.
Re: cost - It's hard for me to get anxious if pharmacy whines about how much my drugs cost, when I've seen orthopods drop hip prosthetics on the floor or when a CT surgeon opens a second valve because he thinks maybe it'll fit better than the first one he opened.
Re: environmental impact - Likewise, the mountain of plastic waste and single-use nonsense dwarfs the effect of the sevo vs des @ 0.5 lpm debate.
Sevo is a greenhouse gas too, so maybe we should be doing TIVAs for everyone? I mean, you can control that, too.
If you want to reduce your medical carbon footprint, start doing spinals for every outpatient case you do. Don't use a kit. Pour some alcohol from a 1 liter bottle on some gauze for your prep, open a needle and a syringe onto a towel, and deliver a $3 anesthetic. This is the standard for most of the developing world.
These conversations remind me of living in California during bad drought years. People would get hassled or ticketed for watering their plants at the wrong time of day, meanwhile it's 105 degrees in July and across the street there's an almond orchard getting flood irrigated twice per week.
We're not the problem.
So you see the negligible effect a one-syringe anesthetic has in the shadow of an ICU's consumption for an end-of-life hospitalization ... but you still do it. Tthis perplexes me.
Have you ever taken an international flight for a vacation? How many syringes will you have to not use to offset that fossil fuel burn? Are you never going to take such a flight again?
How many people reading this thread and worrying about desflurane are going to fly to a warm island and stay in a luxury hotel for a tax-deductible CME conference this winter?
Just devil advocating here. I'm going to guess the great majority of us high-earnings American doctors have massive carbon footprints, and quibbling over syringes and desflurane is an exercise in cognitive dissonance.
I see where you're coming from - small efforts matter. Except for the most part they really don't.
Re: cost - It's hard for me to get anxious if pharmacy whines about how much my drugs cost, when I've seen orthopods drop hip prosthetics on the floor or when a CT surgeon opens a second valve because he thinks maybe it'll fit better than the first one he opened.
Re: environmental impact - Likewise, the mountain of plastic waste and single-use nonsense dwarfs the effect of the sevo vs des @ 0.5 lpm debate.
Sevo is a greenhouse gas too, so maybe we should be doing TIVAs for everyone? I mean, you can control that, too.
If you want to reduce your medical carbon footprint, start doing spinals for every outpatient case you do. Don't use a kit. Pour some alcohol from a 1 liter bottle on some gauze for your prep, open a needle and a syringe onto a towel, and deliver a $3 anesthetic. This is the standard for most of the developing world.
These conversations remind me of living in California during bad drought years. People would get hassled or ticketed for watering their plants at the wrong time of day, meanwhile it's 105 degrees in July and across the street there's an almond orchard getting flood irrigated twice per week.
We're not the problem.
My whole point is that the bigger decisions matter orders of magnitude more, and the syringe skimpers and isoflurane users are still doing things like driving F250s and flying to Fiji and setting the AC to 65 in their 4000 sq ft homes and not carpooling ... and even within the narrow context of just medicine these decisions are lost in the noise and their quiet participation in futile or wasteful care.I mean, the real problem is too many people using too many resources. It's easy to think small daily decisions don't matter
I'm not telling you not to do that, I'm just pointing out that it doesn't really matter.What are you talking about?
How is taking a flight related to wasting syringes and needles? If you do 1000 cases a year and open 20 syringes for each one you're using 20,000 syringes and needles vs my 1000. That's 600,000 unnecessary syringes and needles over a 30 year career. I'm not trying to offset anything, just not wasting all the packaging and materials under the guise of sterility.
One place I was at had a guy who was a real QI guy..he got data for one year imported from the machines, the newer ones show you cost/hr for your flows. He did a educational presentation on using low flows, asked everyone to try it for a month, gathered more data. Showed the hospital we would save a little less than a million a year if everyone ran less than 0.5 (30 something sites, lots of late rooms). Everyone respected him, he asked everyone to try their best to try it out, did troubleshooting. Tracked the data, got a big stipend increase the year after. Wonder how many people would stop using des, use low flow if that was the incentive. Does it really alter your practice. Wonder what all the ‘oh but somebody else is doing something a lot worse’ would think.