Greening the operating room

Greening the operating roomA guest column by the American Society of Anesthesiologists, exclusive to

In an effort to recognize April as Earth Month, the American Society of Anesthesiologists (ASA) is taking action to help hospitals across the country green their operating rooms with a white paper by the ASA Task Force on Environmental Sustainability.

Physicians such as anesthesiologists are responsible for the health of the community, which is dependent on a healthy environment. Unfortunately, the health care sector is not as environmentally friendly as you may think. It accounts for 8 percent of total green house gas emissions in the U.S., according to a study from the University of Chicago. Hospitals have the greatest negative impact on the environment, emitting 39 percent of health care’s total green house gas emissions.

In particular, operating rooms are the biggest consumers of energy and generate 20-30 percent of total hospital waste. As anesthesiologists, we recognize that our role constitutes a hospital-based practice integrated into operating rooms, diagnostic and procedural areas, as well as other patient care areas. As a result, we have the insight and ability among hospital leadership to affect change and promote environmentally-positive practices.

Addressing four specific issues will help anesthesiologists mitigate the negative effects of health care on the environment:

  1. Anesthesia equipment choices
  2. Anesthetic agent choices
  3. Waste stream management and recycling opportunities
  4. Environmental sustainability in perioperative settings and operating room design

Many types of anesthesia equipment are purchased in reusable or disposable form. Reusable equipment requires additional cleaning and disinfecting solutions to prevent contamination. While on the other hand, disposable equipment contributes to the bulk waste of landfills, and may release toxins into the environment. Unfortunately, there is little scientific information to guide best practice. Life cycle analyses (calculations of environmental footprint from manufacturing through disposal) are needed to help determine whether reusable or disposable equipment choices, in particular settings, are better for the environment.

In the meantime, there are solutions to reduce operating room waste, including intraoperative recycling programs to collect plastics and papers free of infectious materials. The collection of disposable equipment for reprocessing by certified companies is another way to minimize waste, as it helps divert disposables out of the waste stream and saves health care dollars. Many organizations also accept the donation of unused clean equipment.

An easy way we can reduce the eco footprint in operating rooms is to modify anesthetic techniques. Potent inhaled anesthetics and nitrous oxide are greenhouse gases. A relatively simple way to reduce and reuse anesthetic agents is to utilize low fresh gas flows during the maintenance phase of the anesthetic. The environmental impact of inhaled agents can also be reduced by preventing the scavenged gases from being released into the atmosphere. Development of systems to collect and reuse anesthetic gases is under way. Life cycle analyses that include inhaled and intravenous agents will help us understand the relative environmental impacts of our various anesthetics.

Operating room design should strive to limit the amount of environmental impact. Organizations such as the Leadership in Energy and Environmental Design (LEED) and Green Guide for Health Care offer green design guidance for remodeling or new construction. Elements to be considered during the design phase should include water and energy conservation, low impact materials for construction and air quality.

Greening the operating room helps reduce waste, energy, cost and the amount of exposure patients and the public have to hazardous chemicals. A greener health care delivery will have a positive impact on the environment.

To access the white paper, please read Greening the Operating Room: Reduce, Reuse, Recycle and Redesign.

T. Kate Huncke and Susan M. Ryan are co-founders of the ASA Task Force on Environmental Sustainability.

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  • dontdoitagain

    How about letting patients opt out of the assinine sedation and g/a for all program at medical facilities?  Not only did my crna decide to use Versed/Midazolam on me in defiance of my wishes, but he decided to disregard my instructions not to use general anesthetic as well.  So not only were the environmental concerns mentioned exacerbated, but an enormous amount of money and time was expended as well, for a simple outpatient surgery which is best done with a block and pain meds.

    • Robert Luedecke

      I am very sorry this happened to you.  I was not part of your anesthesia care team, but I would suggest you write a letter to the individual that performed your anesthesia telling them of your displeasure and asking for the reasons they did not honor your request.  While it is not possible for any anesthesia provider to guarantee that events are always going to turn out as they had planned, it is well within your rights to ask why the anesthesia was done in that way.  You can find the name and address of your anesthesia provider from the hospital or the surgeon.  Most of us that perform anesthesia do not want to have unhappy patients out there and would want to hear from you to have a chance to explain.

      • dontdoitagain

        I did that.  The anesthesia nurse stated that 1) He gives 99% of his patients Versed.  2)  He knows what’s best for me.  3) The doctor wanted it.  He tried the “screaming in pain” excuse, but I managed to convince him that the “amnesia” didn’t work on me by repeating verbatim all the nasty comments he said about me when he thought that I couldn’t/wouldn’t remember. The crna actually LAUGHED when I told him all about it!   I wasn’t “screaming in pain” moving, talking or anything other than lying there LISTENING!  I was horrified.  At the time I didn’t realize that I was expected to have complete amnesia about everything.  If I had known,  maybe it wouldn’t have been so shocking…  Honoring my “request” wasn’t in his vocabulary.  I had no intention of continuing with the surgery if it involved sedation or g/a. HE had no intention of allowing me to stay awake, in any way.  He won.  I’m on the hook for the bill.  I wasn’t asking for guarantees.  I expected to experience some pain, maybe, since the crna said that the nerve block HE gave me was dangerous and had a high fail rate.  His instructions were to use a more local numbing agent if the block was not totally effective.  I know this can be done.  He just chose not to…  Thank you very much for kind words! 

  • paulzi

    For all the interested ones on low flow aneshtesia I suggest:
    1. Go to GOOGLE and type “Low Flow Aneshtesia”, Drager
    2. Go to GOOGLE and type “Low Flow Aneshtesia” ppt, zilberman

  • Robert Luedecke

    As a fellow anesthesiologist and member of the American Society of Anesthesiologists, my compliments to the authors and to the ASA for focusing attention on pollution that comes from the operating room.  Reducing both the huge amount of trash that goes into our landfills and greenhouse gasses we release every day are very worthy of our time and attention.

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