I’ve only just found out there is an entire day dedicated to the work we anaesthetists do! Happy World Anaesthesia Day! To the uninitiated, we may conjure this image of us being crossword loving and coffee drinking clinicians but I’d like to think there is a little more to us than meets the eye!
Being the largest cohort of doctors in the hospital environment, we tend to look after patients from all walks of life across a range of ages – whether that be before they are admitted to hospital, on the ward or on intensive care. This is something we have been doing well for many years. However, we are facing a new challenge in caring for our patients – climate change. This will drive poverty, social and health inequalities and must be tackled head on. We – as anaesthetists – are helping to lead the way, ensuring we are delivering a sustainable healthcare service.
The NHS net zero aims are bold, and Newcastle Hospitals have set themselves an even bolder goal to get to this. As a Fellow in Environmentally Sustainable Anaesthesia, working between Newcastle Hospitals, the Centre for Sustainable Healthcare and the Association of Anaesthetists I’ve been fortunate enough to explore our current strategies and how we can tackle the monumental hurdles we face.
My work at the Freeman Hospital, in Newcastle, has facilitated the disuse of Desflurane and Nitrous Oxide. These are the biggest impact greenhouse gases we use in terms of global warming potential and by volume, respectively. If we are able to continue delivering a safe anaesthetic without these agents then it is morally right we shift our practise. Within this, there is a national movement, through NHS England to continue reducing Desflurane use. Ultimately, the EU will ban this agent by 2026 but it would be great if we could get to zero use before this point!
As we continue to use other volatile anaesthetic agents at low flows, the question then moves as to how we mitigate the ongoing environmental burden we produce? The answer may be behind volatile capture technology – two manufacturers in Europe are currently instigating the use of these devices and we at the Freeman Hospital are conducting pilot studies with the Sagetech device, and with intentions to trial the Baxter Zeosys device in the near future. Only by understanding the efficacy of this technology can we appreciate how effective it could be in reducing our Scope 1 greenhouse gas emissions.
If we move away from anaesthetic gases, as an anaesthetist in theatre, I feel we are still responsible for all the other activities occurring. Theatre energy use is 6 times more burdensome than the rest of the hospital and the biggest consumers of this will be the heating, ventilation and air conditioning systems (HVAC) and Anaesthetic Gas Scavenging Systems (AGSS). There are strategies to mitigate 24 hour running of these systems and only by linking estates with the clinical team have we been able to safely explore this.
One of the biggest frustrations is the ready availability and use of single use devices. Only by challenging the logistical and infection control barriers can we find a shift away from advocating single use items. For example, one reusable laryngoscope has a rateable lifespan of 4,000 uses. This would be 4,000 intubations on 4,000 patients. However, our preference of a single use laryngoscope requires 4,000 laryngoscopes to intubate the same number of patients! To combat this culture of excessive use, I have been able to form a working party at the Association of Anaesthetists, advocating where appropriate, the use of reusable items. Look out for a new set of guidelines coming out over the next year.
A lot of the changes outlined above would hold little weight if there wasn’t an education drive to increase the awareness of sustainability in healthcare. Medical students are the future of our healthcare service and informing them of the pillars of sustainable healthcare in line with the good medical practise curriculum at Newcastle University Medical School has been one of the more rewarding outcomes. But what of us who are currently working? The Centre of Sustainable Healthcare has been a driving force in grassroots sustainability and we have been able to create a course in sustainable anaesthesia – for those of you starting your sustainability journey, it will provide you with the necessary foundations to give you the momentum to create real change.
Overall, it’s been a mentally challenging year in this role but incredibly fulfilling and the work continues. I was recently awarded with the SHINE (Sustainable Healthcare in Newcastle) award at the trust’ annual Celebrating Excellence Awards for promoting all of the above sustainable work. Although the work so far hasn’t been done for any intended credit, it is rewarding to have the recognition and be someone that colleagues can turn to in helping to drive a sustainable future for our healthcare service.
A guiding philosophy from someone whom I share surnames, “…be the change you wish to see in the world”.
Dr Jason Gandhi
Association of Anaesthetists and Centre for Sustainable Healthcare Fellow in Sustainable Anaesthesia, Newcastle upon Tyne Hospitals.
Jason Gandhi is a junior anaesthetist working at Newcastle Hospitals and is undertaking a joint role, with the Association of Anaesthetists and Centre for Sustainable Healthcare, as the Environmentally Sustainable Anaesthetic Fellow. Jason will be continuing to push forward the green agenda nationally within Anaesthesia, focusing on inhalational gas use, anaesthetic gas capture technology and the wider theatre energy use.
