ESA June 2-4th
Gress Gauthier, Pauchard Jean Claude, MD, Nouette-Gaulain Karine, MD PhD
How to reduce our greenhouse gas release from the operating room : an example from Bordeaux University Hospital (France).
Background & goal of study : Anesthesia gases (halogenated agents and nitrous oxide N2O) are the most communly used for general anesthesia maintenance. However, they are greenhouse gases. Solutions, as making the well-reasoned inhaled agent choice and reducing fresh gas flow, may reduce our environmental impact. The aim of the study is to determine the healthcare workers knowledges on ecological footprint and their ecoresponsible professional practice in the operating room of Bordeaux’s university hospital (France).
Materials & Methods : We conducted an observationnal prospective clinical study for the first part of a professional practice patterns evaluation on ecological inhaled agents management in all the operating rooms of Bordeaux’s university hospital. From January to June 2016 we collected datas on intraoperative mecanical ventilation and inhaled agents consumption. Then, from January to May 2017 all the healthcare workers received a survey on their knowledges on ecological footprint and their ecoresponsible professional practice. The study was approved by the relevant ethics committee.
Results & Discussion : 342 patients were included. For induction, the fresh gas flow was <8L/min in less than 19% of cases. The inspiratory oxygen fraction was 1 in 100% of cases. For maintenance of anesthesia, the mean fresh gas flow was 2,5 (+/- 1) L/min.  The fresh gas flow was < 1L/min in 0% of cases. When Target Controlled Inhalation mode was available, it was used in 65% of cases. Nitrous oxide was never used neither for induction nor for maintenance. From January to June 2017, sevoflurane consumption was 496,75 liters which represents 98 158 kilograms carbon dioxide eqivalent (EqkgC02). Desflurane consumption was 48,75 liters which represents 173553 kilograms carbon dioxide eqivalent. These total emissions are equivalent to 1 940 792km of a standard european petrol car. 68 doctors & nurses answered the survey. 99% of them declared using sevoflurane for general anesthesia maintenance. Mean fresh gas flow was declared to be settled between 0,9 and 1,5L/min by 70% of participants. There was little consensus on the question of environmental impact: none of the participants knew the right cost and ecological footprint of inhaled agents. 99% of participants were willing for a more acurate information on this environmental impact. Our study highlights three ways of improving : reducing fresh gaz flow, increasing the use of Target Controlled Inhalation mode and making a weel-reasonned choice of inhaled agent. A protocol of well-reasonned use of inhaled anesthesics was established and information was given to medical practioners.
Conclusion : By promoting a well-reasonned use of inhaled anesthesics and by reducing fresh gas flow, we may decrease our environmental impact. A further study will be conducted to show if these changes in inhaled anesthesics management was succesfull for reducing our ecological footprint.

01 / Evaluation of financial, environmental cost and ecoresponsible professional practice of inhaled anaesthesia : an example from Bordeaux University Hospital (France)