Environmental and patient safety outcomes of a health-system Green Anesthesia Initiative (GAIA): a retrospective observational cohort study
Douglas A. Colquhoun, David Hovord, Robyn Rachel, Yuan Yuan, Graciela Mentz, Prabhat Koppera, Timur Dubovoy, Paul Picton, George A. Mashour
Abstract
BACKGROUND: Inhaled anaesthetics are greenhouse gases. However, changes in the delivery of inhaled anaesthetics can mitigate environmental impact. We hypothesised that system-wide changes to the delivery of anaesthesia care would reduce environmental harm without compromising patient outcomes. METHODS: , equivalents and, secondarily, anaesthetic dose, postoperative nausea and vomiting, pain scores on a 0-10 scale, and reports of intraoperative awareness with explicit recall. FINDINGS: , equivalents were reduced by 14·38 kg per patient (95% CI -14·68 to -14·07; p<0·0001). There was no clinically meaningful difference in median anaesthetic delivered (minimum alveolar concentration -0·02 [95% CI -0·02 to -0·01]; p<0·0001) nor pain scores (-0·34 [-0·39 to -0·29]; p<0·0001). Postoperative nausea and vomiting was unchanged (odds ratio 0·98 [95% CI 0·94-1·02]; p=0·26). A small number of definite intraoperative awareness events were reported in both periods (one pre-intervention and two post-intervention). INTERPRETATION: A health-system wide intervention reduces greenhouse gas emissions attributable to anaesthesia care without detriment to patient outcomes. FUNDING: University of Michigan Medical School and National Institutes of Health.