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IF 24.1 1区医学 Q1 ENVIRONMENTAL SCIENCES

Lancet Planetary Health Pub Date : 2025-02-01 DOI:10.1016/S2542-5196(24)00331-0

Douglas A Colquhoun MB ChB , David Hovord MB BChir , Robyn Rachel MHSA , Yuan Yuan MS , Graciela B Mentz PhD , Prabhat Koppera MD , Timur Z Dubovoy MD , Prof Paul Picton MB ChB , Prof George A Mashour MD

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引用次数: 0

摘要

背景吸入式麻醉剂是温室气体。然而，改变吸入麻醉剂的给药方式可以减轻对环境的影响。方法我们于 2022 年 3 月发起了绿色麻醉倡议（GAIA），旨在减少氧化亚氮的使用、使用对环境危害较小的吸入氟化醚以及增加静脉麻醉剂的使用。在这项回顾性队列研究中，我们使用了 2021 年 3 月 1 日至 2023 年 2 月 28 日期间美国一家学术医疗中心跨多个地点为所有 1 岁以上患者实施的全身麻醉的电子健康记录数据，收集了 GAIA 推出前后的数据。麻醉机记录的数据缺失或无效的患者、因电惊厥治疗而接受全身麻醉的患者以及符合美国麻醉医师协会身体状况分类 6 的患者均被排除在外。利用多变量模型，我们比较了估计的二氧化碳当量，其次是麻醉剂量、术后恶心和呕吐、0-10 级疼痛评分以及术中意识与明确回忆的报告。研究结果我们记录了干预前的 45 692 名患者（23 193 名[50-8%]女性，22 494 名[49-2%]男性，5 名[<0-1%]未知）和干预后的 47 199 名患者（23 981 名[50-8%]女性，23 209 名[49-2%]男性，9 名[<0-1%]未知）。实施 GAIA 后，每位患者的二氧化碳当量减少了 14-38 千克（95% CI -14-68 至 -14-07；p<0-0001）。中位麻醉剂用量（最小肺泡浓度-0-02 [95% CI -0-02 to -0-01]；p<0-0001）和疼痛评分（-0-34 [-0-39 to -0-29]；p<0-0001）没有临床意义上的差异。术后恶心和呕吐的情况没有变化（几率比0-98 [95% CI 0-94-1-02]；P=0-26）。两个阶段都报告了少量明确的术中意识事件（干预前一次，干预后两次）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Environmental and patient safety outcomes of a health-system Green Anesthesia Initiative (GAIA): a retrospective observational cohort study

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

We launched the Green Anesthesia Initiative (GAIA) in March, 2022, with the aims of reducing the use of nitrous oxide, using less environmentally harmful inhaled fluorinated ethers, and increasing intravenous anaesthetic use. In this retrospective cohort study, we used electronic health record data from general anaesthetics performed on all patients older than 1 year between March 1, 2021, and Feb 28, 2023, at a single US academic medical centre across multiple sites, collecting data from before and after the introduction of GAIA. Patients with missing or invalid data recorded by the anaesthesia machine, patients given general anaesthetics for electroconvulsive therapy, and patients who met American Society of Anesthesiologists Physical Status Classification 6 were excluded. Using multivariable modelling, we compared estimated CO₂, 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

We recorded 45 692 patients pre-intervention (23 193 [50·8%] female, 22 494 [49·2%] male, five [<0·1%] unknown) and 47 199 post-intervention (23 981 [50·8%] female, 23 209 [49·2%] male, nine [<0·1%] unknown). After the implementation of GAIA, CO₂, 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.

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来源期刊

Lancet Planetary Health Multiple-

CiteScore

28.40

自引率

2.30%

发文量

272

审稿时长

8 weeks

期刊介绍： The Lancet Planetary Health is a gold Open Access journal dedicated to investigating and addressing the multifaceted determinants of healthy human civilizations and their impact on natural systems. Positioned as a key player in sustainable development, the journal covers a broad, interdisciplinary scope, encompassing areas such as poverty, nutrition, gender equity, water and sanitation, energy, economic growth, industrialization, inequality, urbanization, human consumption and production, climate change, ocean health, land use, peace, and justice. With a commitment to publishing high-quality research, comment, and correspondence, it aims to be the leading journal for sustainable development in the face of unprecedented dangers and threats.