Clinical trial NCT04163848: CARbon Impact of aNesthesic Gas
Official title: CARbon Impact of aNesthesic Gas - A Carbon Footprint Comparison of Sevoflurane and Desflurane in an Optimized Fresh Gas Flow Protocol
Study type: OBSERVATIONAL
Overall status: COMPLETED
Conditions: Gas; Inhalation
Anesthesia
Keywords: Desflurane
Sevoflurane
Fresh gas flow
Environment
Lead sponsor: Ciusss de L'Est de l'Île de Montréal
Sponsor class: OTHER
First posted: 2019-11-15
Enrollment: 58
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Observational model: OTHER
Time perspective: PROSPECTIVE
Sampling method: PROBABILITY_SAMPLE
Study population: General population undergoing laparoscopic gynecologic, urologic or general surgery

Brief summary: Assessing the impact of anesthesia practice on global warming and carbon footprint becomes part of the standard of care and is growing concern within the anesthesia community. Global Warming Potential (GWP) is a measure of how much a given mass of greenhouse gas contributes to global warming over a specified time period. Inhaled anesthetics have various GWP20: 349 for sevoflurane and 3714 for desflurane. However, GWP20 and CDE20 alone are not sufficient to evaluate the environmental impact of anesthetic gases. Other parameters must be included in the analysis: fresh gas flow (FGF), carrier gas (air, O2, N2O) and potency of the anesthetic gas. Unfortunately, the majority of trials did not fully consider the FGF reduction and the fact that desflurane can be administered with new closed or very low-flow anesthesia circuits as opposed as the recommended 2L/min that must be used for sevoflurane according to its monography in Canada. Most of the calculations were made on a purely theoretical approach that could be different from actual measurements based on a strictly monitored anesthesia practice. When continuous and accurate gas monitoring and analysis is used as recommended nowadays, the use of closed or semi-closed-circuit anesthesia with very low FGF might allow for a reduction of more than 80% of the anesthetic gas administration and its consequent pollution. By properly monitoring the anesthesia depth and analgesia adequacy, the investigators can reduce the gas consumption. The proposed study will aim at determining whether with the help of high-quality monitoring (BIS and NOL) and high-end ventilators that allow minimal fresh gas flow, the use of desflurane remains more polluting than sevoflurane.


Eligibility criteria: Inclusion Criteria:

* ASA 1-3 patients,
* laparoscopic general, gynecological or urologic surgery requiring general anesthesia without additional regional anesthesia technique
* fully consented,
* BMI \< 40,
* age \> 18yo,

Exclusion Criteria:

* post-operative need for a neuraxial or regional analgesic technique
* history of active coronary artery disease
* serious cardiac arrhythmia (including atrial fibrillation)
* history of substance abuse
* chronic use of psychotropic and/or opioid drugs
* history of psychiatric diseases with the need of medication
* history of refractory PONV
* allergy or contra-indication to any drug used in the study protocol
* refusal of the patient for participation in the study

Primary outcomes:
measure: CO2 equivalent of volatile inhaled anesthesic gases use in grams
timeFrame: From intubation to end of surgery
Secondary outcomes:
measure: Total volatile inhalated anesthesics consumption in mL
timeFrame: From intubation to end of surgery
measure: Cost in dollars
timeFrame: From intubation to end of surgery
measure: Extubation time in minutes
timeFrame: From stopping anesthesics gases to extubation
measure: Recovery room time in minutes
timeFrame: From end of surgery to 240minutes post-surgery
Other outcomes:
Locations:
city: Montréal
country: Canada
facility: Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est de l'Ile de Montréal
state: Quebec
Study officials:
References: