Scotland NHS ban Desflurane Anesthetic….why should you care? You should.

[deema]

Scotland and soon the UK are to ban the use of Desflurane Anaesthetic on grounds that it has a high global warming foot print. Sounds very laudable? But it ignores the reason why it was developed, the medical benefits and why for most patients it’s better to go under with it. In my opinion it’s lunacy!

Now, I’m not medically trained, I’m not an anaesthetist or claim to have any specialist knowledge. I’m just one of a team of five who designed and developed the Tec 6 which is the thing that administrates the drug to the patient. As such I both had to know a great deal about the drug, its uses, benefits and how it has to be administrated. More importantly, I needed to know how it’s administered safely as we designed all the safety protocols for the delivery system. Im also retired so have no agenda.

Now, it’s few years back (c30 years!) I worked on the Vaporiser (that’s what the delivery system is called; think carburettor type device) but going under anaesthetic is a bit like flying, taking off and landing are the most dangerous, or for anaesthetics, going to sleep and then coming back around. Desflurane is still the best drug for most people, it works incredibly fast, it only needs a very low concentration of it in your blood stream to put you asleep. It needs the lowest concentration of any gas anaesthetic. In fact it’s virtually one breath to fall asleep and one breath of normal air to come around. Other drugs take a long time to come out of the body, and leave you feeling groggy for hours after surgery, that masks other symptoms that may need immediate treatment which isn’t good. One of the big benefits of this characteristic is that patients can leave hospital faster, don’t spend as much time in recovery, don’t need as much resources of the NHS.

Any downsides? Well it’s not the cheapest drug, it used to be around £10 / procedure versus £1 for the other stuff. You probably only need to reduce your stay in hospital by 5 mins to make it far more economic! But the cost is a reason in the early days hospital administrators balked at using it!!

So, if you want the least risk from an anaesthetic, fastest recovery time, shortest stay in hospital, you pick (if a suitable patient) Desflurane, so yes you should care. So what if it adds a bit to global warming, it’s benefits far exceed any downside and the green tree hugging loonies need to understand what stupidity they are inflicting on all of us.

 

[Rewound]

this bunch of, how did you put it "green tree hugging loonies" from the lancet seem to disagree with you.
https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(23)00056-5/fulltext

 

[Agent_zed]

'The use of desflurane across the NHS has fallen from 20% of all anaesthetic gases used, to just 3%, over the last 4-5 years.'
https://www.england.nhs.uk/blog/putting-anaesthetic-emissions-to-bed/
Seems like it already happened and hasn't so far caused a massive issue.

'Stopping the use of desflurane across the NHS, with use allowed only in exceptional clinical circumstances, will further reduce harmful emissions by around 40 kilotonnes of carbon a year – the same as powering 11,000 homes every year.'

Seems like it is quite a substantial reduction to me.

it’s benefits far exceed any downside

That's quite a statement to make. If you don't believe in global climatic change then it may be true, however if global climatic change is occuring due to anthropogenic emmissions then it is incorrect. For example it is shown that Meningitis increases due to dry dusty environments and increased occurances happen in the 'meningitis belt' which is an area of sub saharan africa. This is only set to get worse as the climate warms and desertification increases. Saving 1 person whilst endangering 100's others doesn't seem like a benefit to me.

Additionally (and I am no medical expert) increases in local anaesthesia use seem like a good idea to me as the risk (as i understand it) is significantly lower to the patient.

 

[deema]

@Rewound Have your read the article? It’s informing what the NHS England has decided to do, not a review of the cost to the environment / benefits of the drug.

The article also highlights the amount of electricity hospitals use, so why don’t we just switch off all the wonderful machines that keep people alive that use electricity? Save the planet? So, yes the Lancet article is just highlighting the looney tree huggers decision.

 

[deema]

@Agent_zed Really, waiting lists haven’t increased? Mean time in hospital hasn’t increased? It will have been affected

 

[Agent_zed]

@Rewound Have your read the article? It’s informing what the NHS England has decided to do, not a review of the cost to the environment / benefits of the drug.

The article also highlights the amount of electricity hospitals use, so why don’t we just switch off all the wonderful machines that keep people alive that use electricity? Save the planet? So, yes the Lancet article is just highlighting the looney tree huggers decision.

you are not comparing like for like. The NHS article I posted states there are suitable alternatives. Turning off the electric is not the same as there is no alternative to no electric, unless they implemented a pedal bike to generate individual power needs next to each bed.
Would you oppose using LED light bulbs and automatic lighting in certain rooms over incandesant light bulbs?

Really, waiting lists haven’t increased? Mean time in hospital hasn’t increased? It will have been affected

Whilst I have no data (I doubt you do either) I don't believe the wait times in hospitals is a result of switching from 1 anaesthesia to another. In fact I would guess if you switched to local anaesthesia over general anaesthesia, where possible, you would decrease wait time as there are less complications and the patient can leave the hospital sooner.

Wait times, in my understanding, are mostly down to decrease in staff.

 

[Jacob]

.......... So what if it adds a bit to global warming, it’s benefits far exceed any downside and the green tree hugging loonies need to understand what stupidity they are inflicting on all of us.

"the green tree hugging loonies" shall inherit the earth! If you can't beat 'em - join 'em!

 

[deema]

@Agent_zed I am rather lucky, in that my wife, now also retired used to run hospitals, some of the largest in the UK. I unfortunately have a great deal of understanding how the NHS works.

The closest equivalent to Desflurane requires circa 3 times as much anaesthetic in your blood stream and doesn’t get you under or back as quickly. It’s not as good.

 

[Jacob]

@Agent_zed I am rather lucky, in that my wife, now also retired used to run hospitals, some of the largest in the UK. I unfortunately have a great deal of understanding how the NHS works.

The closest equivalent to Desflurane requires circa 3 times as much anaesthetic in your blood stream and doesn’t now get you under or back as quickly. It’s not as good.

Read this NHS England » Putting anaesthetic emissions to bed: commitment on desflurane

 

[Spectric]

This will just be another issue for the Uk, we don't seem to comprehend our global position and the fact that changes we make have very little global impact because if you are only contributing a very small perecentage in the first place then even with total removal the effects are negligable.

We are basically destroying ourselves and infrastructure for no reason, what is the true impact of this Desflurane Anaesthetic ? Is it anywhere near as bad as the Ozone depleting refrigerants or methane from cattle.

China has more than 1100 coal fired power stations yet we have just three having closed dozens and now we get the huge energy bills, so what will the impact of not having this Anaesthetic available in the Uk, I dare say it will still be used in most other countries though.

 

[Rewound]

@Rewound Have your read the article? It’s informing what the NHS England has decided to do, not a review of the cost to the environment / benefits of the drug.

The article also highlights the amount of electricity hospitals use, so why don’t we just switch off all the wonderful machines that keep people alive that use electricity? Save the planet? So, yes the Lancet article is just highlighting the looney tree huggers decision.

I think the opening few lines sums it up, clearly those high up in the echelons of medicine and doctoring are very very concerned about what we are doing to our atmosphere.

"Climate change is the biggest threat to global public health in the 21st century. From the increase in death and illness due to severe weather to worsening air quality, changing patterns of infection, and disruption to food supplies, the health effects of climate change are far reaching. WHO expects approximately 250 000 additional deaths per year between 2030 and 2050 from climate-sensitive diseases,"

We're making an utter mess of our planet and we need to change our ways.

 

[Jacob]

This will just be another issue for the Uk, we don't seem to comprehend our global position and the fact that changes we make have very little global impact because if you are only contributing a very small perecentage in the first place then even with total removal the effects are negligable.

We are basically destroying ourselves and infrastructure for no reason, what is the true impact of this Desflurane Anaesthetic ? Is it anywhere near as bad as the Ozone depleting refrigerants or methane from cattle.

China has more than 1100 coal fired power stations yet we have just three having closed dozens and now we get the huge energy bills, so what will the impact of not having this Anaesthetic available in the Uk, I dare say it will still be used in most other countries though.

Every little helps. And setting an example, and developing the technology etc etc
China has never caught up with the per capita rate of the 'developed' in the first place, though is top of the list in terms of total carbon emissions currently. Is likely to be world leader in carbon reduction in the near future.
https://naturalenergyhub.com/solar-energy/top-solar-panel-manufacturers-china/

 

[Agent_zed]

@Agent_zed I am rather lucky, in that my wife, now also retired used to run hospitals, some of the largest in the UK. I unfortunately have a great deal of understanding how the NHS works.

The closest equivalent to Desflurane requires circa 3 times as much anaesthetic in your blood stream and doesn’t now get you under or back as quickly. It’s not as good.

I fully admit that I don't have much knowledge of anaesthetics so I can only look at evidence from what I assume to be reliable sources.

https://www.bjanaesthesia.org.uk/article/S0007-0912(20)30766-2/fulltext
Some key points from the above study

'...the magnitude of the effect is minimal (only a few minutes in most circumstances), and it does not appear that this translates to shorter patient stays in the PACU'

'A recent observational study of more than 100 000 cases by Zucco and colleagues, for example found no difference in postoperative pulmonary complications between patients anaesthetised with sevoflurane and desflurane when adjusted for confounding factors.'

'We contend that a trivially more rapid emergence from general anaesthesia with desflurane compared with sevoflurane may be of greater promotional benefit to the manufacturer than either clinical benefit to the patient or organisational benefit to surgical operating efficiency.'

Always happy to learn more and be corrected but the evidence I am seeing from a quick google of what I assume to be reliable sources is not matching up with your assertations so far.

 

[deema]

@Jacob that’s an interesting article, it’s nicely pitched. Firstly it recognises that Desflurane is an important anaesthetic that can do things others can’t, it’s allowed under certain circumstance. There is absolutely no doubt that there are other anaesthetics tha5 can be used instead, but they are not as clinically good. It’s the old cost versus befit. Now, if the political agenda is for reducing green house gases that this have a larger bearing on the decision. Would you rather have a better chance of a good outcome from your operation, increase the chance of survival, reduce the risk of blood clots, brain haemorrhage or, put a tiny bit more CO2 equivalent into the atmosphere?

 

[Agent_zed]

@Jacob that’s an interesting article, it’s nicely pitched. Firstly it recognises that Desflurane is an important anaesthetic that can do things others can’t, it’s allowed under certain circumstance. There is absolutely no doubt that there are other anaesthetics tha5 can be used instead, but they are not as clinically good. It’s the old cost versus befit. Now, if the political agenda is for reducing green house gases that this have a larger bearing on the decision. Would you rather have a better chance of a good outcome from your operation, increase the chance of survival, reduce the risk of blood clots, brain haemorrhage or, put a tiny bit more CO2 equivalent into the atmosphere?

Please provide evidence for the statement about 'having a better chance of a good outcome'. The article I linked to bjanaesthesia.org.uk showed no difference in a study of over 100,000 patients when using sevoflurane as an alternative.

 

[deema]

@Agent_zed Thats a big question, and worthy of a lot of dissertations! However, rather than limiting you towards a load of articles to which there will be contra articles, as is the nature of medicine, I can highlight somethings that might indictae the value of the drug (hopefully my memory is up to it) There are a number of procedures, where being able to vary the depth of anesthetiser is important. Having a rapidly acting drug is beneficial. When under anaesthetic patients can and do become too light and start to have sensation, a drug that can put them back under very very quickly is of benefit. In recovery, the best way of determining side effects is to talk to the patient to ascertain mental capacity, the sooner you can the better, a few minutes can make a huge difference between giving someone oxygen and irreversible brain damage.

 

[Jameshow]

@gasman might have an opinion?!!

 

[Jacob]

@Jacob that’s an interesting article, it’s nicely pitched. Firstly it recognises that Desflurane is an important anaesthetic that can do things others can’t, it’s allowed under certain circumstance. There is absolutely no doubt that there are other anaesthetics tha5 can be used instead, but they are not as clinically good. It’s the old cost versus befit. Now, if the political agenda is for reducing green house gases that this have a larger bearing on the decision.

It's not a "political" agenda it's a survival of life as we know it agenda.

Would you rather have a better chance of a good outcome from your operation, increase the chance of survival, reduce the risk of blood clots, brain haemorrhage or, put a tiny bit more CO2 equivalent into the atmosphere?

Reducing carbon footprint can't be achieved without a cost at one level or another.

 

[deema]

Carbon footprint is all about how you measure it, and also what bias you want to support. So, if a choose to read the following article, I will be persuaded that Desflurane has a much smaller carbon footprint than what the NHS wishes tonuse instead, it’s all about how it’s made.

https://www.sciencedirect.com/science/article/abs/pii/S0921344921000185
Here is the main graph showing the difference between the main anaesthetics. So, taking the NHS car in footprint, rather than whole cost from manufacture to usage of the drug gives totally different results.

 

[deema]

@Jacob, you are entitled to your opinion, if you prefer being knocked on the head, or drinking a bottle of whisky before surgery or just kill off the human population to save the planet that’s all good. But please put down you computer to save the planet, the carbon cost of making it / replacing it / using it (the WWW uses ridiculous amounts of power, enough to power large countries) is far higher than the bit extra produced by using any of the anaesthetics if you need surgery.