Anaesthetic gases and the environment: Is it time for a rethink?

BACKGROUND: General anaesthesia is in common use for patients undergoing surgical procedures, with the option of both inhalational and intravenous anaesthetic techniques. Anaesthetic gases are often excluded from discussions on sustainable healthcare delivery, despite being a significant contributor to the overall environmental impact of healthcare services. METHODS: A literature review was carried out on previously published papers on the impact anaesthetic gases have on our environment and at ways to reduce their impact in current anaesthetic practice. The aim was to write a narrative review detailing the areas of concern as well as the current clinical situation in the European setting. SUMMARY/CONCLUSIONS: The two classes of inhaled anaesthetic agent most frequently used are nitrous oxide and volatile agents (most commonly sevoflurane, isoflurane and desflurane). Both are recognised greenhouse gases that contribute to climate change. Minor modifications in the use of anaesthetic gases can have a significant environmental impact. These modifications include avoiding nitrous oxide whenever possible, avoiding desflurane (and using sevoflurane instead), using low flow anaesthesia during maintenance, swapping volatile-based anaesthesia for a TIVA technique when clinically appropriate and considering the use of central neuraxial or regional anaesthesia in place of general anaesthesia when possible.

Placental weights from normal deliveries in Ireland.

BACKGROUND: The weight of the delivered placenta gives a useful representation of placental function in utero. In the absence of Irish data, many pathologists rely on data from other populations, many of which are now 15 to 30 years old. The development of a population-specific nomogram would aid in the examination of placentas after delivery, allowing pathologists and medical scientists to more easily distinguish between placental physiological changes and pathology. AIMS: To record placental weights among women having a singleton delivery in Dublin and to establish median placental weights for each gestational age after 37 weeks. METHODS: Prospective cohort study in a Tertiary level University Hospital. All singleton pregnancies were included; stillbirths, multiple gestations, and cases with obstetric complications involving the placenta were excluded. The placentas were weighed both untrimmed and trimmed with standard scales. Demographic features including birth weight and maternal parity were also recorded. RESULTS: Four hundred thirty placentas were weighed over a 6-week period. A median term placental weight based on gestational age was established, with a range from the tenth to ninetieth centiles. CONCLUSION: The weight of the placenta is one of several measurements that are easy to acquire, and when recorded in a systematic fashion, provide information not just on an individual, but also on a population basis. Birth weights have increased over the last century, and this study provides national data helping distinction between placental physiology and pathology.