AnesthesiaNCT06084039
Reducing the Carbon Footprint Through Education on the Effects of Inhalation Anesthetics on Global Warming
An observational study of Anesthesia, run by Pusan National University Yangsan Hospital at 1 site in South Korea.
Trial summary
Inhalation anesthetics, such as desflurane, are identified as contributors to global warming, with the European Union planning to ban desflurane in 2026 due to its impact. The World Federation of Societies of Anesthesiologists (WFSA) has published guidelines to reduce air pollution related to inhalation anesthetics. Read more about this study
- Who is it for?
- Any age
- Conditions the study is for
- Anesthesia
- How many people
- 4,478 participants
- Where
- 1 siteSouth Korea
- Study dates
- 1 Aug 2022to 25 Sep 2023
- Phase
- Observational
- Are there results?
- None posted in the registry
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- No healthy volunteers
- Child, Adult, Older adult
Study population: Patients who received general anesthesia using inhalation anesthetics
Who may be able to join
- Patients who underwent surgery under general anesthesia performed for 1 month before and after education on the effects of inhalation anesthetics on global warming
Who cannot join
- Surgery performed under regional anesthesia
- Surgery performed under total intravenous anesthesia
- When the type of inhalation anesthetic is changed during surgery
- Short surgery within 1 hour
- In case of anesthesia by an anesthesiologist who did not attend the education on the effects of inhalation anesthetics on global warming
Trial locations and contacts
1 site in 1 country.
About this study
Official title: Reducing the Carbon Footprint of Operating Rooms Through Education on the Effects of Inhalation Anesthetics on Global Warming
Inhalation anesthetics, such as desflurane, are identified as contributors to global warming, with the European Union planning to ban desflurane in 2026 due to its impact. The World Federation of Societies of Anesthesiologists (WFSA) has published guidelines to reduce air pollution related to inhalation anesthetics. Inhalation anesthetics account for a significant portion of carbon dioxide equivalent (CO2e) emissions in hospitals and surgery. Various anesthetics have different global warming potentials (GWP100), with desflurane having the highest GWP100. Nitrous oxide and isoflurane, although having lower GWP100, can also impact the environment negatively. Studies have shown that educating anesthesia staff about the environmental impact of desflurane and nitrous oxide can lead to significant reductions in their usage, resulting in lower CO2e emissions and cost savings. However, in some regions like Korea, awareness of the environmental impact of inhalation anesthetics is limited. The authors plan to analyze the impact of education on anesthesiologists regarding inhalation anesthetics and assess changes in their usage and CO2e emissions in clinical settings. The goal is to demonstrate that education can positively influence environmental outcomes and reduce economic losses.
Read the detailed description
Environmental issues are a global concern and a problem that everyone must solve together. Recently, there have been efforts to reduce carbon footprint in the medical field. In the field of anesthesiology, as it became known that inhalation anesthetics have a significant impact on global warming, the European Union officially declared in 2022 to ban the use of the inhalation anesthetic desflurane from 2026. Additionally, the World Federation of Societies of Anesthesiologists (WFSA) published guidelines on the use of inhalation anesthetics to reduce air pollution in 2022.
Inhalation anesthetics are known to account for 0.01-0.1% of the total carbon dioxide equivalent (CO2e) contribution to global warming. This is 5% of hospital CO2e and 50% of surgery-related CO2e. Only 5% of the inhalation anesthetic is metabolized in the patient's body, and the remaining 95% is discharged through the anesthetic gas scavenging system of the anesthesia machine and released into the atmosphere without any additional post-processing. Representative inhalation anesthetics that are currently widely used include nitrous oxide (N2O), sevoflurane, desflurane, and isoflurane. Comparing their global warming potential (global warming potential 100, GWP100; which indicates the degree of greenhouse gas effect compared to CO2 over 100 years), nitrous oxide 298, sevoflurane 130, desflurane 2540, and isoflurane 510. Among these, desflurane shows the highest GWP100 and is presumed to be due to its high minimum alveolar concentration. In addition, nitrous oxide and isoflurane have relatively low global warming potential, but they can destroy ozone and, in particular, nitrous oxide has a half-life of 114 years, so it can stay in the atmosphere for a long time and affect global warming.
Several studies have reported significant reductions in CO2e and medical costs along with a reduction in the use of these two anesthetics after educating anesthesia staff on the use of desflurane and nitrous oxide. In one study, desflurane usage was reduced by 95.63% and CO2e was reduced by 87.88%. In another study, desflurane use was reduced from 8.3% to 0.3%, CO2e was reduced from 1,681 to 10, and medical costs were saved by $200,000 over 3 years. In Korea, sevoflurane and desflurane are the most used, but the impact of inhalation anesthetics on global warming is not well-known to clinicians, and there are no related studies.
After educating anesthesiologists about the impact of inhalation anesthetics on global warming, the investigators analyzed the use of inhalation anesthetics and changes in CO2e before and after education in actual clinical situations to determine whether education alone could reduce their use. In addition, the investigators aim to show that this can have a positive impact on global warming and economic losses.
Education on the effects of inhalation anesthetics on global warming was conducted for every anesthesiologist in our hospital, and only medical records were reviewed retrospectively to confirm if there were any changes in choice of inhalation anesthetic, and fresh gas flow before and after receiving the training. Inevitably, patients for whom general anesthesia was performed by untrained anesthesiologists about the effects of inhalation anesthetics on global warming were excluded from the analysis. This is an observational study because there is no intervention applied to the patient, and patients not included in the study are also administered general anesthesia using the same method.
- Conditions
- Anesthesia
What is being measured
The primary outcome is the main question the study is designed to answer.
Concentration of inhalation anesthetic used to maintain general anesthesia
It is calculated using the average value of the inhalation anesthetic concentration and fresh gas flow rate during the entire anesthesia time, excluding 15 minutes after the start of general anesthesia and 15 minutes before the end of anesthesia. The formula for calculating the total amount of inhalation anesthetic is as follows.
Total amount of inhalation anesthetic used (mL)=([(Fresh gas flow rate (L/min)*1000)*(concentration of inhalation anesthetic (vol%))]/ Density (kg/cm3))* duration of anesthesia (hrs)
- Amount of sevoflurane used per hour (mL)
- ([((MW (kg/mol)*(FGF (L/min)*1000)*(concentration of sevoflurane (vol%)/100)/24400)/1000]*60)/ Density (kg/cm3)
- [(200 *(FGF*1000)*(vol%/100)/24400)/1000]*60/ 0.00152
- Amount of desflurane used per hour (mL)
- ([((MW (kg/mol)*(FGF (L/min)*1000)*(concentration of desflurane (vol%)/100)/24400)/1000]*60)/ Density (kg/cm3)
- [(168 *(FGF*1000)*(vol%/100)/24400)/1000]*60/ 0.001465
Measured: Total time for general anesthesia, up to 24hours
Fresh gas flow rate used to maintain general anesthesia
It is calculated using the average value of the inhalation anesthetic concentration and fresh gas flow rate during the entire anesthesia time, excluding 15 minutes after the start of general anesthesia and 15 minutes before the end of anesthesia. The formula for calculating the total amount of inhalation anesthetic is as follows.
Total amount of inhalation anesthetic used (mL)=([(Fresh gas flow rate (L/min)*1000)*(concentration of inhalation anesthetic (vol%))]/ Density (kg/cm3))* duration of anesthesia (hrs)
- Amount of sevoflurane used per hour (mL)
- ([((MW (kg/mol)*(FGF (L/min)*1000)*(concentration of sevoflurane (vol%)/100)/24400)/1000]*60)/ Density (kg/cm3)
- [(200 *(FGF*1000)*(vol%/100)/24400)/1000]*60/ 0.00152
- Amount of desflurane used per hour (mL)
- ([((MW (kg/mol)*(FGF (L/min)*1000)*(concentration of desflurane (vol%)/100)/24400)/1000]*60)/ Density (kg/cm3)
- [(168 *(FGF*1000)*(vol%/100)/24400)/1000]*60/ 0.001465
Measured: Total time for general anesthesia, up to 24hours
Secondary outcomes (1)
CO2e (total carbon dioxide equivalent), driving equivalent (equivalent driving distance, distance traveled by car to generate the same amount of greenhouse gases), and medical costs incurred due to the use of inhalation anesthetics
Based on data examined from medical records, CO2e (total carbon dioxide equivalent), driving equivalent (equivalent driving distance, distance required to drive to generate the same amount of greenhouse gases), and medical costs incurred due to inhalation anesthetics were calculated by Anesthesia cost calculator (https://jscalc.io/calc/do45BOJVrzXMaEGC). The formulas for calculating CO2e (total carbon dioxide equivalent), and driving equivalent are as follows.
- CO2e (kg) =130 * 200* ((FGF*1000)*(concentration of inhalation anesthetic /100)/24400/1000)*60* duration of anesthesia
- driving equivalent (km) = CO2e *3.922
Measured: Total time for general anesthesia, up to 24hours
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted16 Oct 2023
- Study start1 Aug 2022
- Primary completion28 Feb 2023
- Study completion25 Sep 2023
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for AnesthesiaStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Retrospective
- Enrolment
- 4,478 participants (actual)
Sponsor and investigators
- Lead sponsor
- Pusan National University Yangsan Hospital
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Kim Hee Young, Pusan National University Yangsan Hospital
- Investigators
- Hee Young Kim, MD, PhD, Principal investigator, Pusan National University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT06084039
- Sponsor's protocol ID
- 05-2023-067
- Status last verified
- Oct 2023
- First submitted
- 30 Sep 2023
- Last updated
- 31 Oct 2023
- Results posted
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
Study at a glance
From the registry record, last updated by the sponsor on 31 Oct 2023. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Reducing the Carbon Footprint of Operating Rooms Through Education on the Effects of Inhalation Anesthetics on Global Warming
- ClinicalTrials.gov ID
- NCT06084039
- Acronym / sponsor ID
- 05-2023-067
- Conditions
- Anesthesia
- Study type
- Observational
- Recruitment status
- Completed
- Enrolment
- 4,478 participants (actual)
- Lead sponsor
- Pusan National University Yangsan HospitalUniversity, hospital or other
- Study start
- 1 Aug 2022 (actual)
- Primary completion
- 28 Feb 2023 (actual)
- Study completion
- 25 Sep 2023 (actual)
- First posted
- 16 Oct 2023 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Inhalation anesthetics, such as desflurane, are identified as contributors to global warming, with the European Union planning to ban desflurane in 2026 due to its impact. The World Federation of Societies of Anesthesiologists (WFSA) has published guidelines to reduce air pollution related to inhalation anesthetics. Inhalation anesthetics account for a significant portion of carbon dioxide equivalent (CO2e) emissions in hospitals and surgery. Various anesthetics have different global warming potentials (GWP100), with desflurane having the highest GWP100. Nitrous oxide and isoflurane, although having lower GWP100, can also impact the environment negatively. Studies have shown that educating anesthesia staff about the environmental impact of desflurane and nitrous oxide can lead to significant reductions in their usage, resulting in lower CO2e emissions and cost savings. However, in some regions like Korea, awareness of the environmental impact of inhalation anesthetics is limited. The authors plan to analyze the impact of education on anesthesiologists regarding inhalation anesthetics and assess changes in their usage and CO2e emissions in clinical settings. The goal is to demonstrate that education can positively influence environmental outcomes and reduce economic losses.
Detailed description
Environmental issues are a global concern and a problem that everyone must solve together. Recently, there have been efforts to reduce carbon footprint in the medical field. In the field of anesthesiology, as it became known that inhalation anesthetics have a significant impact on global warming, the European Union officially declared in 2022 to ban the use of the inhalation anesthetic desflurane from 2026. Additionally, the World Federation of Societies of Anesthesiologists (WFSA) published guidelines on the use of inhalation anesthetics to reduce air pollution in 2022.
Inhalation anesthetics are known to account for 0.01-0.1% of the total carbon dioxide equivalent (CO2e) contribution to global warming. This is 5% of hospital CO2e and 50% of surgery-related CO2e. Only 5% of the inhalation anesthetic is metabolized in the patient's body, and the remaining 95% is discharged through the anesthetic gas scavenging system of the anesthesia machine and released into the atmosphere without any additional post-processing. Representative inhalation anesthetics that are currently widely used include nitrous oxide (N2O), sevoflurane, desflurane, and isoflurane. Comparing their global warming potential (global warming potential 100, GWP100; which indicates the degree of greenhouse gas effect compared to CO2 over 100 years), nitrous oxide 298, sevoflurane 130, desflurane 2540, and isoflurane 510. Among these, desflurane shows the highest GWP100 and is presumed to be due to its high minimum alveolar concentration. In addition, nitrous oxide and isoflurane have relatively low global warming potential, but they can destroy ozone and, in particular, nitrous oxide has a half-life of 114 years, so it can stay in the atmosphere for a long time and affect global warming.
Several studies have reported significant reductions in CO2e and medical costs along with a reduction in the use of these two anesthetics after educating anesthesia staff on the use of desflurane and nitrous oxide. In one study, desflurane usage was reduced by 95.63% and CO2e was reduced by 87.88%. In another study, desflurane use was reduced from 8.3% to 0.3%, CO2e was reduced from 1,681 to 10, and medical costs were saved by $200,000 over 3 years. In Korea, sevoflurane and desflurane are the most used, but the impact of inhalation anesthetics on global warming is not well-known to clinicians, and there are no related studies.
After educating anesthesiologists about the impact of inhalation anesthetics on global warming, the investigators analyzed the use of inhalation anesthetics and changes in CO2e before and after education in actual clinical situations to determine whether education alone could reduce their use. In addition, the investigators aim to show that this can have a positive impact on global warming and economic losses.
Education on the effects of inhalation anesthetics on global warming was conducted for every anesthesiologist in our hospital, and only medical records were reviewed retrospectively to confirm if there were any changes in choice of inhalation anesthetic, and fresh gas flow before and after receiving the training. Inevitably, patients for whom general anesthesia was performed by untrained anesthesiologists about the effects of inhalation anesthetics on global warming were excluded from the analysis. This is an observational study because there is no intervention applied to the patient, and patients not included in the study are also administered general anesthesia using the same method.
Study design
- Observational model
- Cohort
- Time perspective
- Retrospective
Who may qualify
- Sex
- All
- Healthy volunteers
- Not accepted
- Age groups
- Child, Adult, Older adult
- Study population
- Patients who received general anesthesia using inhalation anesthetics
Key inclusion criteria (1 listed)
- Patients who underwent surgery under general anesthesia performed for 1 month before and after education on the effects of inhalation anesthetics on global warming
Key exclusion criteria (5 listed)
- Surgery performed under regional anesthesia
- Surgery performed under total intravenous anesthesia
- When the type of inhalation anesthetic is changed during surgery
- Short surgery within 1 hour
- In case of anesthesia by an anesthesiologist who did not attend the education on the effects of inhalation anesthetics on global warming
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
Concentration of inhalation anesthetic used to maintain general anesthesia
Time frame: Total time for general anesthesia, up to 24hours
It is calculated using the average value of the inhalation anesthetic concentration and fresh gas flow rate during the entire anesthesia time, excluding 15 minutes after the start of general anesthesia and 15 minutes before the end of anesthesia. The formula for calculating the total amount of inhalation anesthetic is as follows. Total amount of inhalation anesthetic used (mL)=([(Fresh gas flow rate (L/min)*1000)*(concentration of inhalation anesthetic (vol%))]/ Density (kg/cm3))* duration of anesthesia (hrs) * Amount of sevoflurane used per hour (mL) * ([((MW (kg/mol)*(FGF (L/min)*1000)*(concentration of sevoflurane (vol%)/100)/24400)/1000]*60)/ Density (kg/cm3) * [(200 *(FGF*1000)*(vol%/100)/24400)/1000]*60/ 0.00152 * Amount of desflurane used per hour (mL) * ([((MW (kg/mol)*(FGF (L/min)*1000)*(concentration of desflurane (vol%)/100)/24400)/1000]*60)/ Density (kg/cm3) * [(168 *(FGF*1000)*(vol%/100)/24400)/1000]*60/ 0.001465
Fresh gas flow rate used to maintain general anesthesia
Time frame: Total time for general anesthesia, up to 24hours
It is calculated using the average value of the inhalation anesthetic concentration and fresh gas flow rate during the entire anesthesia time, excluding 15 minutes after the start of general anesthesia and 15 minutes before the end of anesthesia. The formula for calculating the total amount of inhalation anesthetic is as follows. Total amount of inhalation anesthetic used (mL)=([(Fresh gas flow rate (L/min)*1000)*(concentration of inhalation anesthetic (vol%))]/ Density (kg/cm3))* duration of anesthesia (hrs) * Amount of sevoflurane used per hour (mL) * ([((MW (kg/mol)*(FGF (L/min)*1000)*(concentration of sevoflurane (vol%)/100)/24400)/1000]*60)/ Density (kg/cm3) * [(200 *(FGF*1000)*(vol%/100)/24400)/1000]*60/ 0.00152 * Amount of desflurane used per hour (mL) * ([((MW (kg/mol)*(FGF (L/min)*1000)*(concentration of desflurane (vol%)/100)/24400)/1000]*60)/ Density (kg/cm3) * [(168 *(FGF*1000)*(vol%/100)/24400)/1000]*60/ 0.001465
1 secondary outcome
CO2e (total carbon dioxide equivalent), driving equivalent (equivalent driving distance, distance traveled by car to generate the same amount of greenhouse gases), and medical costs incurred due to the use of inhalation anesthetics
Time frame: Total time for general anesthesia, up to 24hours
Results and safety
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 31 Oct 2023.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part. This study is not recruiting at the moment.
Hee Young Kim, MD, PhD principal investigator
Pusan National University
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
An observational study of Anesthesia, run by Pusan National University Yangsan Hospital at 1 site in South Korea.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 1 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: finished, as of the sponsor's last update on 31 Oct 2023. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in South Korea. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Concentration of inhalation anesthetic used to maintain general anesthesia (time frame: Total time for general anesthesia, up to 24hours). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 31 Oct 2023.