Dr. Mike NATHANSON
President, Association of Anaesthetists, United Kingdom
Mike Nathanson is a Consultant Anaesthetist at Nottingham University Hospitals NHS Trust. He qualified from the University of London in 1984, and trained in general medicine, intensive care medicine and anaesthesia in London and Nottingham. He was a Visiting Assistant Professor at the University of Texas Southwestern Medical Center in 1993. His clinical interests are mainly neuroanaesthesia, trauma and orthopaedic anaesthesia. He was President of the Neuroanaesthesia Society 2009-11, and an editor of Anaesthesia 2003-13. He has been the UK Council member of the ESA. He was elected a member of Council of the Association of Anaesthetists in 2013, was Honorary Secretary 2016-18, and then elected President in 2020. His main interests are communications, sustainable anaesthesia and education. Outside work, his passions are Notts County FC, golf and his allotment (which are currently: non-league, mid-handicap, and too many weeds, respectively).
Global warning and resulting climate change remain a significant threat to our planet, and therefore to our own health and that of our patients. The precise impact and the relative importance of human contribution vs natural cyclical changes in carbon dioxide concentrations and global temperatures are debated. But the effect of human endeavour does have an impact.
Healthcare systems contribute about 4-6% of carbon emissions in most countries, and in the UK (and there is no reason to believe it is significantly different in other developed countries) anaesthetic gases give rise to about 5% of total healthcare emissions.
Reducing our use of anaesthetic gases (e.g. low flow) or stopping use of them altogether – for example abandoning nitrous oxide and desflurane, has a significant impact and it is relatively easy to reduce carbon emissions from anaesthetic practice by half – a target set by the government in the UK. Use of nitrous oxide pre-mixed with oxygen for analgesia is more difficult to eliminate, however.
Scavenging systems that enable reuse of the volatile agents, or to ‘crack’ (i.e. destroy exhaled nitrous oxide) now exist.
Operating theatres are very energy intensive parts of any hospital. Even simple actions such as switching off the ventilation system at night save both energy and money. Reusing ‘disposable’ equipment is now more common, although regulatory systems may limit their adoption in some countries.
It is up to each of us to change our practice, and to encourage others to do so. Education, training, audit and QI projects should all be used to ‘nudge’ us to change. If each of us makes a small contribution, the combined impact will be significant, and time for Planet Earth is running out. Act now!