CARbon Impact of aNesthesic Gas

Anesthesia Clinical Trial

— CARING  

Official title:

CARbon Impact of aNesthesic Gas - A Carbon Footprint Comparison of Sevoflurane and Desflurane in an Optimized Fresh Gas Flow Protocol

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT04163848
• Other study ID #: 2020-1971
• Status: Completed
• Start date: September 25, 2019
• Est. completion date: January 23, 2020

Study information

• Verified date: January 2021
• Source: Ciusss de L'Est de l'Île de Montréal
• Contact: n/a
• Is FDA regulated: No
• Study type: Observational

Clinical Trial 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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 58
• Est. completion date: January 23, 2020
• Est. primary completion date: January 23, 2020
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years and older

Eligibility

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

Related Conditions & MeSH terms

• Anesthesia
• Gas; Inhalation
• Respiratory Aspiration

Intervention

Other:
• Pollution
CO2 equivalent productions related to anesthetic gases use during general anesthesia for laparoscopic surgery

Locations

Country	Name	City	State
Canada	Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est de l'Ile de Montréal	Montréal	Quebec

Sponsors (1)

Lead Sponsor	Collaborator
Ciusss de L'Est de l'Île de Montréal

Country where clinical trial is conducted

Canada, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	CO2 equivalent of volatile inhaled anesthesic gases use in grams	To compare total volatile inhaled anesthetics consumption in CO2 equivalent (grams) per hour during anesthesia for laparoscopic surgery between two groups: Group "D" for Desflurane and group "S" for Sevoflurane	From intubation to end of surgery
Secondary	Total volatile inhalated anesthesics consumption in mL	To compare the total volatile inhaled anesthetics consumption in mL, mL/h and mL/kg/h during anesthesia for laparoscopic surgery between desflurane and sevoflurane	From intubation to end of surgery
Secondary	Cost in dollars	To compare the total cost of volatile inhalated anesthesics (mL of gaz x $/mL of gaz) for each group	From intubation to end of surgery
Secondary	Extubation time in minutes	To compare the extubation time	From stopping anesthesics gases to extubation
Secondary	Recovery room time in minutes	To compare the time spent in the recovery room	From end of surgery to 240minutes post-surgery