From 7e537e34e468bbf20c5abb21994f4423ef39c9c9 Mon Sep 17 00:00:00 2001 From: Sebastian Gibb Date: Tue, 2 Jan 2024 14:33:00 +0100 Subject: [PATCH] chore: update index.html --- index.html | 364 ++++++++++++++++++++++++++++------------------------- 1 file changed, 196 insertions(+), 168 deletions(-) diff --git a/index.html b/index.html index 6987655..dddc5a6 100644 --- a/index.html +++ b/index.html @@ -387,15 +387,16 @@

Sebastian Gibb, MD1,✉, Nadin Möller1
This study is work-in-progress!
Please find details at https://github.com/umg-minai/vct-or.
-Manuscript date: 2023-12-12 11:11; Version: 3d76e85 +Manuscript date: 2024-01-02 14:32; Version: 8868825

Abstract

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Objectives: -Methods: -Results: -Conclusion: -Keywords:

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Introduction:

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Methods:

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Results:

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Conclusions:

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Keywords: +volatile anaesthesia, sevoflurane, vapour capture technology

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Sebastian Gibb, MD1,✉, Nadin Möller1

1 Department of Anesthesiology and Intensive Care Medicine, University Hospital Greifswald, Ferdinand-Sauerbruch-Straße, D-17475 Greifswald, Germany.

✉ Correspondence: Sebastian Gibb, MD <>

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1 Introduction

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The anthropogenic climate crisis is the largest threat to global health (Daalen et al. 2022). -However, the health care sector itself is responsible for 5-10 % greenhouse gas emissions (Hu et al. 2021). -Almost half of these emissions are caused by anaesthetic gases used in anaesthesia and intensive care (Hu et al. 2021).

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Introduction

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The anthropogenic climate crisis is the largest threat to global health (Daalen et al. 2022). +However, the health care sector itself is responsible for 5-10 % greenhouse gas emissions (Hu et al. 2021). +Almost half of these emissions are caused by anaesthetic gases used in anaesthesia and intensive care (Hu et al. 2021).

Active carbon absorbers can attached to the exhaust port of the anaesthesia machines to capture excess anaesthetic gases can decrease the emissions and recycle valuable anaesthetic gases. -Hinterberg et al. (2022) investigate the efficiency of inhaled anaesthetics recapturing systems, namely CONTRAfluran (ZeoSys medical, Luckenwalde, Germany), in the operating room and found that only 25 % of the vaporised desflurane could be recaptured. -As Kalmar et al. (2023) pointed out the recovery process depend on the amount of recaptured anaesthetic gas and is more sufficient for full carbon absorbers which was not the case in the study by Hinterberg et al. (2022). +Hinterberg et al. (2022) investigate the efficiency of inhaled anaesthetics recapturing systems, namely CONTRAfluran (ZeoSys medical, Luckenwalde, Germany), in the operating room and found that only 25 % of the vaporised desflurane could be recaptured. +As Kalmar et al. (2023) pointed out the recovery process depend on the amount of recaptured anaesthetic gas and is more sufficient for full carbon absorbers which was not the case in the study by Hinterberg et al. (2022). Due to its higher blood-gas coefficients and metabolism rate it could be assumed that the recapture rate for sevoflurane would be even lower as the one for desflurane. -Using SageTech Medical’s Volatile Capture Device (SageTech Medical, Paignton, UK), that in contrast to CONTRAfluran needs an additional anaesthetic gas scavenger system, Gandhi and Baxter (2023) found a recapture rate for sevoflurane of 43-51%.

+Using SageTech Medical’s Volatile Capture Device (SageTech Medical, Paignton, UK), that in contrast to CONTRAfluran needs an additional anaesthetic gas scavenger system, Gandhi and Baxter (2023) found a recapture rate for sevoflurane of 43-51%.

The recapture and recycling rate of the passive anaesthetic gas recapture system, CONTRAfluran, for sevoflurane is still unknown.

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2 Methods

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Methods

In this prospective single-center observational study we collected -9 consecutive CONTRAfluran anaesthetic gas canisters from +10 consecutive CONTRAfluran anaesthetic gas canisters from Oktober 2023 to Dezember 2023 in two different operating rooms.

In the first operating room we mainly took care for patients for ear, nose and throat surgery. @@ -439,18 +440,19 @@

2 Methods

We measured the weight of the ACG and sevoflurane bottles with a precision scale (Kern PCB 2500-2; Kern&Sohn GmbH, Balingen-Frommern; Germany; maximum weight=2500g; d=0.01g).

All data processing and statistical analyses were performed using R version 4.3.1 -(R Core Team 2023).

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Summary tables were generated using the gtsummary package (Sjoberg et al. 2021, 2023). +(R Core Team 2023).

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Summary tables were generated using the gtsummary package (Sjoberg et al. 2021, 2023). All data and analysis can be found at https://github.com/umg-minai/vct-or TODO (add zenodo citation link).

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The Ethics Committee at the University Medicine Greifswald approved this study protocol (reference number: BB 102/23).

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The study was approved by the ethics committee of the University Medicine Greifswald +(reference number: BB 102/23).

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3 Results

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Results

TODO: calc saved CO2-eq

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4 Discussion

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Hinterberg et al. (2022): meisten Filter leer (nur 8 % der möglichen Füllmenge), neuer Filter je Patient, 70 % weight gain attributable to desflurane, höhere MAC und längere Dauer mit geringerer recapture rate assoziiert, laut Supplement, hoher FGF 0.8 l/min

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Discussion

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Hinterberg et al. (2022): meisten Filter leer (nur 8 % der möglichen Füllmenge), neuer Filter je Patient, 70 % weight gain attributable to desflurane, höhere MAC und längere Dauer mit geringerer recapture rate assoziiert, laut Supplement, hoher FGF 0.8 l/min

Hu et al TIVA vs IA + VCT

vgl. Cost Effizienz ggü. AGFS u. CO2-Effizienz ggü. AGFS

Leckage can’t captured @@ -464,50 +466,75 @@

4 Discussion

disposal, based on 2020 UK carbon intensity assumptions, equals total emissions of 45.4 kg of CO2e per 1 kg of captured volatile anaesthetics.

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4.1 Limitations

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Dexter and Epstein (2023) simulation of the dependency of the vct recapture efficiency on the +FGF and duration, as expected: lower FGF lower relative recapture (less wastage) +and longer duration yield lower relative recapture (more saturation);

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simulated values for 8 l/min induction for 15 min, and 0.5 l/min FGF for an hour (vapor set to 3.7% Sevo?; no information about etSevo) are not comparable to our setting: 4-6 l/min for 3-5 min for inhalative induction (or 0.5 l/min for a few minutes after intravenous induction), 0.3 l/min maintenance); 30 ml Sevo consumption in Dexter and Epstein (2023) vs ~ 10 ml/h in our setting

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Limitations

Vapor verliert in 24 h < 0.5 ml Sevo (das nicht über den Filter geht) und mgl. Schwankungen bei maximaler Füllung. Tropfen in “Einfüllstutzen”, damit evtl. Überschätzung des Verbrauchs.

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5 Conclusion

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Conclusion

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6 Acknowledgement

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We thank Marco Reinke and Steffen Suermann from Draeger Medical Deutschland GmbH for exporting the Draeger connect data and for helpful discussions about sevoflurane consumption.

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Declarations

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Ethical approval

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Research involving human subjects complied with all relevant national regulations and institutional policies, as well as the tenets of the Helsinki Declaration (as revised in 2013), and was approved by the ethics committee of the University Medicine Greifswald +(reference number: BB 102/23).

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Availability of data and materials

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The datasets generated and/or analysed during the current study are available in the zenodo repository, +https://doi.org/10.5281/zenodo.10442174 Gibb (2024).

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Competing interests

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All authors state no conflict of interest.

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Funding

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None.

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7 Author Contributions

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Conceptualization, S.G. and S.K.; -data acquisition, N.M. and S.K.; -data analysis, S.G. and N.M.; -writing - draft preparation, S.G.; -writing - review and editing, N.M., S.K. and S.G.; -All authors have read and agreed to the published version of the manuscript.

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Author Contributions

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Conceptualization: SG and SK; Data curation: NM, SG, and SK; Formal analysis: NM and SG; Investigation: NM and SK; Methodology: SG and SK; Supervision: SG and SK; Validation: SG and SK; Writing - original draft: SG; Writing - review & editing: NM, SG, and SK; All authors have read and agreed to the published version of the manuscript.

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Acknowledgement

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We thank Marco Reinke and Steffen Suermann from Draeger Medical Deutschland GmbH for exporting the Draeger connect data and for helpful discussions about sevoflurane consumption.

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8 Data and software availability

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The complete data, code and reproducible analysis can be found at -https://github.com/umg-minai/vct-or.

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9 References

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References

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Daalen, Kim R. van, Marina Romanello, Joacim Rocklöv, Jan C. Semenza, Cathryn Tonne, Anil Markandya, Niheer Dasandi, et al. 2022. “The 2022 Europe Report of the Lancet Countdown on Health and Climate Change: Towards a Climate Resilient Future.” The Lancet Public Health 7 (11): e942–65. https://doi.org/10.1016/S2468-2667(22)00197-9.
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+Dexter, F., and R. Epstein. 2023. “Associations Between Fresh Gas Flow and Duration of Anesthetic on the Maximum Potential Benefit of Anesthetic Gas Capture in Operating Rooms and in Postanesthesia Care Units to Capture Waste Anesthetic Gas.” Anesthesia &Amp; Analgesia 137 (5): 1104–9. https://doi.org/10.1213/ANE.0000000000006610. +
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Gandhi, Jason, and Ian Baxter. 2023. “Efficiency of Inhaled Anaesthetic Recapture in Clinical Practice. Comment on Br J Anaesth 2022; 129: E79-E81.” British Journal of Anaesthesia, March, S0007-0912(23)00073-9. https://doi.org/10.1016/j.bja.2023.02.013.
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+Gibb, Sebastian. 2024. “VCT-OR Data and Analyses.” Zenodo. https://doi.org/10.5281/zenodo.10442174. +
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Hinterberg, Jonas, Theresa Beffart, Andrea Gabriel, Marc Holzschneider, Tim M. Tartler, Maximilian S. Schaefer, and Peter Kienbaum. 2022. “Efficiency of Inhaled Anaesthetic Recapture in Clinical Practice.” British Journal of Anaesthesia 129 (4): e79–81. https://doi.org/10.1016/j.bja.2022.04.009.
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Hu, Xiaocheng, JM Tom Pierce, Tim Taylor, and Karyn Morrissey. 2021. “The Carbon Footprint of General Anaesthetics: A Case Study in the UK.” Resources, Conservation and Recycling 167 (April): 105411. https://doi.org/10.1016/j.resconrec.2021.105411.
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Kalmar, Alain F., Pascal Verdonck, Sarah Saxena, and Jan Mulier. 2023. “Proper Use of CONTRAfluran™ for Optimal Desorption and Reuse of Volatile Anaesthetics. Comment on Br J Anaesth 2022; 129: E79–81.” British Journal of Anaesthesia 131 (3): e71–72. https://doi.org/10.1016/j.bja.2023.06.046.
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9 References

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10 Tables

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Tables

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11 Figures

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Figures

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12 Supplement

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12.1 Overview about anaesthetic gas canisters

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12.1 Overview about anaesthetic g

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12.1 Overview about anaesthetic g

Table 12.1: ENT: ear, nose and throat surgery; Characteristics of all 9 anaesthetic gas canisters. Cases, duration etc. are given as per canister.Table 1: ENT: ear, nose and throat surgery; Characteristics of all 10 anaesthetic gas canisters. Cases, duration etc. are given as per canister.
CharacteristicOverall, N = 91Overall, N = 101 Operating rooms p-value2
21 (ENT), N = 7121 (ENT), N = 81 25 (Neurosurgery), N = 21
Case summary
    Number of cases35.0 (31.6, 50.0)34.4 (31.3, 40.0)42.5 (32.3, 50.8)34.7 (31.5, 50.3) 62.8 (56.4, 69.1)0.078
0.2
    Number of total intravenous anaesthesia cases9.0 (8.0, 13.0)12.0 (9.0, 14.0)10.0 (8.3, 12.8)11.5 (9.0, 13.8) 6.5 (6.3, 6.8)0.056
0.049
    Number of inhaled anaesthesia cases27.0 (21.4, 34.0)22.1 (21.2, 28.5)30.5 (21.6, 39.5)24.5 (21.3, 34.3) 56.3 (50.1, 62.4)0.056
0.044
    Total duration of all cases [h]40.6 (38.3, 53.4)39.9 (38.1, 43.2)43.2 (38.7, 60.8)40.3 (38.2, 48.8) 146.4 (140.3, 152.6)0.056
0.044
    Total duration of total intravenous anaesthesia [h]13.7 (11.0, 17.2)13.4 (10.5, 13.8)13.8 (11.6, 16.5)13.5 (10.7, 14.0) 18.1 (17.6, 18.5) 0.2
    Total duration of inhaled anaesthesia [h]31.9 (27.7, 33.1)29.7 (26.1, 32.0)32.0 (28.2, 44.8)30.8 (26.9, 33.3) 128.4 (121.8, 135.0)0.056
0.044
    Average duration of inhaled anaesthesia [h] 1.2 (1.1, 1.4)1.1 (1.1, 1.2)1.1 (1.0, 1.2) 2.3 (2.2, 2.5)0.056
0.044
Sevoflurane consumption
    Total used sevoflurane volume [mL]307.3 (303.9, 376.8)305.3 (283.2, 319.5)593.7 (575.3, 612.1)0.056
325.8 (310.3, 397.4)312.3 (299.4, 349.7)605.4 (586.6, 624.2)0.044
    Total used sevoflurane weight [g]476.2 (471.1, 584.1)473.3 (439.0, 495.2)495.2 (471.6, 604.1)474.8 (455.0, 531.6) 920.2 (891.7, 948.8)0.056
0.044
    Average used sevoflurane volume per hour [mL/h]9.5 (8.8, 11.1)10.4 (9.5, 11.2)4.6 (4.5, 4.7)0.056
9.6 (8.6, 10.6)10.0 (9.5, 10.8)4.7 (4.6, 4.8)0.044
    Average used sevoflurane weight per hour [g/h]14.7 (13.7, 17.2)16.1 (14.7, 17.4)14.7 (13.1, 16.0)15.2 (14.4, 16.4) 7.2 (7.1, 7.3)0.056
0.044
Anaesthetic gas canister weights
    Initial weight [g]1,028.4 (1,022.8, 1,031.8)1,024.6 (1,022.5, 1,028.5)1,028.5 (1,023.3, 1,031.6)1,026.5 (1,022.7, 1,029.2) 1,032.9 (1,032.4, 1,033.5) 0.2
    Final weight [g]1,404.9 (1,383.1, 1,415.2)1,407.2 (1,361.2, 1,415.2)1,406.0 (1,388.5, 1,415.2)1,411.2 (1,383.1, 1,420.1) 1,394.0 (1,388.5, 1,399.4)0.5
0.4
    Weight gain [g]381.0 (349.1, 384.9)384.4 (335.0, 385.8)382.7 (355.1, 386.3)384.6 (358.0, 392.6) 361.0 (355.1, 367.0)0.5
0.4
    Weight gain/sevoflurane consumption [%]74.1 (60.7, 81.3)76.0 (70.0, 81.7)71.9 (62.0, 80.0)75.0 (68.7, 81.5) 39.3 (38.7, 39.9)0.056
0.044
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12.2 R session information

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R session information

sessionInfo()
## R version 4.3.1 (2023-06-16)
 ## Platform: x86_64-unknown-linux-gnu (64-bit)
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12.2 R session information

 ##  [7] tidyr_1.3.0          jquerylib_0.1.4      broom.helpers_1.13.0
 ## [10] yaml_2.3.7           fastmap_1.1.1        R6_2.5.1            
 ## [13] commonmark_1.9.0     generics_0.1.3       knitr_1.43          
-## [16] backports_1.4.1      forcats_1.0.0        tibble_3.2.1        
+## [16] forcats_1.0.0        backports_1.4.1      tibble_3.2.1        
 ## [19] bookdown_0.34        rprojroot_2.0.3      bslib_0.5.0         
 ## [22] pillar_1.9.0         rlang_1.1.1          utf8_1.2.3          
 ## [25] broom_1.0.5          cachem_1.0.8         stringi_1.7.12      
-## [28] xfun_0.39            sass_0.4.7           cli_3.6.1           
-## [31] withr_2.5.0          magrittr_2.0.3       digest_0.6.33       
-## [34] markdown_1.7         lifecycle_1.0.3      vctrs_0.6.3         
-## [37] evaluate_0.21        glue_1.6.2           gt_0.9.0            
-## [40] fansi_1.0.4          rmarkdown_2.23       purrr_1.0.1         
-## [43] tools_4.3.1          pkgconfig_2.0.3      htmltools_0.5.5
+## [28] xfun_0.39 sass_0.4.7 bibtex_0.5.1 +## [31] cli_3.6.1 withr_2.5.0 magrittr_2.0.3 +## [34] digest_0.6.33 markdown_1.7 lifecycle_1.0.3 +## [37] vctrs_0.6.3 evaluate_0.21 glue_1.6.2 +## [40] gt_0.9.0 fansi_1.0.4 rmarkdown_2.23 +## [43] purrr_1.0.1 tools_4.3.1 pkgconfig_2.0.3 +## [46] htmltools_0.5.5