Renze, Erin

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University of Nebraska Medical Center Research: DigitalCommons@UNMC

Graduate Medical Education Research Journal Volume 4 Issue 1 Article 29 July 2022 Inhaled Anesthetics and Their Environmental Impact: Analyzing and Reducing Desflurane Use to Decrease Our Environmental Footprint Erin Renze Follow this and additional works at: https://digitalcommons.unmc.edu/gmerj  Part of the Higher Education Commons, and the Medicine and Health Sciences Commons Recommended Citation Renze, E. Inhaled Anesthetics and Their Environmental Impact: Analyzing and Reducing Desflurane Use to Decrease Our Environmental Footprint. Graduate Medical Education Research Journal. 2022 Jul 14; 4(1). https://digitalcommons.unmc.edu/gmerj/vol4/iss1/29 This Conference Proceeding is brought to you for free and open access by DigitalCommons@UNMC. It has been accepted for inclusion in Graduate Medical Education Research Journal by an authorized editor of DigitalCommons@UNMC. For more information, please contact digitalcommons@unmc.edu. Inhaled Anesthetics and Their Environmental Impact: Analyzing and Reducing Desflurane Use to Decrease Our Environmental Footprint Creative Commons License This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License. This conference proceeding is available in Graduate Medical Education Research Journal: https://digitalcommons.unmc.edu/gmerj/vol4/iss1/29 Graduate Medical Education Research Journal40 Poster Presentations*Names in bold type indicate presenting author.Inhaled Anesthetics and Their Environmental Impact: Analyzing and Reducing Desflurane Use to Decrease Our Environmental Footprint Erin Renze1, Britta Dosland2, Michelle LeRiger1, Rachel Spitznagel11Department of Anesthesiology, College of Medicine, University of Nebraska Medical Center 2Department of Anesthesiology, Children’s Minnesota – St. PaulMentor: Michelle LeRigerProgram: AnesthesiologyType: Original ResearchBackground: Anesthetic gases are known greenhouse gases (GHGs) with many studies investigating their environmental impact. Desflurane has the highest global warming potential of commonly used volatile anesthetics. Reducing desflurane from the ORs at Children’s Hospital and Medical Center (CHMC) will have a positive impact on the environment and departmental costs. Methods: Baseline desflurane use in 2019 was evaluated based on purchasing data and chart review. The anesthetic GHG footprint was then determined for CHMC for 2019. The project was initiated with removal of desflurane from the ORs. A benchmark was set for reduction in desflurane use by 50% in the year following project implementation. Desflurane use and purchasing data was re-evaluated after removal from the ORs with a goal of 100% elimination over time. Results: Desflurane was used as the primary anesthetic for 71/12,239 cases at CHMC in 2019. Desflurane was not used for any cases from June 15, 2020 – November 2021. Desflurane purchasing was reduced by half in 2020 and to zero in 2021. Conclusion: GHGs are measured in CO2 equivalents to standardize and compare global warming potential. Metric ton CO2 equivalents (MTCO2e) are used to compare quantities of anesthetic gas used to each other or to other activities. Desflurane MTCO2e at CHMC in 2019 accounted for the equivalent of 53,682 miles driven by an average passenger vehicle and accounted for 3.3% of CHMC’s anesthetic gas MTCO2e. In 2020, this was reduced by half and to zero in 2021. Desflurane was eliminated from the ORs at CHMC reducing the GHG emissions. https://doi.org/10.32873/unmc.dc.gmerj.4.1.042Provider Awareness of Blood Draws in the Cardiac Intensive Care UnitGary LaCroix1, 2 Dave Danford1, 2 Amanda Marshall1, 21Department of Pediatric Cardiology, College of Medicine, University of Nebraska Medical Center 2Department of Pediatric Cardiology, Children’s Hospital & Medical CenterMentor: Amanda MarshallProgram: Pediatric CardiologyType: Original ResearchBackground: Pediatric surgical intensive care patients have frequent phlebotomy which may account for substantial blood loss. Evidence suggests blood sample volume should not exceed 4% of total blood volume within a 24-hour period. Providers may be unable to determine if excessive blood is drawn.Methods: A survey comprised of background questions and three vignettes (each included a lab schedule and asking providers to estimate blood volume drawn in 24 hours) was administered to intensive care providers here and elsewhere to assess awareness of blood draw volumes. Differences between actual and estimated volumes were assessed by t-test.Results: Thirty-three providers responded. Table 1 shows respondent demographics. Respondents overestimated blood volume drawn on a 7-day-old following truncus arteriosus repair by 0.97 milliliters with a mean response of 4.27 milliliters. Providers underestimated blood volume drawn on a 6-week-old following D-TGA repair by 2.61 milliliters with a mean response of 12.29 milliliters and a 15-year-old trauma patient by 5.31 milliliters with a mean response of 25.49 milliliters. There was a significant difference between response and blood volume required for each vignette. Responses were no different between provider type, primary job, or years in practice. There was a difference in response for the trauma patient by location, with Nebraska providers being more accurate.Conclusion: Providers are unaware of blood volume drawn for labs in surgical patients, leading to inaccurate estimates of iatrogenic blood loss. Providers need an easily accessible, accurate method, such as a blood draw tab in the medical record, to calculate this in any given 24-hour period. https://doi.org/10.32873/unmc.dc.gmerj.4.1.043Table 1. Volatile anesthetic MTCO2e for Children’s Hospital and Medical Center from 2019-2021. MTCO2e= Metric ton CO2 equivalent. MTCO2e 2019 2020 2021Sevoflurane 68.86 67.23 63.43Desflurane 21.36 10.68 0Nitrous Oxide 545.02 787.02 415.25Total 635.24 864.93 478.68Table 1. Respondent Demographics Role (n=33)Physician 21 (63.3%)Advanced Practitioner 12 (36.4%)Primary Job (n=33)CICU and PICU 15 (45.5%)CICU 6 (18.1%)PICU 12 (36.4%)Practice Location (n=32)Nebraska 19 (59.4%)Other 13 (40.6%)Excluded (did not answer correctly) 1Years in Practice (n=33)<1 6 (18.2%)1 to 5 11 (33.3%)6 to 10 7 (21.2%)>10 9 (27.3%)Sex (n=33)Male 22 (66.7%)Female 11 (33.3%)Age (n=33)<30 2 (6.2%)30 to 40 19 (59.4%)41 to 50 5 (15.6%)>50 6 (18.8%)Excluded (did not answer) 1

Inhaled Anesthetics and Their Environmental Impact: Analyzing and Reducing Desflurane Use to Decrease  Our Environmental Footprint

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Inhaled Anesthetics and Their Environmental Impact: Analyzing and Reducing Desflurane Use to Decrease Our Environmental Footprint

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