CARbon Impact of aNesthesic Gas

NCT04163848 | Completed

• 1 other identifier: 2020-1971
• Study Type: observational
• Target: 58
• Locations: 1 country
• Sites: 1

Brief 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.

Conditions

Gas; Inhalation; Anesthesia

Keywords

Desflurane; Sevoflurane; Fresh gas flow; Environment

Outcome Measures

Primary Outcomes (1)

• 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 Outcomes (4)

• Total volatile inhalated anesthesics consumption in mL

  From intubation to end of surgery

• Cost in dollars

  From intubation to end of surgery

• Extubation time in minutes

  From stopping anesthesics gases to extubation

• Recovery room time in minutes

  From end of surgery to 240minutes post-surgery

Study Arms (2)

Desflurane

desflurane administration based on a BIS index kept between 40-60 and with use of the semi-closed circuit of the Draeger A500 ventilator and its econometer for an optimized fresh gas flow as low as the O2 consumption allows

Other: Pollution

Sevoflurane

sevoflurane administration based on a BIS kept between 40-60 and with use of the semi-closed circuit of the Draeger A500 ventilator with a fixed fresh gas flow of 2L/min as requested in the gas monography

Other: Pollution

Interventions

Pollution OTHER

CO2 equivalent productions related to anesthetic gases use during general anesthesia for laparoscopic surgery

Desflurane; Sevoflurane

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)
• Sampling Method: Probability Sample

Study Population

General population undergoing laparoscopic gynecologic, urologic or general surgery

You may qualify if:

• ASA 1-3 patients,
• laparoscopic general, gynecological or urologic surgery requiring general anesthesia without additional regional anesthesia technique
• fully consented,
• BMI \< 40,
• age \> 18yo,

You may not qualify if:

• 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

Sponsors & Collaborators

• Ciusss de L'Est de l'Île de Montréal: lead

Study Sites (1)

Hôpital Maisonneuve-Rosemont, CIUSSS de l'Est de l'Ile de Montréal

Montreal, Quebec, H1T2M4, Canada

Location

MeSH Terms

Conditions

Mucopolysaccharidosis IV; Respiratory Aspiration

Condition Hierarchy (Ancestors)

Mucopolysaccharidoses; Carbohydrate Metabolism, Inborn Errors; Metabolism, Inborn Errors; Genetic Diseases, Inborn; Congenital, Hereditary, and Neonatal Diseases and Abnormalities; Lysosomal Storage Diseases; Mucinoses; Connective Tissue Diseases; Skin and Connective Tissue Diseases; Metabolic Diseases; Nutritional and Metabolic Diseases; Respiration Disorders; Respiratory Tract Diseases; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Design

• Study Type: observational
• Observational Model: OTHER
• Time Perspective: PROSPECTIVE
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor, Deputy chief of the Department of Anesthesiology of Maisonneuve-Rosemont Hospital, University of Montreal(UDeM)

Study Record Dates

• First Submitted: November 6, 2019
• First Posted: November 15, 2019
• Study Start: September 25, 2019
• Primary Completion: January 23, 2020
• Study Completion: January 23, 2020
• Last Updated: January 27, 2021

Record last verified: 2021-01

Data Sharing

• IPD Sharing: Will not share

Locations

CA (1)