APAGBI Climate commitment statement

Within medicine, and in particular anaesthesia, it can often feel that change and shifts in professional practice take considerable time to come about. However, there is one area where we cannot afford to delay change – the climate emergency which faces us.

As a society, we stand in solidarity with the international paediatric societies’ declaration on responding to the impact of climate change on children. We believe that it is our responsibility to advocate for children’s health and wellbeing; this mandates ensuring the world in which they develop is as conducive to that as possible. Climate change threatens children’s development in many different ways – from natural disasters and extreme weather affecting habitat and agriculture, to competition for usable land and conflict for it, to exploitation of natural resources leading to reduced air quality and increase in childhood disease.

We commit to continued efforts to improve the sustainability of paediatric anaesthesia across the United Kingdom and Ireland. To this end, we advocate for and work towards local and national policy which uses evidence to reduce the carbon footprint within our practice. We will offer support in a structured manner to advance changes in practice which bring this about, and we will welcome opportunities from our professional community to assist where we can.

Resources

• Piped nitrous oxide waste reduction strategy – an approach written up by NHS East Lothian to be adopted by any acute Trust looking to reduce nitrous oxide waste. Includes audit sheet and contact details for the Nitrous oxide project: https://anaesthetists.org/Portals/0/PDFs/Environment/Nitrous waste methodology.pdf
   
• Theatre shutdown checklist – theatres and anaesthetic rooms are some of the most energy-utilising areas of the hospital. Switching off overnight during periods of no activity has huge carbon and money-saving implications for Trusts: https://www.ghasp.org.uk/theatre-shutdown-checklist
   
• Anaesthetic impact calculators – apps for smart phones: Propofol dreams app: https://propofoldreamsapp.wordpress.com/
  • this helps anaesthetists calculate propofol requirements for TIVA and reduce wastage
     
• The anaesthetic impact calculator: https://rcoa.ac.uk/about-college/strategy-vision/environment-sustainability/anaesthetic-impact-calculator
  • this app allows clinicians to calculate and compare the CO2e impact of inhalational anaeshtetic and carrier gases
     
• Green my pension: for members with private pensions (NB: this is not relevant for the NHS pension, as this is an unfunded scheme). https://makemymoneymatter.co.uk/
  • This initiative aims to encourage individuals and organisations to redirect their pensions investments into sustainable businesses who are committed to tackling the climate emergency. For the average pension-holder, £2 in every £10 is linked to environmental devastation around the world. This website allows individuals to make a big impact by signing a letter to their pension provider.
• Real Zero https://realzero.earth/ Real Zero is a non-profit organisation dedicated to catalysing social and economic change, through the healthcare sector to reduce greenhouse gas emissions at the pace and scale required.

29/07/2024

Leading anaesthetic organisations call for removal of pipeline nitrous oxide in the UK and Ireland

This news article can be found on the Royal College of Anaesthetists Site 

Pipeline nitrous oxide should no longer be considered as a means of supplying nitrous oxide in modern anaesthetic practice, according to leading anaesthetic organisations in the UK and Ireland who are calling for nitrous oxide manifolds to be decommissioned. The recommendation relates to pipeline pure nitrous oxide only, meaning that nitrous oxide will remain available via point-of-use cylinders in circumstances where it is judged beneficial to patient care.   

Decommissioning will enable trusts and health boards to save money and reduce their environmental impact while maintaining the highest standards of anaesthetic care for patients. It will not affect use of Entonox, a mixture of nitrous oxide and oxygen commonly known as ‘gas and air’ and used for pain relief, including for women in labour.   

New consensus statement

Download >> Consensus Statement on the Removal of Pipeline Nitrous Oxide in the United Kingdom and Republic of Ireland
The recommendation comes in the form of a new consensus statement led by the Royal College of Anaesthetists (RCoA), in partnership with the Association of Anaesthetists, the College of Anaesthesiologists of Ireland (CAI), the Obstetric Anaesthetists’ Association (OAA) and the Association of Paediatric Anaesthetists of Great Britain and Ireland (APAGBI). 

Many anaesthetists have already moved away from routine nitrous oxide use in general anaesthesia and the new guidance will give trusts and health boards the clinical steer they need to decommission manifolds of cylinders within hospitals.  

The majority of manifolds have a significant leak, with 80-100% of nitrous oxide leaking out to the atmosphere before reaching the point of delivery. This is costly and has an environmental impact because nitrous oxide is a long-lived greenhouse gas with an atmospheric lifetime of over 100 years. Decommissioning pipelines will support NHS net zero goals and have financial savings for trusts and health boards.  

The consensus statement recommends the transition from nitrous oxide manifolds is completed by the end of the 2026/2027 financial year in the UK and the Republic of Ireland. Trusts and health boards are advised to liaise with their supplier of nitrous oxide to ensure the increased demand for point-of-use nitrous oxide cylinders can be met and maintained.