When I was training, we used nitrous oxide on just about every anesthetic. It was easy to use. It was inexpensive. It didn’t tend to effect hemodynamics so it was useful in less stable patients when combined with an opioid. It helped speed induction through the second gas effect. It was not metabolized so renal and liver insufficiency were of less concern.

However, with all of the more recent investigation into reasons for cognitive dysfunction or decline in infants and the elderly following anesthesia, a lot more is now known about the pharmacologic disadvantages of nitrous oxide (1, 2, 3). Continue reading

Can Changing Our Anesthesia Practice Help Save The Polar Bears?

I recently had the incredible opportunity to visit Svalbard, Norway, an archipelago above the Arctic Circle about 600 miles from the North Pole. We were lucky enough to see polar bears, including a rare sighting of a Mom with 3 cubs.

Mother polar bear with her 3 cubs, Svalbard, Norway

Mother polar bear with her 3 cubs, Svalbard, Norway

The landscape was breathtakingly beautiful. But underlying the minute to minute magic was the sober message that the climate was warming and the ice was melting.

photo showing recession of a glacier in Svalbard, Norway with Dr Whitten in the foreground.

Just five years ago, the glacier in the background extended to the point where Dr Whitten is standing in Svalbard.

We passed glacier after glacier that used to fill the fjords we were sailing through, but which now clung to the sides of the canyon walls. Our ship, the National Geographic Explorer, was able to circumnavigate the Svalbard archipelago, something that has rarely been done because the northern ice usually blocks the eastern islands. Those polar bears, and indeed our planet, are in trouble.

However, I came home comfortable in my own mind that I was already doing my part to decrease global warming: using LED light bulbs, solar power, hybrid car, turning off all electrical devices when not in use. Ironically, I soon discovered that the anesthetic gases I use every day are some of the most potent greenhouse gases on the planet.

When we administer anesthesia, we pay a great deal of attention to the concentration of nitrous oxide and halogenated agents such as sevoflurane or desflurane that our patient receives. We know that too much or too little of these gases can harm our patients. We are often less compulsive about avoiding exposure to ourselves, or even our Operating Room colleagues to waste anesthetic gases. Therefore, to remind everyone of best practices on how to protect ourselves from exposure, I’ve been part of a team collaborating with our Workplace Safety department to create a training video on how to minimize Waste Anesthesia Gas (WAG) exposure. Continue reading