Scotland NHS ban Desflurane Anesthetic….why should you care? You should.

[Jacob]

@Jacob, you are entitled to your opinion, if you prefer being knocked on the head, or drinking a bottle of whisky before surgery or just kill off the human population to save the planet that’s all good. But please put down you computer to save the planet, the carbon cost of making it / replacing it / using it (the WWW uses ridiculous amounts of power, enough to power large countries) is far higher than the bit extra produced by using any of the anaesthetics if you need surgery.

I base my opinion on these peoples' opinions, who seem to know more about the issue than you or I.
If you think they are wrong you should be addressing them and explaining the error of their ways.

 

[Agent_zed]

Carbon footprint is all about how you measure it, and also what bias you want to support. So, if a choose to read the following article, I will be persuaded that Desflurane has a much smaller carbon footprint than what the NHS wishes tonuse instead, it’s all about how it’s made.

https://www.sciencedirect.com/science/article/abs/pii/S0921344921000185
Here is the main graph showing the difference between the main anaesthetics. So, taking the NHS car in footprint, rather than whole cost from manufacture to usage of the drug gives totally different results.

That is interesting thanks for posting it.

What I am unsure about though is whether this study takes into account the global warming potential of each gas vs just the actual CO2 emmisions production.

The NHS article states that desflurane has a 'global warming potential 2,500 times greater than carbon dioxide.'. So if this is not part of the above calculations it wouldn't matter if the alternative is 100x greater CO2 emmisions to use as desflurane would still have a vastly increased effect on the environment.

 

[Jacob]

That is interesting thanks for posting it.

What I am unsure about though is whether this study takes into account the global warming potential of each gas vs just the actual CO2 emmisions production.

The NHS article states that desflurane has a 'global warming potential 2,500 times greater than carbon dioxide.'. So if this is not part of the above calculations it wouldn't matter if the alternative is 100x greater CO2 emmisions to use as desflurane would still have a vastly increased effect on the environment.

Well yes - it's not "all about how it’s made" it's about the warming potential of the particular gas.

 

[Spectric]

But please put down you computer to save the planet, the carbon cost of making it / replacing it / using it (the WWW uses ridiculous amounts of power, enough to power large countries) is far higher than the bit extra produced by using any of the anaesthetics if you need surgery.

You have overlooked the huge amounts of power needed in the USA to maintain the data storage centres needed for the WWW and of course storing huge amounts of pointless social media data and then the motor car which consumes huge amounts of energy in its manufacture and subsequent use, this will not go away with electric vehicles but in some ways will be worse because ICE produce exhaust pollutants whereas electric vehicles will leave a legacy of toxic battery waste. I would suggest the savings with no longer manufacturing this anaesthetic are really miniscule, butthe benefits of keeping it seem to outweigh any savings in pollution. The daft thing is that even if we stop using it, it will still be manufactured for other countries so we are just making ourselves look stupid, we do seem to be on a path to some desolate place unless we can introduce intelligence into the decision and policy making process.

 

[Agent_zed]

I would suggest the savings with no longer manufacturing this anaesthetic are really miniscule, butthe benefits of keeping it seem to outweigh any savings in pollution

unless we can introduce intelligence into the decision and policy

Ok but where is the intelligence in your decision. Where is the evidence? what are you basing your suggestion on? People can keep saying it's vitally important and the benefits outweigh the negatives but so far I have not seen evidence for this. It is literally opinions.
The CO2 lifecycle of the gases was the closest thing to evidence against the environmental reasons for switching, but even that is not clear if it takes into account global warming potential over pure CO2 emissions. And this does not have anything to do with whether using an alternative anaethetic is better or worse for a patient.

As an aside I happen to agree with you on electric cars not being a good alternative, but I certainly don't agree we should just throw in the towel on enviromental issues just because other countries aren't bothering right now. Other countries also deforest their land, should we do the same so we can have cheaper wood?

 

[Jacob]

.... butthe benefits of keeping it seem to outweigh any savings in pollution.

Not what the experts say NHS England » Putting anaesthetic emissions to bed: commitment on desflurane

The daft thing is that even if we stop using it, it will still be manufactured for other countries so we are just making ourselves look stupid,

Or imaginative, progressive, intelligent, and setting an example for others to follow. Somebody has to lead the way and why not the UK?

 

[deema]

Probably the most significant clinical evidence of its clinical effectiveness is using the study you’ve highlighted. 20% of all ops used it and only after the government introduced its policy of carbon foot print reduction gas that changed. It was used despite it being more expensive for a reason, a clinical reason that it was the most appropriate for the procedure.

The only ‘damming’ evidence against it is its supposed carbon footprint. Nobody has said there is a better more effective drug, only that others can be used.

 

[Phil Pascoe]

Not what the experts say NHS England » Putting anaesthetic emissions to bed: commitment on desflurane

Or imaginative, progressive, intelligent, and setting an example for others to follow. Somebody has to lead the way and why not the UK?

You seriously believe the rest of the world gives a toss what Britain does or doesn't do? You're deluded.

 

[Agent_zed]

You seriously believe the rest of the world gives a toss what Britain does or doesn't do? You're deluded.

A bit off topic but in certain circumstances yes. For example if we can show renewable energy is viable then other countries will be follow. If we are a leader in the technology then we can sell that expertise. Otherwise we will be playing catch up and have to pay other countries for the tech when we need it.

If you don't believe there is a need to switch from fossil fuels etc then ask yourself why countries in the UAE are desparately trying to diversify into tourism rather than just continuing on with oil sales. It is going to run out eventually!

 

[Jacob]

You seriously believe the rest of the world gives a toss what Britain does or doesn't do? You're deluded.

Britain is still a wealthy and powerful country in world terms, in spite of brexit.
Even if not I don't think the idea of dulling down to match the others is a good idea. Being deliberately stupid doesn't sound like a winning strategy.

 

[Jacob]

....

The only ‘damming’ evidence against it is its supposed carbon footprint.

Yes, the big dominant issue of our time. More important than any other.
But the warming effect is the much bigger issue by far in this particular case, 2500 times the effect of CO2, not just the carbon footprint from production. They are not quite the same thing.

Nobody has said there is a better more effective drug, only that others can be used.

Good, that's OK then.

 

[Phil Pascoe]

Being deliberately stupid doesn't sound like a winning strategy.

Don't do it then.

 

[Doug71]

My friend is part of a company which has developed the technology to capture 99.9% of the volatile anaesthetic agents which can then be recycled and reused.

I get the impression the NHS are not on board with it yet as it costs and they are more budget driven than environment driven.

 

[Ozi]

A bit off topic but in certain circumstances yes. For example if we can show renewable energy is viable then other countries will be follow. If we are a leader in the technology then we can sell that expertise. Otherwise we will be playing catch up and have to pay other countries for the tech when we need it.

If you don't believe there is a need to switch from fossil fuels etc then ask yourself why countries in the UAE are desparately trying to diversify into tourism rather than just continuing on with oil sales. It is going to run out eventually!

Also off topic but a bit of very encouraging information. Everybody knows that one of the biggest problems we face if we want to switch to renewable energy is storing power to use on the infamous "cold still nights". The country currently making the biggest investment and with the highest currently installed capacity..........USA! well done America Also a world leader in CHP from fuel cells! A transfer technology that greatly reduces gas usage per kW. China will follow, their not stupid and they have a population already very concerned about pollution. India as far as I can tell DGAF!

Renewables in this country last year made up 35.5% of our electricity generation, gas 41%, our bills are painful enough, can you imagine what they would be without the wind turbines.

 

[MikeK]

If the personal attacks continue, this thread will be closed.

 

[deema]

A bit off topic but in certain circumstances yes. For example if we can show renewable energy is viable then other countries will be follow. If we are a leader in the technology then we can sell that expertise. Otherwise we will be playing catch up and have to pay other countries for the tech when we need it.

If you don't believe there is a need to switch from fossil fuels etc then ask yourself why countries in the UAE are desparately trying to diversify into tourism rather than just continuing on with oil sales. It is going to run out eventually!

The U.K. doesn’t make large scale wind turbines, that’s everyone else apart from us, the biggest is Vestas based in Denmark. We don’t make solar panels, they mainly come from the far east with coal powered electrical generating stations to make them. The U.K. is not the the leader in green technology. We spend a lot of money on it and help develop other nations technology. Early adopters of technology pay the highest premiums and suffer with all the technical difficulties the learning requires.

 

[deema]

Back on topic…..hmm.

The article that highlights that the U.K. NHS is also banning Desflurane is interesting,
https://www.england.nhs.uk/blog/putting-anaesthetic-emissions-to-bed/
I like to look at the authors backgrounds to see if they are interested in the science behind making a decision, or if it’s just a political perspective they are fulfilling. So, Dr Nick Watts, he is a Doctor, but not an anaesthetist, so will have a passing knowledge of the subject but not specialist trained in it. His job isn‘t clinical he’s the Chief Sustainable Officer for the NHS, with Papers about how he intends to create a net carbon zero NHS. So, his job is about getting rid of the NHS carbon footprint.

https://www.england.nhs.uk/author/dr-nick-watts/
Professor Ramani Moonesinghe is Professor of peri-operative medicine at University College London, she is an anaesthetist and is the Director of the national Health Services Research Centre at the Royal College of Anaesthetists and head of her research department at UCL. She knows her stuff.

The last author is Claire Foreman, she doesn’t appear to be medically trained and is an adminstrator looking at patient experience.
https://www.england.nhs.uk/author/claire-foreman/
The NHS IMO is probably one of the most politically charged environments to work within. The leadership and direction is government led, so if the green agenda is mandated, that’s what happens. If it doesn’t the people get shuffled until a person is in place who does get it done. Those running it don’t last long if they don’t tow the line. It’s an environment at a senior level very few can survive or would want to work within. So, looking at the line up, they have one person to give the report some credibility (Anaesthetist) the main person has a job that’s dependant on delivering the green agenda, and a third who has no specialist knowledge in either environmental issues or clinical anaesthetists. Dont you just love how decisions are made on our behalf?

 

[Jacob]

The U.K. doesn’t make large scale wind turbines, that’s everyone else apart from us, the biggest is Vestas based in Denmark. We don’t make solar panels, they mainly come from the far east with coal powered electrical generating stations to make them.

Just think how far ahead we could have been with constructive state financed R&D!

The U.K. is not the the leader in green technology.

China is

We spend a lot of money on it

No we don't - that is the problem.

and help develop other nations technology

Not really

. Early adopters of technology pay the highest premiums and suffer with all the technical difficulties the learning requires.

Early adoptors usually are ahead of the game. Plenty of others well ahead of the UK.

 

[Ollie78]

Scotland and soon the UK are to ban the use of Desflurane Anaesthetic on grounds that it has a high global warming foot print. Sounds very laudable? But it ignores the reason why it was developed, the medical benefits and why for most patients it’s better to go under with it. In my opinion it’s lunacy!

Now, I’m not medically trained, I’m not an anaesthetist or claim to have any specialist knowledge. I’m just one of a team of five who designed and developed the Tec 6 which is the thing that administrates the drug to the patient. As such I both had to know a great deal about the drug, its uses, benefits and how it has to be administrated. More importantly, I needed to know how it’s administered safely as we designed all the safety protocols for the delivery system. Im also retired so have no agenda.

Now, it’s few years back (c30 years!) I worked on the Vaporiser (that’s what the delivery system is called; think carburettor type device) but going under anaesthetic is a bit like flying, taking off and landing are the most dangerous, or for anaesthetics, going to sleep and then coming back around. Desflurane is still the best drug for most people, it works incredibly fast, it only needs a very low concentration of it in your blood stream to put you asleep. It needs the lowest concentration of any gas anaesthetic. In fact it’s virtually one breath to fall asleep and one breath of normal air to come around. Other drugs take a long time to come out of the body, and leave you feeling groggy for hours after surgery, that masks other symptoms that may need immediate treatment which isn’t good. One of the big benefits of this characteristic is that patients can leave hospital faster, don’t spend as much time in recovery, don’t need as much resources of the NHS.

Any downsides? Well it’s not the cheapest drug, it used to be around £10 / procedure versus £1 for the other stuff. You probably only need to reduce your stay in hospital by 5 mins to make it far more economic! But the cost is a reason in the early days hospital administrators balked at using it!!

So, if you want the least risk from an anaesthetic, fastest recovery time, shortest stay in hospital, you pick (if a suitable patient) Desflurane, so yes you should care. So what if it adds a bit to global warming, it’s benefits far exceed any downside and the green tree hugging loonies need to understand what stupidity they are inflicting on all of us.

I agree with you on this entirely, I am fairly certain the amount of global warming caused is minimal in comparison to many less important but more profitable things.
It looks like another case of green madness.
This is a clear case of benefit outweighing cost.
Many industries just pay farmers to grow giant grass species which capture loads of carbon to "offset" whatever they do.

Nowadays when I hear of something or other being "green" or environmentally friendly it just sort of makes me suspicious.

Ollie

 

[Jacob]

Back on topic…..hmm.

The article that highlights that the U.K. NHS is also banning Desflurane is interesting,
https://www.england.nhs.uk/blog/putting-anaesthetic-emissions-to-bed/
I like to look at the authors backgrounds to see if they are interested in the science behind making a decision, or if it’s just a political perspective they are fulfilling. So, Dr Nick Watts, he is a Doctor, but not an anaesthetist, so will have a passing knowledge of the subject but not specialist trained in it. His job isn‘t clinical he’s the Chief Sustainable Officer for the NHS, with Papers about how he intends to create a net carbon zero NHS. So, his job is about getting rid of the NHS carbon footprint.

https://www.england.nhs.uk/author/dr-nick-watts/
Professor Ramani Moonesinghe is Professor of peri-operative medicine at University College London, she is an anaesthetist and is the Director of the national Health Services Research Centre at the Royal College of Anaesthetists and head of her research department at UCL. She knows her stuff.

The last author is Claire Foreman, she doesn’t appear to be medically trained and is an adminstrator looking at patient experience.
https://www.england.nhs.uk/author/claire-foreman/
The NHS IMO is probably one of the most politically charged environments to work within. The leadership and direction is government led, so if the green agenda is mandated, that’s what happens. If it doesn’t the people get shuffled until a person is in place who does get it done. Those running it don’t last long if they don’t tow the line. It’s an environment at a senior level very few can survive or would want to work within. So, looking at the line up, they have one person to give the report some credibility (Anaesthetist) the main person has a job that’s dependant on delivering the green agenda, and a third who has no specialist knowledge in either environmental issues or clinical anaesthetists. Dont you just love how decisions are made on our behalf?

Are you quite sure you know the subject better than these people?