scholarly journals Carbon Footprint of General, Regional, and Combined Anesthesia for Total Knee Replacements

2021 ◽  
Author(s):  
Forbes McGain ◽  
Nicole Sheridan ◽  
Kasun Wickramarachchi ◽  
Simon Yates ◽  
Brandon Chan ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Life Cycle Assessment ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Carbon Footprint ◽  
Knee Replacements ◽  
Total Knee ◽  
Single Use ◽  
Combined Anesthesia ◽  
Carbon Dioxide Equivalent

Background Health care itself contributes to climate change. Anesthesia is a “carbon hotspot,” yet few data exist to compare anesthetic choices. The authors examined the carbon dioxide equivalent emissions associated with general anesthesia, spinal anesthesia, and combined (general and spinal anesthesia) during a total knee replacement. Methods A prospective life cycle assessment of 10 patients in each of three groups undergoing knee replacements was conducted in Melbourne, Australia. The authors collected input data for anesthetic items, gases, and drugs, and electricity for patient warming and anesthetic machine. Sevoflurane or propofol was used for general anesthesia. Life cycle assessment software was used to convert inputs to their carbon footprint (in kilogram carbon dioxide equivalent emissions), with modeled international comparisons. Results Twenty-nine patients were studied. The carbon dioxide equivalent emissions for general anesthesia were an average 14.9 (95% CI, 9.7 to 22.5) kg carbon dioxide equivalent emissions; spinal anesthesia, 16.9 (95% CI, 13.2 to 20.5) kg carbon dioxide equivalent; and for combined anesthesia, 18.5 (95% CI, 12.5 to 27.3) kg carbon dioxide equivalent. Major sources of carbon dioxide equivalent emissions across all approaches were as follows: electricity for the patient air warmer (average at least 2.5 kg carbon dioxide equivalent [20% total]), single-use items, 3.6 (general anesthesia), 3.4 (spinal), and 4.3 (combined) kg carbon dioxide equivalent emissions, respectively (approximately 25% total). For the general anesthesia and combined groups, sevoflurane contributed an average 4.7 kg carbon dioxide equivalent (35% total) and 3.1 kg carbon dioxide equivalent (19%), respectively. For spinal and combined, washing and sterilizing reusable items contributed 4.5 kg carbon dioxide equivalent (29% total) and 4.1 kg carbon dioxide equivalent (24%) emissions, respectively. Oxygen use was important to the spinal anesthetic carbon footprint (2.8 kg carbon dioxide equivalent, 18%). Modeling showed that intercountry carbon dioxide equivalent emission variability was less than intragroup variability (minimum/maximum). Conclusions All anesthetic approaches had similar carbon footprints (desflurane and nitrous oxide were not used for general anesthesia). Rather than spinal being a default low carbon approach, several choices determine the final carbon footprint: using low-flow anesthesia/total intravenous anesthesia, reducing single-use plastics, reducing oxygen flows, and collaborating with engineers to augment energy efficiency/renewable electricity. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New

scholarly journals Spinal versus general anesthesia for patients undergoing outpatient total knee arthroplasty: a national propensity matched analysis of early postoperative outcomes

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mark C. Kendall ◽  
Alexander D. Cohen ◽  
Stephanie Principe-Marrero ◽  
Peter Sidhom ◽  
Patricia Apruzzese ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Adverse Events ◽  
General Anesthesia ◽  
Knee Arthroplasty ◽  
Anesthetic Management ◽  
Anesthetic Technique ◽  
Anesthetic Techniques ◽  
Short Term ◽  
Knee Replacements ◽  
Total Knee

Abstract Background A comparison of different anesthetic techniques to evaluate short term outcomes has yet to be performed for patients undergoing outpatient knee replacements. The aim of this investigation was to compare short term outcomes of spinal (SA) versus general anesthesia (GA) in patients undergoing outpatient total knee replacements. Methods The ACS NSQIP datasets were queried to extract patients who underwent primary, elective, unilateral total knee arthroplasty (TKA) between 2005 and 2018 performed as an outpatient procedure. The primary outcome was a composite score of serious adverse events (SAE). The primary independent variable was the type of anesthesia (e.g., general vs. spinal). Results A total of 353,970 patients who underwent TKA procedures were identified comprising of 6,339 primary, elective outpatient TKA procedures. Of these, 2,034 patients received GA and 3,540 received SA. A cohort of 1,962 patients who underwent outpatient TKA under GA were propensity matched for covariates with patients who underwent outpatient TKA under SA. SAE rates at 72 h after surgery were not greater in patients receiving GA compared to SA (0.92%, 0.66%, P = 0.369). In contrast, minor adverse events were greater in the GA group compared to SA (2.09%, 0.51%), P < 0.001. The rate of postoperative transfusion was greater in the patients receiving GA. Conclusions The type of anesthetic technique, general or spinal anesthesia does not alter short term SAEs, readmissions and failure to rescue in patients undergoing outpatient TKR surgery. Recognizing the benefits of SA tailored to the anesthetic management may maximize the clinical benefits in this patient population.

scholarly journals Green-house gas mitigation capacity of a small scale rural biogas plant calculations for Bangladesh through a general life cycle assessment

2017 ◽  
Vol 35 (10) ◽  
pp. 1023-1033 ◽  
Author(s):  
Khondokar M Rahman ◽  
Lynsey Melville ◽  
David Fulford ◽  
SM Imamul Huq
Keyword(s):  
Carbon Dioxide ◽  
Global Warming ◽  
Life Cycle Assessment ◽  
Life Cycle ◽  
Global Warming Potential ◽  
Construction Materials ◽  
Biogas Plant ◽  
Small Scale ◽  
Potential Saving ◽  
Carbon Dioxide Equivalent

Calculations towards determining the greenhouse gas mitigation capacity of a small-scale biogas plant (3.2 m3 plant) using cow dung in Bangladesh are presented. A general life cycle assessment was used, evaluating key parameters (biogas, methane, construction materials and feedstock demands) to determine the net environmental impact. The global warming potential saving through the use of biogas as a cooking fuel is reduced from 0.40 kg CO2 equivalent to 0.064 kg CO2 equivalent per kilogram of dung. Biomethane used for cooking can contribute towards mitigation of global warming. Prior to utilisation of the global warming potential of methane (from 3.2 m3 biogas plant), the global warming potential is 13 t of carbon dioxide equivalent. This reduced to 2 t as a result of complete combustion of methane. The global warming potential saving of a bioenergy plant across a 20-year life cycle is 217 t of carbon dioxide equivalent, which is 11 t per year. The global warming potential of the resultant digestate is zero and from construction materials is less than 1% of total global warming potential. When the biogas is used as a fuel for cooking, the global warming potential will reduce by 83% compare with the traditional wood biomass cooking system. The total 80 MJ of energy that can be produced from a 3.2 m3 anaerobic digestion plant would replace 1.9 t of fuel wood or 632 kg of kerosene currently used annually in Bangladesh. The digestate can also be used as a nutrient rich fertiliser substituting more costly inorganic fertilisers, with no global warming potential impact.

scholarly journals The Effect of Intraoperative Sounds of Saw and Hammer on Psychological Condition in Patients with Total Knee Arthroplasty: Prospective Randomized Study

2015 ◽  
Vol 2015 ◽  
pp. 1-6 ◽  
Author(s):  
Erkam Kömürcü ◽  
Hasan Ali Kiraz ◽  
Burak Kaymaz ◽  
Umut Hatay Gölge ◽  
Gürdal Nusran ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Knee Arthroplasty ◽  
Randomized Study ◽  
General Anesthesia Group ◽  
Anesthesia Group ◽  
Negative Effect ◽  
Total Knee ◽  
Spinal Anesthesia Group

Purpose. Surgical procedures are likely to be stressful for patients and their families. Total knee arthroplasty (TKA) is a major surgical procedure used in the treatment of osteoarthritis. During this procedure the sounds of the saw and hammer may irritate the patient and adversely affect mood. The present study examines the effect of these intraoperative sounds during TKA on postoperative mood and anxiety, by comparing two different anesthetic procedures.Methods. A total of 40 patients who underwent TKA for grade IV gonarthrosis participated in the study. Patients were randomly divided into two groups: 20 patients in the general anesthesia group and 20 patients in the spinal anesthesia group. Mood and anxiety changes were evaluated using the Profile of Mood States (POMS) and State-Trait Anxiety Inventory (STAI) instruments, respectively.Results. The postoperative POMS value in the spinal anesthesia group was definitively higher than the general anesthesia group, though the difference in preoperative and postoperative POMS and STAI scores between the two groups was not significant.Conclusion. It would seem that sounds of hammer and saw have no evident negative effect on patient’s mood. Regional anesthesia is advisable for TKA patients and appropriate sedation can be administered during the operation if needed.

scholarly journals The Associations Between Cognitive Dysfunction, Stress Biomarkers, and Administered Anesthesia Type in Total Knee Arthroplasties: Prospective, Randomized Trial

2019 ◽  
Vol 5 (22;5) ◽  
pp. 495-507 ◽  
Author(s):  
Ipek Saadet Edipoglu
Keyword(s):  
General Anesthesia ◽  
Spinal Anesthesia ◽  
Cognitive Dysfunction ◽  
Regional Anesthesia ◽  
Controlled Study ◽  
Glucose Levels ◽  
Stress Biomarkers ◽  
Neurocognitive Tests ◽  
Number Of Patients ◽  
Total Knee

Background: Postoperative cognitive dysfunction (POCD) is a serious complication associated with total knee arthroplasty (TKA) and has been shown to increase the length of hospital stay, cause functional impairment, and morbidity. Objectives: We aimed to determine whether POCD is associated with the use of general or regional anesthesia in patients undergoing TKA. Our hypothesis was that POCD would be reduced in the group that received regional analgesia without any sedations. Our secondary hypothesis was POCD would be associated with biomarkers of surgical stress. Study Design: Randomized controlled study between general and spinal anesthesia. Setting: Single-centered, university hospital, from January to October 2017. Methods: A total of 112 patients were assessed for eligibility, and a total of 57 patients completed the study. We divided the patients into general and regional anesthesia groups. Blood samples were obtained preoperatively at the first intraoperative, the third and the 24th postoperative hour. C-reactive protein (CRP), cortisol, insulin, and blood glucose levels were tested. We used 4 neurocognitive tests that were administered 1 day before operation, 7 days and 30 days after operation. Main outcome measures were neurocognitive tests scores for regional anesthesia without sedation and general anesthesia groups. Cortisol, glucose, insulin, and CRP levels. Results: Patients who received regional anesthesia showed significantly higher Mini-Mental State Examination (MMSE) scored compared with the general anesthesia at the seventh day (P = 0.037). In the general anesthesia group, patients showed significantly higher variations for the Stroop number difference. There were negative correlations between MMSE scores measured at postoperative day 7 and the 1-hour intraoperative cortisol measurements (r = –0.302; P = 0.022) and 3-hour postoperative cortisol measurements (r = –0.295; P = 0.026). Limitations: A limitation was the small number of patients. Conclusions: We demonstrate that regional anesthesia results in better neurocognitive test scores than general anesthesia in patients undergoing TKA. Patients who received regional anesthesia showed lower cortisol, higher insulin, and lower glucose levels. We recommend that patients who undergo arthroplasty surgeries should receive regional anesthesia to avoid POCD at the early stages of the postoperative period. Key words: Cognitive dysfunction, stress biomarkers, acute pain, regional anesthesia, spinal anesthesia

scholarly journals ASSESSMENT OF CARBON FOOTPRINTS OF A TYPICAL NIGERIAN TOWNSHIP POST OFFICE: A CASE STUDY OF KAFANCHAN DISTRICT POST OFFICE, KAFANCHAN, NIGERIA

2021 ◽  
Vol 27 (1) ◽  
pp. 75-80
Author(s):  
RICHARD BALTHI MSHELIA ◽  
FUNSHO BABARINDE
Keyword(s):  
Carbon Dioxide ◽  
Developing Country ◽  
Carbon Footprint ◽  
Research Work ◽  
Carbon Accounting ◽  
Post Office ◽  
Carbon Footprints ◽  
Carbon Footprinting ◽  
Carbon Dioxide Equivalent

This research work focuses on carbon footprinting the operations of a township post office in a developing country. The analysis was carried out in accordance with the Universal Postal Union’s guidelines for carbon accounting. The results showed that for the inventory year, the office’s carbon footprint was 13.3423 tonnes of carbon dioxide equivalent (CO2e). It was found that for each gram of parcel delivered, 0.0171 kgCO2e was emitted into the atmosphere. Results further showed that 82 % of emission is attributed to delivery of mails while 18 % is as a result of sorting and other minor activities within the facility.

scholarly journals Carbon Footprint of Recycled Aggregate Concrete

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
Luis F. Jiménez ◽  
José A. Domínguez ◽  
Ricardo Enrique Vega-Azamar
Keyword(s):  
Carbon Dioxide ◽  
Carbon Footprint ◽  
Environmental Performance ◽  
Greenhouse Gas Emission ◽  
Methodological Approach ◽  
Recycled Aggregate Concrete ◽  
Recycled Aggregate ◽  
Recycled Aggregates ◽  
Production Phase ◽  
Carbon Dioxide Equivalent

Carbon footprint is one of the most widely used tools for assessing the environmental impacts of the production and utilization of concrete as well as of the components derived from it, representing the amount of carbon dioxide and other greenhouse gases associated with this product, expressed as CO2 equivalents. In this paper, carbon footprint was used to compare the environmental performance in the production phase of a concrete made with both recycled and crushed virgin limestone aggregates, using a life cycle analysis methodological approach. Research outcomes revealed, as expected, that carbon dioxide equivalent emissions decreased slightly as the use of recycled aggregates increased. Emissions for concrete with 0.5 w/c were between 347 and 351 kg of CO2-e/m3. It was also corroborated that cement is the material with the greatest influence on greenhouse gas emission generation in the concrete’s production phase, regardless of the use of recycled or virgin aggregates.

Association of Anesthesia Type with Postoperative Outcome and Complications in Patients Undergoing Revision Total Knee Arthroplasty

2020 ◽  
Author(s):  
Chapman Wei ◽  
Arun Muthiah ◽  
Alex Gu ◽  
Theodore Quan ◽  
Kenneth T. Nguyen ◽  
...  
Keyword(s):  
Length Of Stay ◽  
General Anesthesia ◽  
Regional Anesthesia ◽  
Multivariate Analyses ◽  
Revision Total Knee Arthroplasty ◽  
Extended Length ◽  
Total Knee ◽  
Combined Anesthesia ◽  
Revision Tkas ◽  
Perioperative Blood Transfusion

AbstractRevision total knee arthroplasty (TKA) is an increasingly common procedure and is effective in treating knee osteoarthritis, but it has higher complication rates than primary TKA. Anesthetic choice poses perioperative risk that has been extensively studied in primary TKA, showing favorable results for regional anesthesia compared with general anesthesia. The impact of anesthetic choice in revision TKAs is not well studied. A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program database. Patients who underwent revision TKAs between 2014 and 2017 were divided into three anesthesia cohorts: (1) general anesthesia, (2) regional anesthesia, and (3) combined general-regional anesthesia. Univariate and multivariate analyses were used to analyze patient characteristics and 30-day postoperative outcomes. Bonferroni correction was applied for post hoc analysis. In total, 8,820 patients were identified. Of whom, 3,192 patients underwent general anesthesia, 3,474 patients underwent regional anesthesia, and 2,154 patients underwent combined anesthesia. After multivariate analyses, regional anesthesia was associated with decreased odds for any complication (p = 0.008), perioperative blood transfusion (p < 0.001), and extended length of stay (p < 0.001) compared with general anesthesia. In addition, regional anesthesia was associated with decreased odds for perioperative blood transfusion (p < 0.001) and extended length of stay (p = 0.006) compared with combined anesthesia. However, following multivariate analysis, regional anesthesia was not associated with decreased odds of wound, pulmonary, renal, urinary tract, thromboembolic, and cardiac complications, and was not associated with return to operating room, extended length of stay, minor and major complications, and mortality. Retrospective analysis of a large surgical database suggests that patients receiving general anesthesia have increased likelihood for developing adverse postoperative outcomes relative to patients receiving regional anesthesia. Prospective and controlled trials should be conducted to verify these findings.

scholarly journals A sustainable wood biorefinery for low–carbon footprint chemicals production

Science ◽  
2020 ◽  
Vol 367 (6484) ◽  
pp. 1385-1390 ◽  
Author(s):  
Yuhe Liao ◽  
Steven-Friso Koelewijn ◽  
Gil Van den Bossche ◽  
Joost Van Aelst ◽  
Sander Van den Bosch ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Life Cycle Assessment ◽  
Life Cycle ◽  
Economic Analysis ◽  
Gas Phase ◽  
Carbon Footprint ◽  
Bioethanol Production ◽  
Low Carbon ◽  
Printing Ink ◽  
Lower Carbon

The profitability and sustainability of future biorefineries are dependent on efficient feedstock use. Therefore, it is essential to valorize lignin when using wood. We have developed an integrated biorefinery that converts 78 weight % (wt %) of birch into xylochemicals. Reductive catalytic fractionation of the wood produces a carbohydrate pulp amenable to bioethanol production and a lignin oil. After extraction of the lignin oil, the crude, unseparated mixture of phenolic monomers is catalytically funneled into 20 wt % of phenol and 9 wt % of propylene (on the basis of lignin weight) by gas-phase hydroprocessing and dealkylation; the residual phenolic oligomers (30 wt %) are used in printing ink as replacements for controversial para-nonylphenol. A techno-economic analysis predicts an economically competitive production process, and a life-cycle assessment estimates a lower carbon dioxide footprint relative to that of fossil-based production.

Sign in / Sign up

Export Citation Format

Share Document