Reducing the Carbon Footprint of Anesthesia: Low-Flow Anesthesia and Other Techniques.

According to a joint statement by the US National Academy of Sciences and the UK Royal Society, it is now more certain than ever that human activity is a leading cause of rapid, accelerated climate change. Our volatile anesthetics have up to 2,000 times more greenhouse gas contributing potential than the same amount of carbon dioxide, yet no emission regulations have been imposed. The carbon footprint of volatile agents exists in all anesthesia practices, indirectly affecting all humans. It manifests daily in the clinical practice of over 30,000 certified registered nurse anesthetists in the United States, as their anesthetic choices directly impact the environment. However, education about anesthetic choice and its impact has been overlooked, making many anesthesia providers unaware of meaningful ways to reduce ecological and economic costs. Decreasing the use of volatile agents by low-flow techniques and the use of a total intravenous anesthetic could dramatically reduce carbon footprint produced by anesthesia. The authors review other advantages of limiting or avoiding volatile agents beyond green anesthesia such as decreased costs, reduced postoperative nausea and vomiting, and lowering the risk of malignant hyperthermia.

Rapunzel syndrome in a pediatric patient: a case report.

This case report describes a 2.5-year-old girl who was hospitalized with complaints of abdominal pain and vomiting for 2 days. Abdominal ultrasound revealed small bowel-to-small bowel intussusception. Diagnostic laparoscopic-assisted exploration of the abdomen revealed 4 separate intestinal intussusceptions along with multiple dark intraluminal masses within the small intestine. Laparoscopic reduction of the intussusceptions was unsuccessful. Laparotomy allowed palpation of the entire small intestine with extraction of the masses, which were found to be human hair (trichobezoars). The intussusceptions were reduced, and the multiple masses were removed through a single enterotomy. The child recovered following surgery and was discharged home to her family. The surgeon counseled the parents before discharging the patient and recommended follow-up counseling for their child. The parents were given information about trichophagia and strategies to reduce the behavior in their child. A comprehensive literature review revealed this to be the youngest reported case of intussusception and Rapunzel syndrome due to trichobezoars.

Anesthetic management in a pediatric patient with Noonan syndrome, mastocytosis, and von Willebrand disease: a case report.

This case report describes anesthetic considerations for a 6-year-old boy, admitted for adenoidectomy under general anesthesia, who had a complicated medical history, including mastocytosis, Noonan syndrome, and von Willebrand disease. Each affected the anesthetic plan and was addressed preoperatively among all surgical and anesthesia providers. Mastocytosis created a major concern, with its increased numbers of histamine-filled mast cells. Each drug that was added or eliminated from the anesthetic plan, to prevent histamine release by the activation of triggers, was considered. Patient handling and temperature control were also concerns. One of Noonan syndrome's characteristics is heart anomalies. This patient had a history of a patent foramen ovale and pulmonary stenosis; therefore, air was carefully removed from all intravenous lines and syringes. The main concern for bleeding difficulties was attributed to the history of von Willebrand disease, which results in prolonged bleeding time and can lead to delayed bleeding or serious postsurgical hemorrhage. Desmopressin was administered preoperatively to increase platelet aggregation and the von Willebrand factor level. The use of aspirin and other nonsteroidal anti-inflammatory drugs was avoided. We discuss the clinical and anesthetic management of this case with a review of pertinent literature.