麻醉与气候变化：是时候觉醒了吗？一项快速定性评估，探讨麻醉从业者对 TIVA 过渡和减少地氟醚的看法。
Anaesthesia and climate change: time to wake up? A rapid qualitative appraisal exploring the views of anaesthetic practitioners regarding the transition to TIVA and the reduction of desflurane.
机构信息
Department of Targeted Intervention, University College London (UCL), Charles Bell House, 43-45 Foley Street, London, W1W 7TY, UK.
Department of Psychology, University of Bradford, Bradford, UK.
出版信息
BMC Anesthesiol. 2024 Aug 30;24(1):300. doi: 10.1186/s12871-024-02693-5.
BACKGROUND
The National Health Service (NHS) has pledged to reach carbon net-zero by 2040. In alignment with this goal, a London hospital's anaesthesia department is actively reducing desflurane use and transitioning towards total intravenous anaesthesia (TIVA) as a sustainable alternative, contributing to environmentally responsible practices within the healthcare sector.
METHODS
We conducted a rapid qualitative appraisal through online interviews with 17 anaesthetic practitioners to explore their perspectives regarding this climate change mitigation strategy. Data analysis was undertaken through the use of rapid appraisal sheets and a framework analysis method.
RESULTS
Participants highlighted the disadvantages of TIVA, including the increased effort, heightened monitoring requirements, operational challenges, and a lack of clinical confidence associated with its use. Despite these reservations, participants acknowledged TIVA's potential to reduce postoperative nausea. There were perceptions that senior staff members might resist this change due to habits and scepticism over its impact on climate change. To facilitate greater TIVA adoption, participants recommended enhanced training, the implementation of a dashboard to raise awareness of greenhouse gas (GHG) emissions, and the presence of strong climate change leadership within the department. Participants believed that a shift to TIVA should be followed by specific measures such as addressing waste management which is crucial for GHG reduction, emphasising the perceived link between waste and emissions.
CONCLUSIONS
The evaluation examines stakeholder attitudes, perceptions, and behaviours, focusing on transitioning from desflurane to TIVA. The study highlights the importance of staff engagement, organisational support, and underscores the crucial role that healthcare practitioners and leadership play in fostering sustainability within the healthcare sector.
背景
国民保健制度（NHS）承诺到 2040 年实现碳净零排放。为了实现这一目标，伦敦一家医院的麻醉科正在积极减少地氟醚的使用，并向全静脉麻醉（TIVA）过渡，作为一种可持续的替代方案，为医疗保健部门的环保实践做出贡献。
方法
我们通过在线访谈对 17 名麻醉医生进行了快速定性评估，以探讨他们对这一气候变化缓解策略的看法。数据分析采用快速评估表和框架分析方法。
结果
参与者强调了 TIVA 的缺点，包括增加的工作量、更高的监测要求、操作上的挑战，以及对其使用缺乏临床信心。尽管存在这些保留意见，但参与者承认 TIVA 有可能减少术后恶心。有人认为，由于习惯和对其对气候变化影响的怀疑，资深员工可能会抵制这种改变。为了促进更广泛地采用 TIVA，参与者建议加强培训，实施一个仪表盘来提高对温室气体（GHG）排放的认识，并在部门内有强有力的气候变化领导。参与者认为，从 TIVA 转变应该采取具体措施，如解决废物管理问题，这对减少温室气体排放至关重要，强调了废物与排放之间的关联。
结论
该评估考察了利益相关者的态度、看法和行为，重点是从地氟醚向 TIVA 过渡。该研究强调了员工参与、组织支持的重要性，并强调了医疗保健从业者和领导层在促进医疗保健部门可持续性方面的关键作用。
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