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Propofol is commonly administered in operating rooms to initiate anesthesia. For the continuation of anesthesia, a continuous infusion through a separate syringe pump is the go-to method for total intravenous anesthesia. Nevertheless, this practice has its drawbacks: propofol accounts for approximately 45 percent of pharmaceutical waste in surgical settings, with 25 percent of the substance remaining unused. Recent research from the University Hospital Bonn (UKB) and the University of Bonn has illustrated that there’s a more efficient approach that significantly decreases this waste. The researchers demonstrated that employing a single syringe pump for both the induction and maintenance phases of anesthesia can lead to a reduction of propofol waste by 30 to 50 percent. The findings of this study have been published in the British Journal of Anaesthesia.
Given the pressing issue of climate change, hospitals must adopt sustainable solutions to conserve resources. Anesthesiology and intensive care are highly resource-intensive fields, contributing significantly to both medical and operational waste that needs to be properly managed. “Propofol stands out as a major contributor to medication waste,” states Prof. Dr. Mark Coburn, head of the Department of Anesthesiology and Operative Intensive Care Medicine (KAI) at the UKB, who is also affiliated with the University of Bonn. This anesthetic is administered initially to induce sleep in patients and then maintained with a continuous infusion through a separate syringe pump. Unfortunately, “in certain medical facilities, up to 45 percent of all medication waste is attributed to propofol,” highlights Dr. Florian Windler, a KAI assistant physician at the UKB. Additionally, nearly a quarter of the propofol prepared is either wasted or underused by the close of surgical procedures.
Is a single syringe pump more sustainable?
A research group based in Bonn has explored whether employing a single syringe pump for both anesthesia induction and maintenance, as opposed to separately, leads to less propofol being wasted. Anesthesiologists have already begun using this method in practice. There are no known safety risks to patients associated with this approach. Nonetheless, the researchers were keen to assess its environmental impact by analyzing propofol usage and waste through the anesthesia protocols of over 300 surgeries conducted from June 2021 to June 2023. They contrasted traditional practices with those that utilized a single syringe pump, while also evaluating whether factors such as patient demographics, along with their alcohol and drug use, influenced wastage levels.
The results revealed that, on average, utilizing the single syringe pump led to a 30 percent reduction in propofol waste for each operation. In cases where the surgery duration ranged from 20 to 100 minutes, the waste decrease peaked at nearly 50 percent when a separate syringe was not used. Factors like the age, gender, weight, or existing medical conditions of patients did not affect the operating room waste amounts. However, patients with regular alcohol or substance use generally required more anesthetic, resulting in higher overall waste. “Interestingly, this waste increase was only noted when a second syringe was used. When opting for the single syringe pump, we saw waste reduction soar up to 49 percent,” adds co-author Prof. Coburn.
A more eco-friendly anesthesia method for the future
“Our findings suggest that adopting a single syringe pump for both induction and maintenance offers the best overall solution,” Dr. Windler concludes based on the observed data. This method holds great potential as a more environmentally-friendly approach. Furthermore, from an economics standpoint, if this procedure is implemented 10 to 15 times daily, it could lead to savings of around 1,300 frequently used 20-milliliter vials of propofol annually. “Considering both ecological and economic perspectives, the conventional induction method utilizing a separate syringe should be reevaluated,” urges Prof. Coburn. He is a proponent of the Green Team at KAI at the UKB, emphasizing the need for enhanced sustainability in clinical practices. “Our investigation into propofol waste shows that we can mitigate our environmental impact while upholding high-quality patient care,” he explains.
Funding: This study was supported by the Sustainability Commission of the Medical Faculty of the University of Bonn and by the Department of Anesthesiology and Operative Intensive Care Medicine at the University Hospital Bonn.
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