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M. Andersen, O. J. Nielsen, T. J. Wallington, B. Karpichev, and S. P. Sander, Assessing the Impact on Global Climate from General Anesthetic Gases, Anesth Analg, vol.114, issue.5, pp.1081-1086, 2012.

M. Andersen, S. P. Sander, O. J. Nielsen, D. S. Wagner, T. J. Sanford et al., Inhalation anaesthetics and climate change ?, Br J Anaesth, vol.105, issue.6, pp.760-766, 2010.

J. Sherman and F. Mcgain, Environmental Sustainability in Anesthesia: Pollution Prevention and Patient Safety, Adv Anesth, vol.34, issue.1, pp.47-61, 2016.

J. Sherman, C. Le, V. Lamers, and M. Eckelman, Life Cycle Greenhouse Gas Emissions of Anesthetic Drugs, Anesth Analg, vol.114, issue.5, p.1086, 2012.

N. Unies, Protocole de Kyoto la convention-cadre des Nations Unies sur les changements climatiques. Kyoto Jpn Ligne Httpunfccc Intresourcedocsconvkpkpfrench Pdf Page Consult 15 Avril, 1998.

, Montreal Protocol on Substances that Deplete the Ozone Layer -UN Documents: Gathering a body of global agreements, 2018.

A. J. Macneill, R. Lillywhite, and C. J. Brown, The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. Lancet Planet Health, vol.1, pp.381-389, 2017.

B. Lortat-jacob, V. Billard, W. Buschke, and F. Servin, Assessing the clinical or pharmaco-economical benefit of target controlled desflurane delivery in surgical patients using the Zeus® anaesthesia machine*, Anaesthesia, vol.64, issue.11, pp.1229-1264, 2009.

S. Tay, L. Weinberg, P. Peyton, D. Story, and J. Briedis, Financial and environmental costs of manual versus automated control of end-tidal gas concentrations, Anaesth Intensive Care, vol.41, issue.1, pp.95-101, 2013.

T. Taylor and P. Mackie, Carbon footprinting in health systems: one small step towards planetary health. Lancet Planet Health, vol.1, pp.357-365, 2017.

I. I. Grenelle and . Pdf,

P. S. Myles, K. Leslie, M. Chan, A. Forbes, P. J. Peyton et al., The safety of addition of nitrous oxide to general anaesthesia in at-risk patients having major non-cardiac surgery (ENIGMA-II): a randomised, single-blind trial. The Lancet, vol.384, pp.1446-54, 2014.

G. Herzberg and B. L. Crawford, Infrared and Raman Spectra of Polyatomic Molecules, J Phys Chem, vol.50, issue.3, pp.288-288, 1946.

, Radiative forcing of climate by hydrochlorofluorocarbons and hydrofluorocarbons, J Geophys Res Atmospheres, vol.100, issue.D11, pp.23227-23265, 2012.

Y. Ishizawa, General Anesthetic Gases and the Global Environment, Anesth Analg, vol.112, issue.1, pp.213-220, 2011.

A. C. Brown, C. E. Canosa-mas, A. D. Parr, J. Pierce, and R. P. Wayne, Tropospheric lifetimes of halogenated anaesthetics, Nature, vol.341, issue.6243, pp.635-642, 1989.

T. Langbein, H. Sonntag, D. Trapp, A. Hoffmann, W. Malms et al., Volatile anaesthetics and the atmosphere: atmospheric lifetimes and atmospheric effects of halothane, enflurane, isoflurane, desflurane and sevoflurane, BJA Br J Anaesth, vol.82, issue.1, pp.66-73, 1999.

M. K. Vollmer, T. S. Rhee, M. Rigby, D. Hofstetter, M. Hill et al., Modern inhalation anesthetics: Potent greenhouse gases in the global atmosphere, Geophys Res Lett, vol.42, issue.5, pp.2014-062785, 2015.

S. A. Montzka, G. S. Dutton, P. Yu, E. Ray, R. W. Portmann et al., An unexpected and persistent increase in global emissions of ozone-depleting CFC

, Nature, vol.557, issue.7705, pp.413-420, 2018.

, Greening the OR 2 -American Society of Anesthesiologists

, International Anesthesiology Clinics, 2019.

. Lww, , 2017.

S. Singaravelu and P. Barclay, Automated control of end-tidal inhalation anaesthetic concentration using the GE Aisys Carestation TM ?, Br J Anaesth, 2013.

, Apr, vol.1, issue.4, pp.561-567

E. D. Kharasch, D. C. Hankins, and K. E. Thummel, Human Kidney Methoxyflurane and Sevoflurane Metabolism Intrarenal Fluoride Production as a Possible Mechanism of Methoxyflurane Nephrotoxicity, Anesthesiol J Am Soc Anesthesiol, vol.82, issue.3, pp.689-99, 1995.

E. D. Kharasch, C. Jubert, and A. Compound, 3-Trifluoro-2-fluoromethoxypropanoic Acid during Low-flow Sevoflurane Anesthesia Biomarkers for Exposure, Risk Assessment, and Interspecies Comparison, Uptake and Metabolism to Mercapturic Acids, vol.3, issue.5, pp.1267-1267, 1999.

E. I. Eger, D. D. Koblin, T. Bowland, P. Ionescu, M. J. Laster et al., Nephrotoxicity of Sevoflurane Versus Desflurane Anesthesia in Volunteers

, Anesth Analg, vol.84, issue.1, pp.160-168, 1997.

L. Ong-sio, D. Cruz, R. Bautista, and A. F. , Sevoflurane and renal function: a meta-analysis of randomized trials. Med Gas Res, vol.7, pp.186-93, 2017.

H. J. Lowe and E. A. Ernst, The Quantitative Practice of Anesthesia: Use of Closed Circuit, vol.260, 1981.

D. S. Martin and M. Grocott, Oxygen therapy and anaesthesia: too much of a good thing, Anaesthesia, vol.70, issue.5, pp.522-529, 2015.

G. Jakutis, I. Norkien?, D. Ringaitien?, and T. Jovai?a, Cardiovascular effects of hyperoxia during and after cardiac surgery -Spoelstra-de Man -2015 -Anaesthesia -Wiley Online Library, Acta Medica Litu, vol.24, issue.3, 2017.

K. O. Pryor, T. Iii, C. A. Lien, and P. A. Goldstein, Surgical Site Infection and the Routine Use of Perioperative Hyperoxia in a General Surgical Population: A Randomized Controlled Trial, JAMA, vol.291, issue.1, pp.79-87, 2004.

H. Helmerhorst, R. De-wilde, D. H. Lee, M. Palmen, and J. Jansen,

D. J. Westerloo, Intraoperative oxygen concentration and neurocognition after cardiac surgery: study protocol for a randomized controlled trial | Trials | Full Text, vol.7, 2017.

K. Leslie, P. S. Myles, M. Chan, A. Forbes, M. J. Paech et al., Nitrous Oxide and Long-term Morbidity and Mortality in the Enigma Trial, Anesth Analg

, Feb, vol.1, issue.2, pp.387-93

. Faut-il_supprimer_le_protoxyde_d_azote_au_bloc_operatoire__,

, Gilani S, Sofi K. Is nitrous oxide necessary for general anaesthesia?, J Ayub Med Coll Abbottabad JAMC, vol.20, pp.149-52, 2008.

S. J. Sherman and B. F. Cullen, Nitrous Oxide and the Greenhouse Effect

, Anesthesiol J Am Soc Anesthesiol, vol.68, issue.5, pp.816-816, 1988.

J. Muret, M. Matezak, and M. Houlle, Le bloc opératoire durable. Prat En Anesth Réanimation, vol.21, pp.98-101, 2017.

G. Gress, J. Pauchard, and K. Nouette-gaulain, How to reduce anesthesia induced ecological impact?

J. Feldman, Managing Fresh Gas Flow to Reduce Environmental Contaminatio

. Lww, , 2017.

P. S. Myles, K. Leslie, M. Chan, A. Forbes, M. J. Paech et al., Avoidance of Nitrous Oxide for Patients Undergoing Major SurgeryA Randomized Controlled Trial, Anesthesiol J Am Soc Anesthesiol, vol.107, issue.2, pp.221-252, 2007.

D. Benhamou, I. Constant, D. Longrois, S. Molliex, K. Nouette-gaulain et al., Use of volatile anaesthetic agents in anaesthesia: A survey of practice in France in 2012, Anaesth Crit Care Pain Med, vol.34, issue.4, pp.205-214, 2015.

M. Andersen, O. J. Nielsen, T. J. Wallington, B. Karpichev, and S. P. Sander, Assessing the Impact on Global Climate from General Anesthetic Gases, Anesth Analg, vol.114, issue.5, pp.1081-1086, 2012.

M. Andersen, S. P. Sander, O. J. Nielsen, D. S. Wagner, T. J. Sanford et al., Inhalation anaesthetics and climate change ?, Br J Anaesth, vol.105, issue.6, pp.760-766, 2010.

J. Sherman and F. Mcgain, Environmental Sustainability in Anesthesia: Pollution Prevention and Patient Safety, Adv Anesth, vol.34, issue.1, pp.47-61, 2016.

J. Sherman, C. Le, V. Lamers, and M. Eckelman, Life Cycle Greenhouse Gas Emissions of Anesthetic Drugs, Anesth Analg, vol.114, issue.5, p.1086, 2012.

N. Unies, Protocole de Kyoto la convention-cadre des Nations Unies sur les changements climatiques. Kyoto Jpn Ligne Httpunfccc Intresourcedocsconvkpkpfrench Pdf Page Consult 15 Avril, 1998.

, Montreal Protocol on Substances that Deplete the Ozone Layer -UN Documents: Gathering a body of global agreements, 2018.

A. J. Macneill, R. Lillywhite, and C. J. Brown, The impact of surgery on global climate: a carbon footprinting study of operating theatres in three health systems. Lancet Planet Health, vol.1, pp.381-389, 2017.

B. Lortat-jacob, V. Billard, W. Buschke, and F. Servin, Assessing the clinical or pharmacoeconomical benefit of target controlled desflurane delivery in surgical patients using the Zeus® anaesthesia machine*, Anaesthesia, vol.64, issue.11, pp.1229-1264, 2009.

S. Tay, L. Weinberg, P. Peyton, D. Story, and J. Briedis, Financial and environmental costs of manual versus automated control of end-tidal gas concentrations, Anaesth Intensive Care, vol.41, issue.1, pp.95-101, 2013.

T. Taylor and P. Mackie, Carbon footprinting in health systems: one small step towards planetary health. Lancet Planet Health, vol.1, pp.357-365, 2017.

I. I. Grenelle and . Pdf,

P. S. Myles, K. Leslie, M. Chan, A. Forbes, P. J. Peyton et al., The safety of addition of nitrous oxide to general anaesthesia in at-risk patients having major noncardiac surgery (ENIGMA-II): a randomised, single-blind trial. The Lancet, vol.384, pp.1446-54, 2014.

G. Herzberg and B. L. Crawford, Infrared and Raman Spectra of Polyatomic Molecules, J Phys Chem, vol.50, issue.3, pp.288-288, 1946.

, Radiative forcing of climate by hydrochlorofluorocarbons and hydrofluorocarbons, J Geophys Res Atmospheres, vol.100, issue.D11, pp.23227-23265, 2012.

Y. Ishizawa, General Anesthetic Gases and the Global Environment, Anesth Analg, vol.112, issue.1, pp.213-220, 2011.

A. C. Brown, C. E. Canosa-mas, A. D. Parr, J. Pierce, and R. P. Wayne, Tropospheric lifetimes of halogenated anaesthetics, Nature, vol.341, issue.6243, pp.635-642, 1989.

T. Langbein, H. Sonntag, D. Trapp, A. Hoffmann, W. Malms et al., Volatile anaesthetics and the atmosphere: atmospheric lifetimes and atmospheric effects of halothane, enflurane, isoflurane, desflurane and sevoflurane, BJA Br J Anaesth, 1999.

M. K. Vollmer, T. S. Rhee, M. Rigby, D. Hofstetter, M. Hill et al., Modern inhalation anesthetics: Potent greenhouse gases in the global atmosphere, Geophys Res Lett, vol.42, issue.5, pp.2014-062785, 2015.

S. A. Montzka, G. S. Dutton, P. Yu, E. Ray, R. W. Portmann et al., An unexpected and persistent increase in global emissions of ozone-depleting CFC-11, Nature, vol.557, issue.7705, pp.413-420, 2018.

, Greening the OR 2 -American Society of Anesthesiologists, 2018.

, Ecological Responsibility in Anesthesia Practice : International Anesthesiology Clinics, 2017.

, Model-based automatic feedback control versus human control of end-tidal isoflurane concentration using low-flow anaesthesia -British Journal of Anaesthesia

S. Singaravelu and P. Barclay, Automated control of end-tidal inhalation anaesthetic concentration using the GE Aisys Carestation TM ?, Br J Anaesth, vol.110, issue.4, pp.561-567, 2013.

E. D. Kharasch, D. C. Hankins, and K. E. Thummel, Human Kidney Methoxyflurane and Sevoflurane Metabolism Intrarenal Fluoride Production as a Possible Mechanism of Methoxyflurane Nephrotoxicity, Anesthesiol J Am Soc Anesthesiol, vol.82, issue.3, pp.689-99, 1995.

E. D. Kharasch, C. Jubert, and A. Compound, 3-Trifluoro-2-fluoromethoxypropanoic Acid during Low-flow Sevoflurane Anesthesia Biomarkers for Exposure, Risk Assessment, and Interspecies Comparison, Uptake and Metabolism to Mercapturic Acids, vol.3, issue.5, pp.1267-1267, 1999.

E. I. Eger, D. D. Koblin, T. Bowland, P. Ionescu, M. J. Laster et al., Nephrotoxicity of Sevoflurane Versus Desflurane Anesthesia in Volunteers, Anesth Analg, vol.84, issue.1, pp.160-168, 1997.

L. Ong-sio, D. Cruz, R. Bautista, and A. F. , Sevoflurane and renal function: a metaanalysis of randomized trials. Med Gas Res, vol.7, pp.186-93, 2017.

H. J. Lowe and E. A. Ernst, The Quantitative Practice of Anesthesia: Use of Closed Circuit, vol.260, 1981.

D. S. Martin and M. Grocott, Oxygen therapy and anaesthesia: too much of a good thing, Anaesthesia, vol.70, issue.5, pp.522-529, 2015.

G. Jakutis, I. Norkien?, D. Ringaitien?, and T. Jovai?a, Severity of hyperoxia as a risk factor in patients undergoing on-pump cardiac surgery, Acta Medica Litu, vol.24, issue.3, p.153, 2017.

, Cardiovascular effects of hyperoxia during and after cardiac surgery -Spoelstra-de Man -2015 -Anaesthesia -Wiley Online Library, 2019.

K. O. Pryor, T. Iii, C. A. Lien, and P. A. Goldstein, Surgical Site Infection and the Routine Use of Perioperative Hyperoxia in a General Surgical Population: A Randomized Controlled Trial, JAMA, vol.291, issue.1, pp.79-87, 2004.

H. Helmerhorst, R. De-wilde, D. H. Lee, M. Palmen, J. Jansen et al., Hemodynamic effects of short-term hyperoxia after coronary artery bypass grafting. Ann Intensive Care, vol.7, 2017.

, Intraoperative oxygen concentration and neurocognition after cardiac surgery: study protocol for a randomized controlled trial | Trials | Full Text, 2019.

,

K. Leslie, P. S. Myles, M. Chan, A. Forbes, M. J. Paech et al., Nitrous Oxide and Long-term Morbidity and Mortality in the Enigma Trial, Anesth Analg, vol.112, issue.2, pp.387-93, 2011.

. Faut-il_supprimer_le_protoxyde_d_azote_au_bloc_operatoire__, , p.2017

S. Gilani and K. Sofi, Is nitrous oxide necessary for general anaesthesia?, J Ayub Med Coll Abbottabad JAMC, vol.20, pp.149-52, 2008.

S. J. Sherman and B. F. Cullen, Nitrous Oxide and the Greenhouse Effect, Anesthesiol J Am Soc Anesthesiol, vol.68, issue.5, pp.816-816, 1988.

J. Muret, M. Matezak, and M. Houlle, Le bloc opératoire durable. Prat En Anesth Réanimation, vol.21, pp.98-101, 2017.

G. Gress, J. Pauchard, and K. Nouette-gaulain, How to reduce anesthesia induced ecological impact?

J. Feldman, Managing Fresh Gas Flow to Reduce Environmental Contaminatio

. Lww, , 2017.

P. S. Myles, K. Leslie, M. Chan, A. Forbes, M. J. Paech et al., Avoidance of Nitrous Oxide for Patients Undergoing Major SurgeryA Randomized Controlled Trial

, Anesthesiol J Am Soc Anesthesiol, vol.107, issue.2, pp.221-252, 2007.

, Hippocrate Au moment d'être admis à exercer la médecine, je promets et je jure d'être fidèle aux lois de l'honneur et de la probité

, Mon premier souci sera de rétablir, de préserver ou de promouvoir la santé dans tous ses éléments, physiques et mentaux, individuels et sociaux

, Je respecterai toutes les personnes, leur autonomie et leur volonté, sans aucune discrimination selon leur état ou leurs convictions. J'interviendrai pour les protéger si elles sont affaiblies

, Même sous la contrainte, je ne ferai pas usage de mes connaissances contre les lois de l'humanité

, J'informerai les patients des décisions envisagées, de leurs raisons et de leurs

, Nous avons conduit une évaluation des pratiques professionnelles incluant la diffusion d'un protocole de bonne pratique d'utilisation des gaz d'anesthésie. L'objectif principal du travail est de réduire le coût écologique de l'anesthésie inhalée au CHU de Bordeaux. Matériels & Méthodes : Nous avons conduit une étude avant-après entre la période février-avril 2017 (phase I) et février-avril 2018 (phase II), de façon monocentrique, prospective et observationnelle. Les données, recueillies en aveugle, concernaient les modalités de ventilation mécanique et les consommations d'halogénés de l'ensemble des blocs opératoire du CHU de Bordeaux. Entre l'évaluation avant-après, avait lieu une phase d'amélioration et de retour sur expérience s'adressant à tout le personnel médical et paramédical

. Le-critère-de, Une analyse de régression logistique était prévue pour rechercher les facteurs associés à un réglage du DGF pour l'entretien > 2L/min. Résultats : 770 procédures d'anesthésie ont été étudiées (350 de février à avril 2017, 420 de février à avril 2018). Le DGF moyen réglé pour l'entretien de l'anesthésie générale est passé de 1.7 ± 1.6 L/min à 1.1 ± 0.8 L/min entre les phases I et II

, Comparée à la phase 1, la consommation en agents d'anesthésie était réduite de 23% pour le sevoflurane et de 36% pour le desflurane lors de la phase II ce qui représentait une réduction d'émission en gaz à effet de serre équivalente à 51 542 kgEqCO2. En analyse multivariée, seul l'entretien de l'anesthésie sur un mode total intraveineux était associé à un réglage du DGF moyen supérieur à 2L/min. Conclusion : L'élaboration d'un protocole d'utilisation raisonnée des agents halogénés permet de réduire le coût carbone de l'anesthésie, Entre la phase I et la phase II, il n'y avait pas de différence significative dans l'utilisation du mode AINOC pour l'entretien de l'anesthésie (48% des cas

, Volatile agents are worldwide daily used anesthesic agents. However, they are responsible for notorious greenhouse gas effect. No management program for reduction of volatile agents consumption and emission exists. The purpose of this study was to determine the effect of the implementation of a management program based on a multimodal strategy to reduce environmental impact caused by volatile agents. Methods: We performed an audit of clinical practice before and after implementation of the management program, Titre et résumé en anglais How to reduce anesthesia induced ecological impact? An example from Bordeaux University Hospital Background

, 350 procedures were included in Phase I and 420 in Phase II. We hypothesized that the management program implementation would lead to a reduction of greenhouse gas emission. The primary outcome was the reduction of mean fresh gas flow (FGF) used for maintenance of general anesthesia. Results: The implementation of the management program led to a 35% decrease in mean FGF between the two phases (1.7 ± 1.6 L/min vs 1.1 ± 0.8 L/min for Phase I and Phase II respectively, p <0.001) which represented a 51 542 kg EqCO2 reduction in green-house gas emission. Conclusion: The implementation of a management program for a well-reasoned use of volatile agents led to a significant reduction of greenhouse gas emission