Reducing wastage of drugs in obstetric anaesthesia

Background

The contribution of anaesthesia to climate change is widely acknowledged (1). Intercollegiate guidelines have summarised recommendations to reduce the environmental burden of the operating theatre (2). Multiple recommendations relevant to obstetric anaesthesia are made including point 5, “minimise drug waste”.

Obstetric anaesthesia often involves pre-preparation of drugs for time critical anaesthesia provision. US studies suggest that approximately 50% of pre-prepared emergency drugs are wasted (3). Environmental consequences of drug wastage include emissions related to manufacture, transport, incineration, and residual microplastics and drug effects in wastewater. However, concerns regarding perceived loss of drug potency and sterility is a concern and patient safety should not be compromised during attempts to reduce wastage.

Frequent pre-preparation of drugs, staff changeover and absence of evidence-based guidelines may make us more prone to wastage. Drug wastage was thought most likely to occur at the start of each shift, potentially due to labelling, uncertainty regarding date of drug preparation and anaesthetist preference for particular GA drugs.

A general anaesthetic (GA) drug box has recently been introduced to the obstetric emergency theatre to improve the storage of relevant drugs in preparation for category 1 Caesarean section.

Aims