Why Propofol is the Eco-Hero

Unlike volatile agents that escape into our atmosphere as GHGs, propofol takes a different route. Administered intravenously, about 88% of it is metabolized and excreted as inactive metabolites, while less than 1% exits unchanged. This means almost nothing enters our sewage systems to pollute our water – high five, propofol!

The Plot Twist: Propofol’s Dark Side

But wait, every hero has a weakness. For propofol, it’s drug waste. Shockingly, propofol accounts for around 45% of all disposed drugs. Studies reveal that 33% – 55% of prepared propofol is discarded. Yikes! Besides the environmentally unfriendly impact of excessive drug waste, propofol’s other dark side is that it is not biodegradable and can be toxic to aquatic life. This makes it ultra important to prevent propofol waste from contaminating our water systems. Lastly, propofol waste must be incinerated at 1000 degrees celsius, an energy-intensive process which adds to propofol’s carbon footprint. This is why we need to use propofol very efficiently and dispose of it in the appropriate medication waste containers.

Tips for Reducing Propofol Waste and Its Impact

Here’s how you can make TIVA the most sustainable choice:

1. Prep Smart: Prepare propofol on an as-needed basis in amounts predicted by patient age and medical issues. One syringe for induction is usually enough for most patients, and if more is needed, you can draw up additional amounts from your infusion pump tubing side port or give a bolus via the infusion pump.
2. Consider Surgery Duration: For short procedures, avoid spiking a large bottle or filling a 60 ml syringe when preparing your infusion. Also, stay in touch with the surgical team so you can more efficiently utilize smaller vials toward the end of longer surgeries, preventing substantial waste from spiking a large bottle close to surgery completion.
3. Donate Leftovers: Remember, drawn-up propofol (Pfizer, Fresenius) is safe for up to 12 hours. Pass off any unused propofol to a colleague to minimize waste.
4. Make Propofol TIVA Greener: Use standard medication infusion pumps instead of syringe pumps during longer cases to cut down on plastic waste.
5. Optimize Disposal: Dispose of unused propofol in appropriate medication waste containers that allow proper processing, and contract with waste-to-energy companies for sustainable destruction of propofol.

In our daily practice, we have the choice of either releasing GHG to the atmosphere or using propofol-based TIVA wisely. While using low total fresh gas flows with volatile agents is a substantial move in the right direction, “minimal-wasteTIVA” stands out as the sustainable winner.