Pain Control

 “I can no longer obey; I have tasted command, and I cannot give it up.” – Napoleon Bonaparte

We have it on good authority that it sometimes gets quite cold in Canada during wintertime. As our Canadian readers can attest, in such brutal conditions machinery often acts a little funky. Batteries refuse to turn over, hard things become brittle, fluids freeze or gum up, and dimensions of solid materials quite literally contract. Operating an automobile in this environment can be particularly challenging for the passenger and engine alike, as both need to be warmed up before they can be expected to perform within specifications. In particularly harsh conditions, a car might require 15-20 minutes of idling before the engine and cabin reach comfortable conditions, and remote car starters have become incredibly popular solutions.

Brrr, eh? | Getty

An ironclad canon of the Church of Carbon™ is that parishioners are not allowed to have nice things, which explains the following bit of regulatory tomfoolery:

“In what it is calling ‘a bold move’ to combat climate change, the City of Ottawa has introduced a strict by-law limiting residents from using remote car starters to warm up their vehicles for more than one minute before driving. The law, intended to reduce greenhouse gas emissions and improve local air quality, has sparked heated debate, especially given Ottawa’s notoriously harsh winters.

The new rule allows vehicles to idle for just 60 seconds if the driver is not inside. For residents braving the cold inside their cars, idling is permitted for up to 10 minutes if temperatures are below freezing. Those caught letting their vehicle run unattended beyond the one-minute limit, even on private property, risk being fined by by-law officers.”

Further in the same report, we find an early leading candidate for quote of the year:

“‘Every little bit counts,’ said city councillor Laura Green. ‘We know it’s cold, but we also know that climate change is a real and urgent problem. This is about protecting our future.’”

We should confess that we have been unable to verify that Laura Green exists or is quoted accurately in the article. No such person is listed on the city leadership’s website, for example, suggesting her name or job title may have been inaccurately reported. Nonetheless, the quote so perfectly encapsulates one of the fatal flaws of climate dogma that we decided to run with it anyway. Not every little bit counts equally, and the inability to balance the well-being, livelihoods, and political amenability of everyday citizens against the goals of bureaucratic planners is the genesis of the ongoing global popular revolt.

Lest you doubt the veracity of that last statement, explain this:

“A Washington [State] Democrat hopes to study the impact of medical anesthesia on climate change. The goal is to address the environmental impact of the anesthetic gases used in medical, dental and veterinary practices. The bill said the state could prohibit the manufacture, distribution, sale or use of anesthetic gases.

Senate Bill 5236 orders the Department of Ecology to commission a study of anesthetic gases, including desflurane, isoflurane, sevoflurane, halothane and nitrous oxide because they are recognized as potent greenhouse gases contributing to climate change. The study must determine the extent to which the gases are used in Washington, provide an estimate of the emissions from anesthesia, and recommend measures to either reduce or completely eliminate emissions from these gases.”

Hope it’s not the placebo! | Getty

These are just two of the myriad dictates we could have chosen. Absurd and pointless, they are especially interesting because the precise carbon emissions available for reduction are quantifiable. They can also be contextualized against global trends in the great carbon counting game. What benefit does shivering in the cold during a blizzard or biting down on a leather strap during surgery deliver to the greater good? Let’s break out our trusty calculators and do our bit.

 

To enumerate the quid of the good citizens of Ottawa’s newly mandated pro quo, we need look no further than the official city press release celebrating the good news:

“By reducing unnecessary vehicle idling, we are lowering greenhouse gas emissions and improving Ottawa’s air quality. If every Ottawa driver reduced daily idling in their vehicles by two minutes, carbon dioxide emissions would decrease by about 31.2 million kilograms a year...”

To the casual observer, 32.1 million kilograms sure seems like a big number. Heck, that’s 32.1 billion grams, or, better still, 32.1 trillion milligrams. When this awesome sum is recast in the internationally accepted standard measure of carbon emissions—million tonnes of CO2 equivalents (MM CO2e)—0.0321 is a rather more flaccid contribution. By way of comparison, China accounted for 12,604 MM CO2e in 2023, squandering Ottawa’s newly mandated sacrifice every 80 seconds, or nearly 1,100 times a day.

Xièxiè |

Turning our heretical analytical lens to the carbon cost of anesthesia, we begin by noting that the bill is, at its core, simply a mandate to spend taxpayer money quantifying the “problem” and studying abatement strategies, as admitted directly in the proposed legislation:

“(1) The department of ecology must commission a study to be completed by July 1, 2026, that (a) Determines the potential sources of gases with a high global warming potential that are used for anesthetic purposes within Washington; (b) Determines how these gases are used in Washington; (c) Estimates the quantity of emissions; (d) Recommends potential points of regulation for each of these gases; and (e) Recommends measures for reducing or eliminating emissions of these gases.

(2) By October 1, 2026, the department of ecology, in consultation with the department of health and considering the results of the study commissioned under subsection (1) of this section, must submit recommendations to the appropriate committees of the legislature regarding any further statutory changes needed in order to appropriately and effectively reduce greenhouse gas emissions associated with the use of anesthetic gases, including any recommendations to prohibit the manufacture, distribution, sale, or use of specific anesthetic gases.”

While the text of the bill makes no mention of what all this studying will cost Washington’s taxpayers, we suspect it is decidedly more than a Doomberg subscription, the acquisition of which could be split between the four sponsoring state senators for a mere $75 each. In the span of an afternoon’s worth of research, we were able to quantify the carbon prize on offer and identify how Washington could best capture the bulk of it. What follows is an abridged summary of that effort, which we suspect will be more than good enough for government work.

According to commentary in The Lancet Planetary Health a few years ago, “[i]n 2014 the release of hydrofluorocarbon and chlorofluorocarbon anaesthetic gases stood at the equivalent of 3 million tonnes of carbon dioxide.” To estimate Washington’s share of this sum, we make the conservative assumption that the Group of Seven (G7) nations are the exclusive users of such gases. In a happy coincidence, Washington’s population (7.8 million) is precisely 1% of the G7’s total (780 million), pegging its total carbon bill for anesthesia at 0.03 MM CO2e, or roughly 1 “Ottawa Sacrifice,” our new preferred yardstick for measuring all the little bits that count. This is a minuscule fraction of Washington’s total estimated annual carbon emissions of 96 MM CO2e.

And what if this paltry prize is still deemed worthy of pursuit? Again, no great effort is needed to quickly identify a path forward. The American Association of Anesthesiologists (ASA) has published the estimated global warming potential over 100 years (GWP₁₀₀) for desflurane, isoflurane, nitrous oxide, and sevoflurane, while Wikipedia fills in the data on halothane. Here it is in chart form:

 

The obvious policy proposal that flows from these data is to consider restricting the use of desflurane and prioritizing other gases. The study published in The Lancet Planetary Health quoted earlier concurs, pointing out that 80% of anesthesia emissions arise “from desflurane alone.” However, this is where clinical efficacy must be weighed against carbon obsessions, as desflurane is widely used for good reason: it offers faster induction of anesthesia, more precise control over its depth, and more rapid emergence once surgery is complete, among other benefits.

We close with an alternative suggestion for the leaders of Washington, Ottawa, and other political do-gooders who have too much time and taxpayer money on their hands. It is okay to occasionally give a little of both back and do nothing. You aren’t going to save the world from catastrophe working from small to big, and the rest of us would prefer a warm car to drive to the hospital, where we trust clinicians—not climatologists or their political enablers—to have the final say on treatment options.