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Anaesthetic mask hooks: their economic and environmental costs

2016; Elsevier BV; Volume: 116; Issue: 4 Linguagem: Inglês

10.1093/bja/aew044

1471-6771

S. Radhakrishna, Deepak Rangappa,

Healthcare and Environmental Waste Management

Anaesthetic facemasks are among the most commonly used airway devices. Many facemasks manufactured and sold in the UK still have mask hooks (Fig 1). Since the advent of the laryngeal masks and the second-generation supraglottic devices, the hooks and the harness are no longer in use in most European countries. A short survey in four hospitals in the West Midlands, UK, showed that the hooks on the anaesthetic face masks were removed by the anaesthetic team and discarded unused straight from the packaging. They felt that the hooks interfered with the ease and comfort of holding the mask. Three UK-based product managers of companies that manufacture masks were asked to clarify the position regarding the hooks. They were not surprised with our survey findings and were aware that the hooks were not used by anaesthetists in most of the UK and Europe. They had to manufacture them as standard because mask anaesthesia with the use of the head harness was still popular and practised in North America, which was a big market for their products. The logistics of supplying only to a European market without the hook was far costlier than the manufacture and supply of the hooks to all regions. The overall extra cost was less than 2% of the total value of the face mask. The introduction of the Boyle’s machine in 19181Drury PM Anaesthesia in the 1920s.Br J Anaesth. 1998; 80: 96-103Abstract Full Text PDF PubMed Scopus (6) Google Scholar and Magill’s anaesthetic apparatus in 1932 were huge leaps in the administration of anaesthetic vapours.2Duncum BM The Development of Inhalational Anaesthesia: with Special Reference to the Years 1846–1900. Oxford University Press, Oxford1994Google Scholar The anaesthetist still had to hold the mask over the face of the patient, single or double handed, to maintain the airway and administer the anaesthetic. In the late 1930s, to secure the face-piece to the patient’s face, Dr Clausen invented the Clausen’s ring and harness. Without the modern-day electronic devices, patient safety depended on careful and meticulous clinical monitoring of the patient. This ingenious device served to free the anaesthetist’s hands, so that they could concentrate on patient monitoring. The introduction of the rubber face mask helped in providing a softer and better seal to the patient as opposed to the metal masks. The rubber masks were marketed with a removable five-point metal ring and a rubber harness. Over the years, the move to single-use clear silicone masks gave anaesthetists the advantage to monitor any oral secretions or vomitus. The silicon masks marketed in the UK have a removable colour-coded plastic ring with four hooks. Polytetrafluoroethylenes3British Plastics FederationHistory of Plastics. Secondary History of Plastics. 2008http://www.bpf.co.uk/plastipedia/plastics_history/Default.aspxGoogle Scholar (Teflon) invented in 1938 and polyethylene in 1939 triggered the revolution that flooded the domestic and commercial markets with plastic goods. The disposable nature of these items has remained a challenge for environmentalists. It has been estimated that the cradle-to-grave carbon footprint4Dormer A Finn DP Ward P et al.Carbon footprint analysis in plastics manufacturing.Journal of Cleaner Production. 2013; 51: 133-141Crossref Scopus (99) Google Scholar of 1 kg of recycled polyethylene terephthalate trays containing 85% recycled content is 1.538 kg CO2 equivalent (CO2e). This is equivalent to the footprint of 0.5 litres of car diesel as calculated using the CO2e conversion charts provided by the Department for Environment, Food and Rural Affairs5affairs DfefarGreenhouse Gas Conversion Factor repository.in: Secondary Greenhouse Gas Conversion Factor repository. 2014http://www.ukconversionfactorscarbonsmart.co.uk/Google Scholar. It is estimated that 85% of hospital equipment is made of plastic, and 25% of this is accounted for by disposable i.v. fluid bags and tubing. US hospitals discard nearly 425 000 tonnes of plastic annually.6North EJ Halden RU Plastics and environmental health: the road ahead.Rev Environ Health. 2013; 28: 1-8Crossref PubMed Scopus (240) Google Scholar Worldwide, 300 million tonnes of plastic are produced, of which ∼50% is disposable material, such as plastic wrappers and packaging. In 2008, in the USA 32 million tonnes of plastic were disposed, of which 86% (29.2 million tonnes) went into landfill, 8% was incinerated, and 6% recycled. Plastic in landfill is not sustainable because it deprives land that can be used for higher societal value. Incineration releases greenhouse gases and carcinogens, such as polycyclic aromatic hydrocarbons and dioxins. The mask hooks are largely discarded unused. Although the hooks weigh only a few milligrams, the vast amounts of these discarded unused hooks over the past few decades could add up to a large amount of plastic and a considerable carbon footprint. Should the manufacturers stop this waste and supply the hooks separately to countries that need them? The easy answer is ‘yes’, but this is an arena of debate, in which science and sound logic appear to lose to the world of commerce. None declared. Download .zip (.0 MB) Help with zip files Download .zip (.0 MB) Help with zip files