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Anaesthetic mask hooks - their economic and environmental costs

2016; Elsevier BV; Volume: 117; Linguagem: Inglês

10.1093/bja/el_13432

1471-6771

S. Radhakrishna, Deepak Rangappa,

Medical History and Innovations

Anaesthetic facemasks are amongst the most commonly used airway devices. Many facemasks manufactured and sold in the UK still have mask hooks (Figure 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 4 hospitals in the West Midlands, showed that the hooks on the anaesthetic face masks were removed by the anaesthetic team and discarded unused straight from the packaging. They felt the hooks interfered with the ease and comfort of holding the mask. Figure Three UK based product managers that manufacture masks were asked to clarify the position regarding the hooks. They were not surprised with oursurvey findings and were aware that the hooks were not used by anaesthetists in most of 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. Origin of the Mask hooks The introduction of the Boyle's machine in 1918 [1Drury PM Anaesthesia in the 1920s.Br J Anaesth. 1998; 80: 96-103Abstract Full Text PDF PubMed Scopus (6) Google Scholar] and Magic's anaesthetic apparatus in 1932 were huge leaps in the administration of anaesthetic vapours [2Duncum BM, editor. The development of inhalational anaesthesia: with special reference to the years 1846- 1900, 1994.Google 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 they could concentrate on patient monitoring. The introduction of rubber face mask helped in providing a softer and better seal to the anaesthetist 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 clear single use silicone masks gave anaesthetists the advantage of being able to monitor any oral secretions or vomitus. Thesilicon masks marketed in the UK have a removable colour coded plastic ring with 4 hooks. Impact on the Environment Polytetrafluoroethylenes [3Federation BP History of Plastics. Secondary History of Plastics 2008.http://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 of these items has remained a challenge for environmentalists. It has been estimated that cradle-to-grave carbon footprint [4Dormer A Finn DP Ward P et al.Carbon footprint analysis in plasticsmanufacturing.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 CO2e. This is equivalent to the footprint of 0.5 litres of car diesel as calculated using the CO2e conversion charts provided by DEFRA [5Department for Environment Food & Rural Affairs Greenhouse Gas Conversion Factor repository. Secondary Greenhouse Gas Conversion Factor repository 2014.http://www.ukconversionfactorscarbonsmart.co.uk/Google Scholar] (Department for Environment, Food and Rural Affairs). It is estimated that 85% of hospital equipment is made of plastic and 25% of these are accounted for by disposable intravenous 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 (238) Google Scholar]. World over, 300 million tonnes of plastic are produced out of which approximately 50% is disposable material like plastic wrappers and packaging. In 2008, in the US, 32 million tonnes of plastic were disposed, out of which 86% (29.2 million tonnes) went in to landfill, 8% incinerated and 6% recycled. Plastics in landfill is not sustainable as it deprives land that can be used for higher societal value. Incineration releases greenhouse gases and carcinogens like polycyclic aromatic hydrocarbons and dioxins. The mask hooks are largely discarded unused. Although the hooks weigh onlya 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, where science and sound logic appear to lose to the world of commerce. Conflict of Interest: