Waste I

We are in a world and a society that abhors waste. We recycle, reuse, reduce. We compost, ration what we buy and throw out, measure our carbon footprint. We are conscientious of how green we are. I have blogged on this in the past, but hospitals are immensely wasteful. They are slow to adopt this movement that has already taken other industries and lifestyles by wildfire. Anesthesia is no different. I got a comment on my last post about what happens to extra or unused syringes. It got me thinking about anesthetic waste.

Some of our waste is generated by single-dose vials. When I draw up succinylcholine, I draw up a 10cc syringe. Very few patients would require the full 10cc, and furthermore, there are few situations in which you dose succinylcholine twice due to risk of bradycardia and asystole. So for any patient who gets succinylcholine, some amount is wasted. Although I could calculate how much each patient would need and draw up a syringe with just the right amount, the vials are supposed to be single-dose; sterility is not guaranteed if I use a vial for multiple syringes. So like every other anesthesiologist, I draw up the full dose even though I never intend to give it all. This costs the system not only the additional drug, but also the biochemical disposal of the extra medication and the financial costs. This boggles my mind; why haven't we figured out a way to reduce this? And the topic raises other concerns; should patients be charged for the amount of medication they receive (such as 5cc of succinylcholine) or the entire vial (10cc, even though 5cc was simply discarded)? Should manufacturers change their vial sizes? Should we start pushing for multi-dose vials?