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Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)

Background and Aims We humans do not have a planet B to spare, but anesthesiologists can adopt a plan to reduce carbon footprint. One example are regional techniques that reduce the use of plastic (breathing circuits, masks, endotracheal tubes), anesthetic gases, one of which is desfluorane with a 20- year warming potential, generating a greenhouse effect.

Methods The following are 3 successful surgeries (shoulder replacements) performed under regional anesthesia and sedation, proposing a plan that is friendlier to our planet (plan A). Patients were operated on in the beach chair position under sedation, with an ultrasound-guided superior trunk and superficial cervical plexus block, (15mL of a 0.5% lidocaine plus 0.375% levobupivacaine solution was administered). Bispectral Index Scale and vital signs monitoring, verbal communication, were performed.

Results Patients‘ characteristics: Peter: 83-year-old male, 82 kg, 176 cm, hypertensive, pacemaker user due to atrial fibrillation. Denisse: 74-year-old female, 70 kg, 165 cm, hypertensive and diabetic. Jacqueline: 91-year-old female, 65 kg, 165 cm, hypertensive, generalized arthrosis. After surgery, a discharge assessment showed they were able to go home, without analgesic requirements.

Conclusions Anesthesiologists can be leaders within the medical community when it comes to eco-friendly measures, which in these cases were: • Plan A: choosing wisely (regional vs. general) • Plan B: reducing gas flows, syringes, medications, circuits, gloves, extension sets, connectors. In summary, among those selected patients who require anesthesia for upper arm, brachial plexus block plus sedation maybe considered as the sole option. In addition to clinical outcomes, there is an environmental responsibility in the context of health care.